142 Chapter 6 implementation of MLCC initiatives. This influence may outweigh the consideration of scientific evidence in the implementation of MLCC.32 35 39 45 46 58 62 “This change leader midwife’s efforts were also countered by one of the medical professional organisations, which put forward the opinion during the consultation phase of the implementation process that if this change occurred, ‘mothers and babies will die’, despite this being completely at odds with the evidence.” 32(Page 41) Clients can also take on the role of informal leaders by putting pressure on healthcare professionals and policymakers to respond to their preferences and needs. The mechanism that can lead to the implementation of MLCC, is shown in CMO4, Table 2. However, it is important to note that not all client demands or protests lead to concrete actions or changes.74 Role ambiguity and conflict Conflicting perceptions of roles, responsibilities, and power structures between midwives, obstetricians, and other healthcare professionals can lead to tensions, misunderstandings, and inefficiencies in care. Healthcare professionals may resist changes to traditional care models, due to concerns about shifts in power and authority within interprofessional teams. The mechanisms in place, are shown in Table 3, CMO5, with a distinction between midwives and obstetricians. With a predominant emphasis on the medical model of care in maternity care networks,39 49 55 56 the medicalisation of childbirth elevates obstetricians to a position of greater power and authority, often placing them at the top of the hierarchy.35 To implement MLCC, a significant shift in power dynamics is required, making midwives fully accountable and autonomous for their practice, with the authority to independently manage and coordinate care, and the ability to refer to an obstetrician when necessary.16 36 39 40 45 50 51 64 69 This shift requires redefining roles and establishing clear boundaries to support the midwives’ autonomy within the maternity care model. Even in countries where midwives have achieved an autonomous position, they still encounter limitations to their independence, often imposed or dictated by stakeholders with other interests.36 “Most panel members in the study agreed that integration of maternity care in The Netherlands is important to enhance continuity of care, client-centered care, and collaboration between maternity health care professionals in primary and secondary care. Panel members agreed that professional autonomy of the primary care midwife is an important condition when integrating care. The primary care midwives would like to expand their tasks and responsibilities during labor but consensus among professionals was only reached for them to continue providing care in case of prolonged ruptured membranes.” 36(Page 203)
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