Barriers and facilitators for implementation of continuity of midwife care: A review of reviews

Background: Continuity of Midwife Care (CoMC) significantly improves maternal and neonatal outcomes, including reducing mortality. However, global implementation remains limited, hindered by various barriers and facilitators across healthcare settings. This review of reviews synthesizes existing evidence on barriers and facilitators to CoMC implementation using the Consolidated Framework for Implementation Research (CFIR) as an analytical tool. Methods: Following the Joanna Briggs Institute (JBI) methodology, a review of reviews was conducted. Comprehensive searches of Embase, Medline, CINAHL, and grey literature identified reviews published between 2013 and 2024 that addressed CoMC implementation. Data were categorized by CFIR 2.0 domains: innovation characteristics, outer setting, inner setting, characteristics of individuals, and implementation processes. Results: Six reviews met inclusion criteria. Barriers to CoMC were systemic and included hierarchical power dynamics, limited midwife autonomy, workforce shortages, and inadequate policy support. Facilitators were more context-specific, influenced by healthcare infrastructure and resources. Key facilitators included supportive leadership, collaborative care models, and national guidelines promoting CoMC. Conclusion: Barriers to CoMC are deeply embedded in healthcare systems, while facilitators are highly dependent on local contexts. Bridging the evidence-practice gap requires applying implementation science methodologies, such as CFIR, to inform policy and intervention strategies. Collaboration between countries with similar healthcare systems can foster knowledge-sharing and adaptation of successful CoMC models. These findings offer actionable insights for policymakers and healthcare professionals to advance CoMC integration globally.