Midwifery · 2026
Increasing access to midwifery models of care: A case study of the first Midwifery-Led Birth Center in a public facility in Malawi.
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Kafulafula Ursula Kalimembe, Malirakwenda Richard, Matchere Pacharo, Chodzaza Elizabeth, Carpenter Kelly, Nindi-Nyondo Anda, Mann Julie
Аннотация
BACKGROUND: Midwifery-Led Birthing Centers offering the midwifery model of care, as defined by the International Confederation of Midwives, are an evidenced-based intervention proven to offer high-quality, patient-centered, cost-effective care and reduce maternal and neonatal mortality. There are very few of these types of birthing centers in low-middle income countries, where maternal and neonatal mortality are highest. Additionally, there is limited research and understanding of how to implement such centers. From 2020 to 2025, multi-stakeholders collaborated to develop the first Midwifery-Led Birth Center in a public facility in Malawi.
METHODS: An intrinsic case study design is used to describe the development and implementation of the first Midwifery-Led Birth Center in a public facility in Malawi. Qualitative data was obtained from archival records and program documents as well as a key stakeholder meeting. Quantitative data was gathered through analysis of routinely collected service data at the facility. The Network of Care approach is used as the theoretical framework to analyze data.
FINDINGS: The development and implementation of the Midwifery-Led Birth Center took over five years from conception to implementation. It required collaboration among several stakeholders to ensure acceptance and integration into the broader healthcare system. Attention was given to delineating roles and responsibilities of stakeholders; developing policies, referral mechanisms and standards of care; educating staff and community on Respectful Maternity Care; creating a monitoring and evaluation system; and improving infrastructure and procurement of medication and equipment.
CONCLUSION: The findings presented in this case study and discussion of facilitators, challenges, and unforeseen consequences could provide insight for others interested in implementing Midwifery-Led Birth Centers in similar settings.
METHODS: An intrinsic case study design is used to describe the development and implementation of the first Midwifery-Led Birth Center in a public facility in Malawi. Qualitative data was obtained from archival records and program documents as well as a key stakeholder meeting. Quantitative data was gathered through analysis of routinely collected service data at the facility. The Network of Care approach is used as the theoretical framework to analyze data.
FINDINGS: The development and implementation of the Midwifery-Led Birth Center took over five years from conception to implementation. It required collaboration among several stakeholders to ensure acceptance and integration into the broader healthcare system. Attention was given to delineating roles and responsibilities of stakeholders; developing policies, referral mechanisms and standards of care; educating staff and community on Respectful Maternity Care; creating a monitoring and evaluation system; and improving infrastructure and procurement of medication and equipment.
CONCLUSION: The findings presented in this case study and discussion of facilitators, challenges, and unforeseen consequences could provide insight for others interested in implementing Midwifery-Led Birth Centers in similar settings.