Understanding the implementation of continuity-enhancing innovations as steps towards midwife-led continuity of care: A qualitative study using Normalization Process Theory

by Renate Simmelink, Anneke Pouwels, Marianne Nieuwenhuijze, Arie Franx, Hanneke Harmsen van der Vliet – Torij, Ank de Jonge, Corine Verhoeven, Nadine van der Lee Objective To examine how specific midwife-led continuity of care elements are implemented and sustained in a maternity care system where independent community midwives collaborate with hospital-based care professionals. Methods An explanatory qualitative study was conducted, using the Normalization Process Theory as a conceptual framework.

Maternity care networks that had implemented an innovation contributing to midwife-led continuity of care were included in the study. Stakeholders invited to participate in semi-structured interviews included community midwives, hospital-based midwives, obstetricians, managers, an obstetric nurse, and healthcare insurance company employees.

Participants were recruited through an initial purposive sampling strategy. As data collection progressed, theoretical sampling was applied.

Results A total of 47 interviews were conducted with stakeholders from nine different maternity care networks. While many participants expressed strong conceptual support for midwife-led continuity of care (coherence), this did not always translate into aligned action in practice (collective action).