Transforming midwifery education and practice: leveraging innovative learning frameworks, digital health technologies and interprofessional collaborative care to improve maternal-neonatal outcomes

M. Abi Rami; Ragini K. S.; Suma L.; Ambli V.; Mohammed Umar; Beaulah Mercy Mary T.; Pooja Bakshi; Suhashini; Balamurugan

doi:10.18203/2349-3291.ijcp20261546

Authors

M. Abi Rami National Consortium, Indian Nursing Council, India
Ragini K. S. Department of Child Health Nursing, Patel College of Nursing, Rajiv Gandhi University of Health Sciences (RGUHS), Tumkur, Karnataka, India
Suma L. Department of Obstetrics and Gynaecological Nursing, Shridevi College of Nursing, Rajiv Gandhi University of Health Sciences (RGUHS), Tumkur, Karnataka, India
Ambli V. Department of Obstetrics and Gynaecological Nursing, Panna Dhai Maa Subharti Nursing College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
Mohammed Umar Department of Nursing, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
Beaulah Mercy Mary T. Department of Obstetrics and Gynaecological Nursing, Vatsalya Institute of Nursing and Paramedical Sciences, North Eastern Hill University (Affiliated), Shillong, Meghalaya, India
Pooja Bakshi Department of Obstetrics and Gynaecological Nursing, Adeshwar Nursing Institute, Pt. Deendayal Upadhyaya Ayush University of Health Sciences, Jagdalpur/Raipur, Chhattisgarh, India
Suhashini Department of Obstetrics and Gynaecological Nursing, H. K. E. S. College of Nursing, Rajiv Gandhi University of Health Sciences (RGUHS), Kalaburagi, Karnataka, India
Balamurugan Indira Gandhi Government General Hospital and PG Institute, Puducherry University (Affiliated), Puducherry, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20261546

Keywords:

Midwifery, Midwifery education, Continuity of care, Simulation training, Collaborative care, Maternal outcomes, Neonatal outcomes

Abstract

Midwifery plays a pivotal role in improving maternal and neonatal health outcomes through the provision of skilled, respectful, and woman-centered care. However, variations in educational preparation and care delivery models continue to influence the quality and consistency of midwifery practice across settings. This systematic review aimed to synthesize evidence on innovative midwifery educational frameworks and collaborative care models and their impact on maternal and neonatal outcomes. A comprehensive search of PubMed, Scopus, CINAHL, and Cochrane Library databases was conducted in accordance with PRISMA 2020 guidelines. Studies published between 2000 and 2025 evaluating midwifery education innovations, midwife-led continuity of care, and collaborative maternity care models were included. A total of 35 studies met the inclusion criteria, comprising systematic reviews, randomized controlled trials, cohort studies, mixed-methods research, and policy analyses. Findings indicate that competency-based education, simulation-based training, and structured mentorship significantly enhance midwives’ clinical competence, teamwork, and preparedness for obstetric emergencies. Care model evidence demonstrates that midwife-led continuity of care is associated with increased spontaneous vaginal birth rates, reduced obstetric interventions, improved maternal satisfaction, and comparable or improved neonatal outcomes. Collaborative care models further strengthened care coordination and safety when supported by effective referral systems and interprofessional collaboration. Overall, integrating innovative educational strategies with midwifery-centered and collaborative care models contributes to improved maternal–neonatal outcomes and quality of care. Strengthening midwifery education and expanding evidence-based care models should be prioritized in maternal health policy and practice.

References

World Health Organization. Strengthening quality midwifery education for universal health coverage. Geneva: WHO; 2017. Available at: https://iris.who.int/handle/10665/259278. Accessed on 22 February 2026.

World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: WHO; 2018. Available at: https://www.who.int/publications/i/item/9789241550215. Accessed on 22 February 2026.

World Health Organization. Trends in maternal mortality 2000-2020. Geneva: WHO; 2023.

Available at: https://www.who.int/publications/i/item/9789240068759. Accessed on 22 February 2026.

International Confederation of Midwives. Global standards for midwifery education. The Hague: ICM; 2021.

