BACKGROUND:
Midwifery-led care models are widely recognised for their numerous benefits, yet their adoption remains limited across many countries due to various systemic and contextual challenges. These models are associated with improved maternal and neonatal outcomes, long-term sustainability, satisfaction, and favourable economic impacts. Nevertheless, shifting from traditional doctor-led or shared-care approaches to midwifery-led models often encounters resistance.

OBJECTIVES:
This qualitative systematic review aimed to explore and synthesise existing evidence on how key stakeholders perceived the barriers and facilitators to implementing midwifery-led care models in their own contexts.

METHODS:
The review was conducted following the Joanna Briggs Institute (JBI) methodology for qualitative evidence synthesis. It included a comprehensive search across multiple databases, independent screening and quality appraisal by two reviewers, structured data extraction, and thematic synthesis. The Consolidated Framework for Implementation Research (CFIR) was used to categorise findings, and the ConQual approach assessed the confidence in the evidence.

RESULTS:
Seven studies met the inclusion criteria. From these, 14 distinct findings emerged—five facilitators and nine barriers—reflecting the views of a range of stakeholders, including women, midwives, physicians, and educators. The findings were mapped across four CFIR domains: the innovation itself, the outer setting, the inner setting, and individual characteristics. Key themes included financial considerations, cultural norms, regulatory and policy frameworks, perceived urgency for change, interpersonal dynamics, organisational infrastructure, information accessibility, and individual competence. These results highlight the complex, multi-level factors influencing implementation efforts.

CONCLUSIONS:
Successful and sustainable integration of midwifery-led care models requires tailored, context-sensitive strategies guided by implementation science. Particular emphasis should be placed on stakeholder engagement and policy reform to address existing barriers and leverage enablers effectively.

KEY MESSAGE:
This review offers unique, evidence-based insights into the challenges and enablers of transitioning from doctor-led to midwifery-led care models, synthesising stakeholder perspectives. It provides critical guidance for policymakers and health systems to develop context-sensitive strategies for sustainable implementation. Poster session 1 (Group A)