A Synthesis of Principles and Approaches From the Field of Implementation Science for Studying Midwifery Integration in the United States

Midwifery care has not been widely or equitably implemented in the United States despite a large body of evidence supporting its effectiveness in improving health outcomes. Implementation science is an emerging field that rigorously studies how to translate evidence-based models of care, like midwifery, into practice to improve population health outcomes. Principles and approaches from implementation science can be applied to midwifery care integration to understand how midwifery care is provided and functions effectively across different settings. This state of the science review provides a primer in implementation science and its application to midwifery care. Using theories, models, and frameworks from implementation science across all stages of the research process promotes shared language across studies, thereby increasing generalizability and reproducibility. Theories, models, and frameworks also help to elucidate mechanisms for successful implementation. Developing a catalog of implementation strategies with associated implementation outcomes can bring uniformity and efficiency to efforts to implement midwifery care in different settings. Successful midwifery care implementation is largely dependent on organizational-level context; therefore, utilizing implementation frameworks and strategies that center on the organization is encouraged. Midwifery-integration researchers can leverage study designs from implementation science, such as hybrid approaches that simultaneously study implementation and effectiveness, use positive deviance approaches that study exemplar cases, and apply lessons learned to under-performing settings. Implementation science also provides methods for systematically studying adaptation and equitable implementation that are particularly relevant for midwifery care in the US context.