175 Realist review of Midwife-Led Continuity of Care implementation Role ambiguity and conflict Theory Context Mechanism Proximal outcome Supporting references Resource Response Role conflict There is a division of roles in society, where obstetricians are expected to be primarily responsible for overseeing and managing maternity care. In many hospitals there is a hierarchical structure in which obstetricians hold authority and decisionmaking power. The implementation of MLCC leads to a shift in roles and power dynamics. The implementation of MLCC creates a discrepancy between the traditional roles and expectations of obstetricians and midwives, and the evolving roles introduced by MLCC. Midwives who feel empowered by MLCC may experience greater autonomy and decision-making authority in providing holistic care to women throughout the pregnancy and childbirth continuum. Empowered midwives may be willing to collaborate with other stakeholders to address the challenges of implementing MLCC. 1-7 12-14 16 17 29 31 33 35 42 43 Midwives who experience uncertainty and anxiety about taking on greater responsibility and authority, may be concerned about their competence or fear potential backlash from medical colleagues. The anxiety of uncertain midwives may hinder collaboration with other stakeholders. Obstetricians who recognise the potential benefits of MLCC may see added value in the evolving role of midwives. Obstetricians who support the integration of MLCC into the maternity care system, may advocate for collaboration, shareddecision-making, and mutual respect. 6
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