169 Realist review of Midwife-Led Continuity of Care implementation (continued) Macro-level challenges Theory Context Mechanism Proximal outcome Supporting references Resource Response On the other hand, limited financial resources may result in budget constraints that restrict investments in training and support for interprofessional teams. Restrictive legal frameworks can limit midwives’ autonomy and scope of practice, thus hindering their ability to fully engage in MLCC. Regulatory policies that prioritise standard models of care may create disincentives for healthcare organisations to adopt innovative approaches, such as MLCC. macro-level barriers can lead to micro-level interpersonal conflicts between healthcare providers over roles, responsibilities, and decision-making authority within interprofessional teams. These interpersonal conflicts can undermine trust, communication, and teamwork. As a consequence, healthcare providers may experience tensions, misunderstandings, and power struggles as they navigate competing priorities, perspectives, and expectations within the restrictive maternity care system. 6
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