# Pre- and Post-establishment Factors Affecting the Perceived Sustainability of Midwifery Outpatient Clinics: An Exploratory Cross-Sectional Study in Japan

## TL;DR

This study explores factors that influence the sustainability of midwife-led outpatient clinics in Japan, emphasizing the importance of empowering women and personalized care.

## Contribution

The study identifies specific pre- and post-establishment factors affecting the sustainability of midwife-led outpatient clinics in Japan.

## Key findings

- Empowering women in their pregnancy and birth is a significant pre-establishment factor for clinic sustainability.
- The ability to engage deeply with pregnant women is a key post-establishment factor for sustainability.

## Abstract

Background

In Japan, a shortage of obstetricians has led to a decline in facilities offering delivery services. To address this issue and meet the diverse needs of pregnant and postpartum women, in-hospital midwifery systems and midwife-led outpatient clinics have increasingly been established. However, there are no reports on the sustainability of midwife-led outpatient clinics. For these clinics to fulfill their future roles, it is necessary to clarify their implementation status and the factors affecting their sustainability.

Aim

This study aimed to identify factors associated with the perceived sustainability of midwife-led outpatient clinics, considering both pre- and post-establishment periods.

Methods

This exploratory cross-sectional study targeted midwives and nurse managers in Japan who were involved in both the establishment and ongoing management of midwife-led outpatient clinics. Surveys were distributed to 68 clinics nationwide, yielding 81 responses from 35 facilities. The final analysis included 53 valid responses (65.4%). Binomial logistic regression was performed to identify factors associated with the dependent variable, perceived sustainability of the midwife-led outpatient clinic, after adjusting for potential confounders.

Results

The pre-establishment factor significantly associated with perceived sustainability was “empowering women to take an active role in their pregnancy and birth” (OR 7.63; 95% CI 1.54-37.86). The post-establishment factor was “the ability to engage deeply with pregnant women” (OR 10.96; 95% CI 2.00-60.14).

Conclusion

Our findings suggest that enhancing the sustainability of midwife-led outpatient clinics requires more than improving operational efficiency. It is crucial to foster an environment where midwives can fully utilize their professional expertise to support patient empowerment and deliver individualized care.