Barriers and facilitators to the implementation of a midwifery-led care model: a qualitative systematic review

 Goncalves, A. S., Pestano-Santos, M., McCourt, C., & Prata, A. P. (2025). Barriers and facilitators to the implementation of a midwifery-led care model: a qualitative systematic review. Midwifery, 158, https://doi.org/10.1016/j.midw.2025.104514.

Abstract

Problem Despite the overwhelming benefits of midwifery-led care models, in many countries, for several reasons, there is a resistance to their implementation.

Background These care models provide both short-term and long-term advantages for mothers and newborn, demonstrate sustainability, and offer economic benefits.

Aim This qualitative systematic review explores and synthesises evidence on stakeholders’ perceptions of the barriers and facilitators to implementing a shift from doctor-led or shared-care models to midwifery-led models of care.

Conclusion Context-specific strategies informed by implementation science must be developed to support the sustainable integration of midwifery-led care models, with a particular emphasis on policy development and stakeholder engagement.

Open access – https://www.sciencedirect.com/science/article/pii/S0266613825002323

The international confederation of midwives essential competencies for midwifery practice: A revision process – 2024

Embo, M., Levy, M., & Pairman, S. (2025). The international confederation of midwives essential competencies for midwifery practice: A revision process – 2024. Midwifery, 149, https://doi.org/10.1016/j.midw.2025.104525.

Abstract

Objective To achieve global expert consensus on the revision of Essential Competencies for Midwifery Practice 2019.

Methods A team worked closely with ICM and key stakeholders to systematically revise the ICM Essential Competencies for Midwifery Practice 2019 framework, documenting quantitative and qualitative data. The framework was updated through a literature review (phase 1), two-round validation (phase 2), translation (phase 3), Board approval (phase 4), face-validity assessment (phase 5), and final adjustments before dissemination (phase 6).

Findings The review included midwifery experts from all ICM regions and related organizations. While ICM initially aimed for a minor revision, the framework expanded from 4 to 5 categories, 31 to 37 competencies, 130 to 250 knowledge indicators, and 182 to 296 skills and behaviours indicators resulting in a major revision. The key change was adding a new category (two) on sexual and reproductive health and rights, focused on contraception, comprehensive abortion care, and gender-based violence and abuse. Four new competencies were added to category one, focusing on technology, interdisciplinary care, prescribing medications and human disasters. Minor adjustments in categories three, four and five focused on normal/physiological birth, midwifery models of care and emergency care.

Conclusion The 2024 revision and update of the ICM Essential Competencies for Midwifery practice (2019) integrates current evidence, global guidance documents and expert input to reflect current midwifery practice globally.

Open access – https://www.sciencedirect.com/science/article/pii/S0266613825002438

The effect of early mother-infant skin-to-skin contact on pain and anxiety during episiotomy repair

Baradwan, D., Hefedh, B., Khadawardi, K., Alanazi, A., et al. (2025). The effect of early skin-to-skin contact on pain and anxiety during episiotomy repair: A systematic review and meta-analysis of randomized controlled trials. Midwifery, 148, https://doi.org/10.1016/j.midw.2025.104460.

Highlights

• Episiotomy pain contributes to mothers’ apprehension about normal vaginal birth.
• Early and continuous skin-to-skin contact (SSC) promotes maternal-infant bonding, regulates neonatal temperature, and supports breastfeeding.
• We studied SSC effectiveness in pain and anxiety relief during episiotomy repair.
• SCC is effective in alleviating pain and anxiety during episiotomy repair.

Full abstract https://www.sciencedirect.com/science/article/abs/pii/S0266613825001780

Prolactin modulation of thermoregulatory circuits provides resilience to thermal challenge of pregnancy

Ladyman, S. R., Georgescu, T. R., Stewart, A. M., Cheong, I., Grattan, D. R., & Brown, R. S. E. (2025). Prolactin modulation of thermoregulatory circuits provides resilience to thermal challenge of pregnancy. Cell Reports, 44(4),115567.

This work demonstrates that prolactin is an important regulator of the thermoregulatory neural circuits in the hypothalamus during reproduction. The hormone-induced changes anticipate the additional metabolic load of late pregnancy and provide thermal resilience against elevated environmental temperatures.

Open access – https://www.cell.com/cell-reports/fulltext/S2211-1247(25)00338-9

How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study

Peters, L., De Jonge, A., de Boer, M., Downe, S., & Dahlen, H. G. (2025). How does the first index mode of birth in public or private hospitals predict subsequent births? A 16-year Australian population-based linked data study. BMJ Open, 15(1), e086212.doi: 10.1136/bmjopen-2024-086212.

