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CONFERENCE PROCEEDING
Reimagining continuity of midwifery care in Indonesia through twinning with Canada
1
Faculty of Medicine Universitas Airlangga, Midwifery Study Programme, Surabaya, Indonesia
2
Universitas Airlangga, Midwifery, Surabaya, Indonesia
3
Universitas Airlangga, Obstetrics and Gynecology, Surabaya, Indonesia
4
University of Queensland, Public Health, Brisbane, Australia
5
McMaster University, Obstetrics and Gynecology, Hamilton, Canada
Eur J Midwifery 2026;10(Supplement 1):A65
ABSTRACT
PURPOSE:
This initiative aims to enhance the Continuity of Care (CoC) model in Indonesia by adapting evidence-based midwifery-led practices from Canada through a structured twinning partnership. The project develops localized modules and policy recommendations to support integrated, midwife-led care at the primary level.
DISCUSSION:
Midwifery services in Indonesia remain fragmented and primarily guided by quantitative targets, such as requiring a minimum of six antenatal visits. However, no regulation mandates consistent carers or a relational model of care throughout pregnancy, birth, and postpartum. This undermines the core principles of CoC and limits its effectiveness. Although the Health Minister’s Regulation No. 21 of 2021 promotes uninterrupted care to reduce maternal and neonatal morbidity and mortality, its operationalization such as the “six hands” requirement (doctor, midwife, nurse) for all births, even at the primary care level adds complexity and contradicts global best practices. Through a three-year twinning project, Indonesian and Canadian midwifery institutions engage in mutual learning, mapping CoC structures, exchanging knowledge, developing context-specific modules, and producing policy briefs to support a relational, midwife-led model.
EVIDENCE WHERE RELEVANT:
A 2024 systematic review by Sandall et al., involving over 18,500 women in five countries, found that midwife-led CoC significantly reduced caesarean rates and increased spontaneous vaginal births. These findings align with global standards and support Indonesia’s need to strengthen midwifery autonomy and adopt relationship-based care. This project illustrates how global evidence can be contextualized to build a more sustainable model of physiological birth.
KEY MESSAGE:
Twinning enables innovation and local adaptation. This project offers a roadmap for Indonesia to implement midwife-led CoC models that are evidence-based, context-responsive, and aligned with international best practices to improve maternal and newborn outcomes. Continuity of care - implementation 3
This initiative aims to enhance the Continuity of Care (CoC) model in Indonesia by adapting evidence-based midwifery-led practices from Canada through a structured twinning partnership. The project develops localized modules and policy recommendations to support integrated, midwife-led care at the primary level.
DISCUSSION:
Midwifery services in Indonesia remain fragmented and primarily guided by quantitative targets, such as requiring a minimum of six antenatal visits. However, no regulation mandates consistent carers or a relational model of care throughout pregnancy, birth, and postpartum. This undermines the core principles of CoC and limits its effectiveness. Although the Health Minister’s Regulation No. 21 of 2021 promotes uninterrupted care to reduce maternal and neonatal morbidity and mortality, its operationalization such as the “six hands” requirement (doctor, midwife, nurse) for all births, even at the primary care level adds complexity and contradicts global best practices. Through a three-year twinning project, Indonesian and Canadian midwifery institutions engage in mutual learning, mapping CoC structures, exchanging knowledge, developing context-specific modules, and producing policy briefs to support a relational, midwife-led model.
EVIDENCE WHERE RELEVANT:
A 2024 systematic review by Sandall et al., involving over 18,500 women in five countries, found that midwife-led CoC significantly reduced caesarean rates and increased spontaneous vaginal births. These findings align with global standards and support Indonesia’s need to strengthen midwifery autonomy and adopt relationship-based care. This project illustrates how global evidence can be contextualized to build a more sustainable model of physiological birth.
KEY MESSAGE:
Twinning enables innovation and local adaptation. This project offers a roadmap for Indonesia to implement midwife-led CoC models that are evidence-based, context-responsive, and aligned with international best practices to improve maternal and newborn outcomes. Continuity of care - implementation 3
| eISSN: | 2585-2906 |
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