School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.
Centre for Trials Research, Cardiff University, Cardiff, UK.
BMC Pregnancy Childbirth. 2024 Aug 14;24(1):540. doi: 10.1186/s12884-024-06649-y.
Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging.
In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence.
Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced.
By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.
助产士连续照护模式（MCoC）是一种护理模式，在这种模式中，同一名助产士或一小队助产士在整个妊娠、分娩和产后期间为妇女提供支持。该模式已被一些高收入国家的政策制定者优先考虑，但广泛实施和可持续性证明具有挑战性。
在本次对全球关于助产士连续照护模式实施和可持续性的文献的叙述性综述和综合分析中，我们确定了实施这种产妇护理模式的障碍和促进因素。通过将现有研究证据映射到实施研究综合框架（CFIR）上，我们确定了组织在规划和实施助产士连续照护模式时需要考虑的因素，以及当前研究证据中的空白。
使用 CFIR 分析国际证据表明，关于助产士连续照护模式实施的证据是零散的，而且变革的动力没有得到批判性的审视。现有文献对创新的核心方面关注不足，例如随叫随到的工作安排的核心地位以及与助产专业价值观的一致性。对助产士连续照护模式引入的政治和结构背景也关注有限。
通过将国际研究证据与 CFIR 综合起来，我们确定了组织在规划和实施助产士连续照护模式时需要考虑的因素。我们还呼吁提供更系统和更具背景的证据，以帮助理解助产士连续照护模式的实施或不实施。现有证据应进行批判性评估，并在支持关于该护理模式及其实施的主张时更谨慎地使用，特别是在实施的背景与所引用的研究不同的情况下。
