Patient Safety in Community-Based Independent Midwifery: A Global Systematic Review of Conceptual Models and Frameworks

Abstract

Independent, community-based midwifery, defined as midwife-led care delivered outside obstetrician-led hospital wards, including home births, freestanding or alongside birth centers, and continuity-of-care teams for predominantly low-risk pregnancies, requires clear conceptual guidance to ensure patient safety. Guided by PRISMA 2020, we conducted a global search of Scopus, PubMed, Web of Science, and CINAHL (January 2013–December 2025). Of 1,215 records screened, 34 studies (2015–2025) met inclusion and were synthesized thematically. Six clusters of frameworks emerged: continuity-of-care and community-integrated models; reflective and ethical practice models; education and professional training frameworks; policy and governance reform; interprofessional communication and collaboration; and spatial, cultural, and structural influences on care. Illustrative examples include the Midwifery Continuity of Carer model (operationalizing relationship-based safety via smaller caseloads and coherent pathways), the US MERA consensus framework (standardizing regulation and scope to support safer system integration), the MIDWIZE midwife-led care framework, and the WHO Safe Childbirth Checklist. Cross-cutting implementation enablers included relational trust, professional ethics, system integration, experiential learning, and equity-oriented design. Practically, these frameworks inform training (simulation and reflective pedagogy), strengthen handover protocols and interprofessional norms, guide person-centered facility and service design, and support regulatory alignment to broaden safe access to midwife-led care. Policy relevance lies in adopting standardized regulatory models and capacity-building approaches to embed continuity, cultural safety, and accountability, with potential downstream gains in maternal–newborn outcomes.