Midwifery · 2026
Current status and challenges in establishing and maintaining in-hospital midwife-led units in Japan: a nationwide cross-sectional study.
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Yamamoto Mami, Okatsu Aiko, Kataoka Yaeko
Аннотация
PURPOSE: This study describes the current status of in-hospital midwife-led units in Japan and explores factors related to their establishment process, maintenance, and perceived challenges among facilities operating these units.
METHODS: A nationwide cross-sectional study was conducted in maternity facilities across Japan during September-November 2024. Using the Ministry of Health, Labour and Welfare's online system 'Shussan Navi', 1859 facilities providing childbirth services (excluding birthing centres) were identified. Data were collected via Google Forms. Facilities with established in-hospital midwife-led units were asked about their current operational status, factors facilitating and challenging establishment, and factors related to maintenance. Descriptive statistics were calculated. Exploratory subgroup comparisons were conducted using chi-square or Fisher's exact tests.
RESULTS: A total of 267 facilities responded to the survey, of which 263 provided consent and were included in the analysis. Among these, 38 of 263 facilities (14.4%) had established in-hospital midwife-led units. The most frequently reported facilitators of establishment were obstetrician cooperation, midwives' motivation and initiative, and psychological support from supervisors (35/38, 92.1% each). Eighteen of 38 facilities (47.4%) reported midwives' anxiety as a challenge during establishment. Twenty-six of 38 facilities (68.4%) reported difficulties in maintaining their units; among these, 24 of 26 facilities (92.3%) identified securing sufficient women willing to give birth in the unit as a major challenge. Among the 20 facilities that reported facilitators of maintenance, 19 of 20 (95.0%) identified strong commitment and motivation among midwives. Twenty-three of 38 facilities (60.5%) anticipated future difficulties; among these, 21 of 23 (91.3%) identified a decline in the number of women planning to give birth in the unit.
CONCLUSION: Sustaining in-hospital midwife-led units requires training skilled midwives and strengthening interprofessional collaboration. Given the increasing prevalence of mixed obstetric wards and declining birth rates, further efforts are needed to support the sustainable operation of in-hospital midwife-led units.
METHODS: A nationwide cross-sectional study was conducted in maternity facilities across Japan during September-November 2024. Using the Ministry of Health, Labour and Welfare's online system 'Shussan Navi', 1859 facilities providing childbirth services (excluding birthing centres) were identified. Data were collected via Google Forms. Facilities with established in-hospital midwife-led units were asked about their current operational status, factors facilitating and challenging establishment, and factors related to maintenance. Descriptive statistics were calculated. Exploratory subgroup comparisons were conducted using chi-square or Fisher's exact tests.
RESULTS: A total of 267 facilities responded to the survey, of which 263 provided consent and were included in the analysis. Among these, 38 of 263 facilities (14.4%) had established in-hospital midwife-led units. The most frequently reported facilitators of establishment were obstetrician cooperation, midwives' motivation and initiative, and psychological support from supervisors (35/38, 92.1% each). Eighteen of 38 facilities (47.4%) reported midwives' anxiety as a challenge during establishment. Twenty-six of 38 facilities (68.4%) reported difficulties in maintaining their units; among these, 24 of 26 facilities (92.3%) identified securing sufficient women willing to give birth in the unit as a major challenge. Among the 20 facilities that reported facilitators of maintenance, 19 of 20 (95.0%) identified strong commitment and motivation among midwives. Twenty-three of 38 facilities (60.5%) anticipated future difficulties; among these, 21 of 23 (91.3%) identified a decline in the number of women planning to give birth in the unit.
CONCLUSION: Sustaining in-hospital midwife-led units requires training skilled midwives and strengthening interprofessional collaboration. Given the increasing prevalence of mixed obstetric wards and declining birth rates, further efforts are needed to support the sustainable operation of in-hospital midwife-led units.