Abstract

Objectives In this descriptive study, we aimed to assess how the index mode of birth and subsequent birth modes vary over time for public and private hospital maternity care funding models. The second aim was to determine to what extent the index mode of birth predicts subsequent birth modes in general and whether this differs in public versus private hospital maternity care funding models. With our aim, we have an innovative approach, specifically the women’s life course approach, which is hypothesis-generating and can be assessed in future studies.

Design, setting and participants New South Wales population-linked data of low-risk women were analysed (2001–2016). Demographics and public/private care were recorded. Modes of the index birth and subsequent modes of second and third births (ie, spontaneous vaginal, instrumental vaginal elective/emergency caesarean birth) were registered. For those with 2 births and 3 births, 16 and 64 subsequent births patterns were created.

Primary and secondary outcome measures Trend of index modes of birth and subsequent modes of birth over time and the prediction of subsequent birth modes based on the index birth. These outcomes were stratified for the initial maternity care funding model.

Results In total, 172 041 low-risk nulliparous women were included in the initial cohort, 54.1% had a spontaneous index vaginal birth and 71% had their index birth in public hospitals. During the study period, 131 675 women had 2 births and 44 677 of these women had 3 births, respectively. Among women birthing in public hospitals, higher proportions of index and subsequent vaginal births were observed than in private hospitals, with fewer instrumental vaginal births and caesarean sections. Large differences were observed for birth patterns: vaginal-vaginal (public 55.8% vs private 36.8%) and vaginal-vaginal-vaginal (public 57.2% vs private 38.8%). Women with an index spontaneous vaginal birth showed a high probability (91.3%) of subsequent spontaneous vaginal births. When stratified by maternity care funding model, the probabilities were similar: 91.6% in public hospitals and 90.2% in private hospitals.

Conclusions Our study of low-risk Australian women (2001–2011) found that those giving birth in public hospitals had higher proportions of spontaneous vaginal births compared with private hospitals, where caesarean sections were more common. Women with an index spontaneous vaginal birth had a very high probability to have subsequent vaginal births. These findings suggest that index mode of birth may be a predictor for subsequent modes of birth.

Full article available https://pmc.ncbi.nlm.nih.gov/articles/PMC11781108/

A content analysis of women’s experiences of debriefing following childbirth: The birth experience study (BESt)

Bannister, L., Hammond, A., Dahlen, H. G., Keedle, H. (2025). A content analysis of women’s experiences of debriefing following childbirth: The birth experience study (BESt). Midwifery,146, 104421, https://doi.org/10.1016/j.midw.2025.104421

Abstract

Background The early postpartum period is highly vulnerable, with the World Health Organization estimating that 13 % of women globally experience postnatal mental health disorders. Postnatal care often lacks the resources allocated to antenatal and intrapartum care, leading to maternal psychological needs being overlooked. Understanding women’s lived experiences of debriefing is crucial as it provides insights into the practical and emotional aspects of debriefing that effectiveness studies alone cannot capture. Debriefing, a psychological intervention, can help prevent postnatal mental health issues, though the most effective approaches are still debated.

Aim To explore Australian women’s views on the role of debriefing in postnatal care, including its benefits and suggestions for implementation.

Methods The Birth Experience Study (BESt) was a national online survey conducted in 2021 which focused on the experiences of Australian women who had given birth at any time in the preceding five years. The survey included questions about their debriefing experiences, who they debriefed with, and their suggestions for optimal timing of debriefing. Qualitative content analysis was applied to 2154 open-ended responses discussing postnatal debriefing experiences.

Findings Of 2514 responses, two main categories were found that focused on the debriefing experience and suggestions for optimal timing for debriefing following birth. Women highlighted the importance of being heard compared to being dismissed and not being able to validate their feelings.

Conclusion Women value debriefing, and its effective implementation depends on individual experiences and needs. The findings suggest that debriefing should become standard practice, with maternity clinicians trained to provide this crucial aspect of postnatal care.

Full article available https://www.sciencedirect.com/science/article/pii/S0266613825001391

Social media influencers in the space of pregnancy and parenting: a scoping review protocol

Hives, L., Bray, E. P., Nowland, R., & Thomson, G. (2024). Social media influencers in the space of pregnancy and parenting: a scoping review protocol. BMJ Open, 14(10), e087200 DOI:10.1136/bmjopen-2024-087200

Abstract

Introduction Social media influencers (SMIs) are popular sources of online information on various topics, including many aspects of health. Recently, there has been an upsurge in SMIs creating content about pregnancy and parenting, including from midwives, pregnant women and parents. Despite its popularity, SMI content on pregnancy and parenting is not currently regulated, which allows for misinformation and potential harm to women and their children. Research has also found that most women do not discuss the information they access online with their healthcare providers.

