gms | German Medical Science

Background: From 2003 the concept of midwife-led unit was developed by the Verbund Hebammenforschung [1]. Until 2017 seventeen midwife-led units were implemented in Germany. Several studies showed good outcomes for mothers and babies combined with lower intervention rates [2], but there is no countrywide implementation of the new model, however.

Aim: The aim of this qualitative study is to illuminate the attitudes and knowledge of midwives on the concept and analyze factors impending or promoting implementation.

Methods: For this cross-sectional qualitative study, semi-structured interviews have been conducted with five hospital-employed midwives and evaluated by qualitative content analysis.

Results: The qualitative interviews lead to 15 categories, which mainly target the impending and promoting factors due to the key questions. It can be observed that midwives rate the concept positively while they don´t know it completely and complain about the lack of information. As arguments in favor of the midwife-led unit they mention more independence in the work structure, a promotion of the profession in the public, an improvement of the relation between midwives and doctors and the reduction of workforce fluctuation in hospitals. They also see benefits for pregnant women, such as choice of model of care in hospitals, better quality of care and the elimination of transfers compared to out-of-hospital settings. The midwife-led unit can also meet the need of pregnant women to have safety structures in case of emergency. As inhibiting factors are mentioned fewer possibilities for obstetric training of doctors, decreasing cooperation with doctors in the hospital and structural aspects (facilities, superiors). The takeover of new competencies and responsibility is partly considered problematic.

Conclusions: The insufficient level of knowledge of midwives should be met by information about the concept and its benefits and disadvantages. This study shows that important factors in the self-image of midwives have to be fulfilled for a wide-range implementation of the concept. Part of it is the development of skills like the treatment of birth injuries. The positive attitude towards the concept is due to higher autonomy. If the concept can be implemented widely it will also have positive impact on work satisfaction [3].

Ethical criteria and conflict of interests: The research / project was not submitted to an ethics committee for the following reasons: Voluntary participation, protection of persons through anonymity. It was financed from own resources. There is no conflict of interest.