Policy Brief

Implementing Midwife-Led Birth Centres 

Midwife-Led Birth Centres
ICM
Last Edited 29 January 2025 13:54 CET

A midwife-led birthing centre (MLBC) is a dedicated space – either within or separate from a higher-level health facility – where care is provided for pregnant women and newborns at low risk of complications. MLBCs must be integrated into the local health care services, so that midwives can consult and refer women to secondary and tertiary level services if needed. As a minimum, MLBCs provide care during labour and birth, but may also provide antenatal, immediate postnatal care and sexual and reproductive health care.

Midwives are essential providers of primary health care and can play a major role in the provision of universal health care. Midwives are key providers of sexual, reproductive, maternal, newborn and adolescent health care. One way for midwives to provide care is through MLBC. MLBCs essentially provide primary level care with criteria describing the level of care provided and guidelines to manage referral to secondary or tertiary level care. 

ICM’s MLBC study was undertaken in four countries – Uganda, South Africa, Bangladesh and Pakistan. This Brief outlines the key findings, presents the Pathway to Change which highlights the processes and mechanisms needed to scale up MLBCs and provides a series of actions to support successful implementation of MLBCs.

Case Studies

Midwife-led birthing centres in four countries: a case study.

The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.

Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey.

This study provides up-to-date evidence about which countries have MLBCs, and some information about the characteristics of MLBCs in LMICs. Low- and lower-middle-income countries were more likely than upper-middle-income countries to have MLBCs. The most common type of MLBC was freestanding. Public-sector midwife-led birthing centres were more common in middle-income than in low-income countries. Some were staffed entirely by midwives and some by a multidisciplinary team. We identified challenges to the midwifery philosophy of care, legislative and regulatory requirements, and effective referral systems.

The peer-reviewed literature does not provide a comprehensive picture of the locations and characteristics of MLBCs in LMICs. Many of our findings echo those from high-income countries, but some appear to be specific to some or all LMICs. The study highlights knowledge gaps, including a lack of evidence about the impact and costs of MLBCs in LMICs.

Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review.

This review brings together available empirical evidence about MLBCs in LMICs using a NOC framework. The NOC framework facilitated the identification of gaps and can eventually be adapted for use as an assessment tool to address gaps and overcome barriers in similar settings or may help to develop strategies for implementing sustainable MLBCs successfully.

Midwife-led birthing centres in Bangladesh, Pakistan, and Uganda: An economic evaluation of case study sites.

MLBCs offer a potentially cost-effective model of care for providing safe and high-quality care to women giving birth in LMICs. However, the cost of operating an MLBC varies greatly, and this does affect cost-effectiveness. Further research, including prospective evaluation of implementation of new MLBCs, is recommended to confirm the results produced in our study.

Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review.

This review brings together available empirical evidence about MLBCs in LMICs using a NOC framework. The NOC framework facilitated the identification of gaps and can eventually be adapted for use as an assessment tool to address gaps and overcome barriers in similar settings or may help to develop strategies for implementing sustainable MLBCs successfully.