183 Realist review of Midwife-Led Continuity of Care implementation (continued) Personal and professional boundaries Theory Context Mechanism Proximal outcome Supporting references Resource Response Shared philosophy Midwives often come from diverse backgrounds and may hold varying philosophies and practices regarding maternity care. To implement MLCC, it is essential to bring together midwives who share a common philosophy and approach to care. Mutual understanding, trust, and a sense of shared purpose are fostered by aligning the team around a shared philosophy. This alignment helps to reduce misunderstanding and conflict, and ensure that all midwives are working towards the same goals and standards of care. As a result, a cohesive and collaborative team culture emerges, leading to the successful implementation and sustainability of MLCC within the team. 1 5 7 8 10 18 23 24 27 30 32 36 45 Accountability for clients There are various organisation forms of maternity care. In standard care, the client is seen by multiple care providers during pregnancy. Providing MLCC, one midwife (sometimes with a practice partner) is responsible for the entire maternity care of her clients. This way, the midwife and client get to know each other, leading to relational continuity. Being the responsible care provider, the midwife can feel a great accountability towards her clients. She wants to provide the best possible care and work to the full scope of her practice. When the midwife is able to keep developing, she may experience high work satisfaction, which keeps her motivated to keep providing MLCC. She will keep developing as a midwife. 7 10 16 20 23 31 34 36 44 Being the responsible care provider, the midwife may experience a constant fear to provide substandard care, with a possible fear of blame. The midwife will prefer group midwifery, where responsibility is shared by several midwives. 6
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