Available at: https://internationalmidwives.org/resources/icm-global-standards-for-midwifery-education/. Accessed on 22 February 2026.

International Confederation of Midwives. Professional framework for midwifery practice. The Hague: ICM; 2025.

Available at: https://internationalmidwives.org/resources/professional-framework-for-midwifery-practice/. Accessed on 22 February 2026.

Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, et al. Midwifery and quality care: findings from an evidence-informed framework. Lancet. 2014;384(9948):1129-45.

Homer CSE, Friberg IK, Dias MAB, Ten Hoope-Bender P, Sandall J, Speciale AM, et al. The projected effect of scaling up midwifery. Lancet. 2014;384(9948):1146-57.

Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016;4:CD004667.

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7:CD003766.

Cooper S, Cant R, Porter J, Bogossian F, McKenna L, Brady S, et al. Simulation-based learning in midwifery education: a systematic review. Women Birth. 2012;25(2):64-78.

Crofts JF, Winter C, Sowter MC. Practical simulation training for maternity care. BJOG. 2011;118(3):11-6.

Brazil V, Purdy E, Bajaj K, Connell C. Simulation-based education for patient safety. BMJ Qual Saf. 2019;28(6):475-83.

Wu N, Huang Y, Chen Y, Zhang H, Liu L, Wang J, et al. Effect of simulation-based obstetric emergency training on team performance. BMC Med Educ. 2024;24:312.

Fikre R, Getachew M, Abdella A, Tesfaye M, Negash W, Alemu A, et al. Effectiveness of midwifery-led care on pregnancy outcomes in low- and middle-income countries. PLoS One. 2023;18(6):e0287012.

Kuipers Y, de Groot J, Stevens T, van der Lee N, Hildingsson I, Lindgren H, et al. Midwife continuity of care and maternal outcomes: a meta-analysis. Int J Nurs Stud. 2025;146:104564.

Rowe R, Knight M, Hollowell J, Kurinczuk JJ, Linsell L, Macfarlane A, et al. Collaborative continuity of midwifery care: a scoping review. Oxford: National Perinatal Epidemiology Unit. 2022. Available at: https://www.npeu.ox.ac.uk/assets/downloads/pru-mnhc/Fullcollaborative_continuity_of_midwifery_care_scopingreviewfinalreport.pdf. Accessed on 22 February 2026.

Hunter B, McCourt C, Lee J, Harris M, Nejad S, Wiseman O, et al. Strengthening midwifery education and workforce capacity. Midwifery. 2022;110:103333.

Podder L, Rahman M, Sarker BK, Ahmed S, Islam R, Karim F, et al. Revitalizing midwifery education to improve maternal outcomes. BMC Pregnancy Childbirth. 2025;25:114.

ten Hoope-Bender P, de Bernis L, Campbell J, Downe S, Fauveau V, Fogstad H, et al. Improvement of maternal and newborn health through midwifery. Lancet. 2014;384(9948):1226-35.

Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon. Lancet. 2016;388(10056):2176-92.

Downe S, Finlayson K, Oladapo O, Bonet M, Gülmezoglu AM. What matters to women during childbirth. PLoS One. 2018;13(4):e0194906.

Bohren MA, Tunçalp Ö, Miller S. Transforming intrapartum care. BJOG. 2020;127(1):2-6.

Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every Newborn: progress, priorities and potential. Lancet. 2014;384(9938):189-205.

Filby A, McConville F, Portela A. What prevents quality midwifery care? Hum Resour Health. 2016;14:30.

Van Lerberghe W, Matthews Z, Achadi E, Ancona C, Campbell J, Channon A, et al. Country experience with strengthening midwifery. Lancet. 2014;384(9949):1587-605.

Bick D, Cheyne H, Chang YS, Fisher J. Maternal postnatal health. Lancet. 2021;398(10302):303-14.

Horton R, Clark S. The perinatal revolution. Lancet. 2014;384(9948):1111-2.

Campbell OM, Graham WJ. Strategies for reducing maternal mortality. Lancet. 2006;368(9543):1284-99.

