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

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.