This is the first scoping review to map the existing evidence on SMIs in the context of pregnancy and early parenting.

Methods and analysis The scoping review will be conducted from May to December 2024 and reported using guidance from Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. 10 academic databases will be searched for relevant studies, using keywords and subject headings for the concepts of “social media”, “influencers”, “pregnancy” and “parenting.” All primary and secondary research studies of pregnancy and early parenting SMIs will be included. Two authors will screen the identified studies for eligibility. The risk of bias of the included studies will not be assessed. Extracted data will be presented in tables and will be described narratively.

Ethics and dissemination Ethical approval was not needed for this scoping review. Results will be published in a peer-reviewed journal, presented at conferences, posted on social media and presented to relevant groups.

Full article available https://bmjopen.bmj.com/content/14/10/e087200

Reconsidering “inclusive language:” Consequences for healthcare and equitableness of a growing linguistic movement to address gender identity with a path forward.

Bartick, M., Dahlen, H., Gamble, J., Walker, S., Mathisen, R., & Gribble, K. (2025). Reconsidering “inclusive language:” Consequences for healthcare and equitableness of a growing linguistic movement to address gender identity with a path forward. Sexual and Reproductive Healthcare, 44, 101088, 1877-5756.

Abstract

Increasingly, the language of female reproduction is changing, so terms directly referencing people’s sex are replaced with terms obscuring sex, a language form commonly called “inclusive language” but more accurately is “desexed language.” Desexed language is promoted as assisting individuals experiencing an inner sense of themselves (a gender identity) in conflict with their sex, a state described as being transgender or gender-diverse. It seemingly assumes no harm to the general population. However, the scant existing research suggests it may not be well accepted or understood. There are a variety of types of desexed language, including globalizing language (e.g. replacing “women” with “people”), biology-based language (e.g. “lactating individuals,” “menstruators”), neologisms (“chestfeeding”), appropriation of terms with other meanings (“sex assigned at birth”), and additive language (e.g. “women and birthing people”). Second- and third-person language (e.g. “if you are sexually active,” “those who are pregnant”) can be a type of desexed language depending on context. Desexed language is likely to have an adverse impact on people with low health literacy and language skills, risk alienation, and cause confusion, especially in non-Western countries and cultures. It may even cause harm to transgender and gender-diverse people who also need clear health communications as well as specialized healthcare. Widespread use of desexed language is contrary to the usual practice of implementing targeted tailored communications for those with specialized needs while using the most effective language for most people for general communications. Comprehensive research on the impact of desexed language is urgently needed.

Full article available https://www.sciencedirect.com/science/article/pii/S1877575625000266

Human milk bank services and Islamic milk kinship: pathways and processes for ensuring respect for religious law and tradition in the provision of donor human milk for small vulnerable newborns

https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-025-00704-w

Gribble, K.D., Zambrano, P., Omer-Salim, A. et al. (2025). Human milk bank services and Islamic milk kinship: pathways and processes for ensuring respect for religious law and tradition in the provision of donor human milk for small vulnerable newborns. Int Breastfeed J, 20(31), 1877-5756.

Abstract

Islam provides strong support for infants to be breastfed, including for wet nursing where mothers are unable to breastfeed. Amongst those infants who may be in need of breastmilk from another woman are small vulnerable newborns. These infants can benefit from donor human milk from a human milk bank (HMB). However, in Islamic contexts, HMBs must be both medically and religiously safe and take account of the religious principle of milk kinship whereby the consumption of breastmilk can create a family relationship between the donor mother and the infant. This paper explores the variety of circumstances under which milk kinship may be created and highlights the two main pathways followed by HMBs to ensure religious safety. It presents the case of the KK HMB in Singapore as an example demonstrating how close collaboration between medical and religious authorities can enable HMBs to provide donor human milk to small vulnerable newborns. Finally, key processes for HMB establishment in the context of Islamic milk kinship are outlined including partnering with key religious leaders, knowing and working with local understandings of milk kinship, ensuring clear communication, proactively addressing community concerns and designing and adapting HMB processes to ensure religious requirements can be maintained.

Full article available https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-025-00704-w