GRADE Working Group. GRADE guidelines: rating the certainty of evidence. BMJ. 2011;343:d5926.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses (PRISMA). BMJ. 2009;339:b2535.

Lassi ZS, Kumar R, Mansoor T, Salam RA, Das JK, Bhutta ZA. Essential interventions for maternal, newborn and child health. PLoS Med. 2014;11(12):e1001720.

Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths? Lancet. 2014;384(9940):347-70.

Tunçalp Ö, Were WM, MacLennan C, Oladapo OT, Gülmezoglu AM, Bahl R, et al. Quality of care for pregnant women and newborns. Lancet Glob Health. 2015;3(8):e486-97.

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. Mistreatment of women during childbirth. PLoS Med. 2015;12(6):e1001847.

Renfrew MJ, Downe S, Finlayson K, Fleming A. Midwifery education and workforce sustainability. Midwifery. 2019;69:1-4.

Bogossian FE, Cant RP, Ballard EL, Cooper SJ, Levett KM, McKenna LG, et al. Locating best practice in clinical midwifery education. Nurse Educ Today. 2016;37:127-35.

McKenna L, Bogossian F, Hall H, Brady S, Fox-Young S, Cooper S. Is simulation a substitute for clinical practice? Nurse Educ Today. 2011;31(7):682-6.

ICM, WHO, UNFPA. State of the world’s midwifery 2021. Geneva: WHO. 2021.

Available at: https://www.unfpa.org/sowmy. Accessed on 22 February 2026.

Graham WJ, Varghese B. Quality, quality, quality: neglect in maternal health. Lancet. 2012;379(9811):e5-6.

Adegoke AA, Mani S, Abubakar A, Van den Broek N. Capacity building for skilled birth attendants. Reprod Health. 2015;12:51.

O’Connell R, Downe S. A metasynthesis of midwives’ experience. Midwifery. 2009;25(3):e1-13.

Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, et al. Potential impact of midwives in LMICs. PLoS One. 2021;16(8):e0254961.

Wilson AN, Homer CSE. Third stage of labour management. Women Birth. 2020;33(1):e1-7.

Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care. Cochrane Database Syst Rev. 2008;4:CD004667.

Kennedy HP, Yoshida S, Costello A, Declercq E, Dias MAB, Duff E, et al. Asking different questions about childbirth. Lancet. 2016;388(10056):2236-7.

Smith V, Begley C, Devane D. Team midwifery care for women at low risk of complications. Cochrane Database Syst Rev. 2012;8:CD007257.

De Jonge A, Mesman JAJM, Mannien J, Zwart JJ, van Dillen J, van Roosmalen J. Severe adverse maternal outcomes in midwifery-led care. BMJ Open. 2013;3:e002818.

Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B, et al. Caseload midwifery care versus standard care. BJOG. 2013;120(3):356-64.

Dixon L, Guilliland K, Pallant J, Sidebotham M, Fenwick J, McAra-Couper J, et al. The influence of continuity of midwifery care. Women Birth. 2016;29(6):561-7.

Ryan P, Revill P, Devane D, Normand C. Cost-effectiveness of midwife-led care. Midwifery. 2013;29(4):368-76.

Sandall J, Devane D, Soltani H, Hatem M, Gates S. Improving quality and safety in maternity care. BMJ. 2010;341:c6079.

UNFPA. The state of the world’s midwifery 2021. New York: UNFPA; 2021. Available at: https://www.unfpa.org/sowmy. Accessed on 22 February 2026.

World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. Geneva: WHO; 2016. Available at: https://www.who.int/publications/i/item/9789241511216. Accessed on 22 February 2026.

World Health Organization. Transitioning to midwifery models of care. Geneva: WHO. 2023.

Available at: https://iris.who.int/handle/10665/366620. Accessed on 22 February 2026.

White Ribbon Alliance. Respectful maternity care charter. Washington DC; 2019. Available at: https://www.whiteribbonalliance.org/respectful-maternity-care/. Accessed on 22 February 2026.