BACKGROUND:
The updated Belgian clinical practice guideline on intrapartum care for low-risk births requires the transfer of document-based knowledge into actionable directives for workflow integration.

OBJECTIVES:
To systematically identify and prioritise clinical questions requiring enhanced implementation support, understand the context of implementation barriers and facilitators and define a set of healthcare behavioural implementation activities for Belgian maternity services.

METHODS:
We employed an integrated knowledge translation approach, combining the Knowledge-To-Action and Intervention Mapping framework. This approach involves identifying the clinical questions that need enhanced implementation support, analysing the context of barriers, and defining change and performance objectives. Feedback from a Belgian multi-stakeholder consulting group and Advisory Board informed the process.

RESULTS:
Two clinical questions require enhanced implementation support: (1) initial clinical investigations during labour and (2) ongoing clinical investigations and interventions during a low-risk birth. Barriers to implementing the recommendations include individual healthcare professional factors and professional interactions. Implementation necessitates that healthcare professionals acknowledge the physiological perspective of labour and birth, remain informed about the evidence and accept the evidence that underpins the management of low-risk births while incorporating shared decision-making and seeking the woman’s consent. Achieving behavioural change requires a shift in attitudes, intentions, knowledge, social norms and skills.

CONCLUSIONS:
The identified barriers to implementing recommendations highlight the critical role of interpersonal dynamics in successful guideline implementation. The findings emphasise the need to foster communication, collaboration, and mutual understanding across professional boundaries to enhance maternity care services.

KEY MESSAGE:
Expecting end users to adopt guidelines does not guarantee effective implementation. Successful implementation requires more than logistical solutions—it demands a shift in professional culture. Policymakers should address structural challenges within maternity care and invest in structured implementation support to facilitate adherence to guidelines. Guideline implementation necessitates strategies to promote teamwork and communication, alongside a collaborative workplace culture. Enabling environment 1