Adnani Qorinah Estiningtyas Sakilah, Nurfitriyani Ela, Merida Yunri, Khuzaiyah Siti, Okinarum Giyawati Yulilania, Susanti Ari Indra, Adepoju Victor Abiola, Hashim Sarena Haji
Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Master of Midwifery Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
BMC Health Serv Res. 2025 Mar 28;25(1):463. doi: 10.1186/s12913-025-12612-0.
Midwifery continuity of care during pregnancy, childbirth, and postpartum is essential for improving maternal and neonatal health outcomes. In low- and middle-income countries (LMICs), however, challenges such as healthcare worker shortages, limited infrastructure, poor healthcare access, and cultural barriers often hinder the effective provision of midwifery services. These issues contribute to unsustainable and inadequate care, adversely affecting maternal and newborn health. This study examines the impact of these challenges on the midwifery continuity of care and its subsequent effect on maternal and neonatal outcomes.
A scoping review was conducted following Arksey and O'Malley's framework. We analyzed 43 articles published between 1932 and 2023 across four databases. Included studies were conducted in LMICs, focused on continuous care models, and published in English. The review aimed to capture the varied impacts of midwifery care on health outcomes.
The review found that midwifery continuity of care in LMICs significantly improves maternal and newborn health by reducing medical interventions, increasing physiological births, and enhancing maternal satisfaction and breastfeeding rates. The approach also lowers newborn mortality and morbidity. Success factors include community acceptance, midwives' cultural competence, and collaboration with traditional birth attendants. Barriers such as insufficient funding and resistance to change persist. Midwife-led continuity of care (MLCC) was associated with a 16% reduction in neonatal loss and a 24% reduction in pre-term births. Also, MLCC decreases newborn mortality by 10-20% and increases breastfeeding rates by up to 30%. Effective implementation requires integrating midwifery services into existing health systems, securing funding, expanding training, and strengthening community partnerships.
Midwifery continuity of care enhances maternal and neonatal health in LMICs by minimizing unnecessary medical interventions and improving maternal satisfaction and breastfeeding outcomes. However, cultural and socioeconomic factors influence its acceptance. Further research is needed to integrate traditional birth attendants into formal health systems, overcome resistance to change, and develop strategies for effective collaboration between traditional and professional care providers.
孕期、分娩期及产后的助产连续性照护对于改善孕产妇和新生儿健康结局至关重要。然而，在低收入和中等收入国家（LMICs），诸如医护人员短缺、基础设施有限、医疗服务可及性差以及文化障碍等挑战，常常阻碍了助产服务的有效提供。这些问题导致了不可持续且不充分的照护，对孕产妇和新生儿健康产生了不利影响。本研究考察了这些挑战对助产连续性照护的影响及其对孕产妇和新生儿结局的后续作用。
按照阿克西和奥马利的框架进行了一项范围综述。我们分析了1932年至2023年间在四个数据库中发表的43篇文章。纳入的研究在低收入和中等收入国家开展，聚焦于连续性照护模式，且以英文发表。该综述旨在了解助产照护对健康结局的各种影响。
该综述发现，低收入和中等收入国家的助产连续性照护通过减少医疗干预、增加自然分娩、提高孕产妇满意度和母乳喂养率，显著改善了孕产妇和新生儿健康。这种方法还降低了新生儿死亡率和发病率。成功因素包括社区接受度、助产士的文化能力以及与传统接生员的合作。资金不足和对变革的抵触等障碍依然存在。由助产士主导的连续性照护（MLCC）与新生儿死亡减少16%以及早产减少24%相关。此外，MLCC使新生儿死亡率降低10%至20%，并使母乳喂养率提高多达30%。有效实施需要将助产服务纳入现有的卫生系统、确保资金、扩大培训并加强社区伙伴关系。
助产连续性照护通过尽量减少不必要的医疗干预并改善孕产妇满意度和母乳喂养结局，提高了低收入和中等收入国家的孕产妇和新生儿健康。然而，文化和社会经济因素影响其接受度。需要进一步开展研究，将传统接生员纳入正规卫生系统，克服对变革的抵触，并制定传统和专业照护提供者之间有效合作的策略。
