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Despite increasing implementation, sustainability of these clinics has not been well reported. This exploratory cross-sectional study surveyed midwives and nurse managers involved before and after clinic establishment and used binomial logistic regression to identify factors linked to perceived sustainability. Findings highlighted women-empowerment before establishment and deep engagement with pregnant women after establishment as key associated factors.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pre-and-post-establishment-factors-affecting-the-perceived-sustainability-of-midwifery-outpatient-clinics-an-exploratory-cross-sectional-study-in-japan/445172/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pre-and-post-establishment-factors-affecting-the-perceived-sustainability-of-midwifery-outpatient-clinics-an-exploratory-cross-sectional-study-in-japan/445172.png","ImageObject",300,407,{"name":92,"@type":93},"CatatanPagi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-04","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What problem motivated this study?","Question",{"text":112,"@type":113},"A shortage of obstetricians in Japan has reduced delivery facilities, creating a need to understand whether midwife-led outpatient clinics can remain sustainable over time.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Who participated in the study and how was data collected?",{"text":117,"@type":113},"The study targeted midwives and nurse managers in Japan who were involved in both establishing and managing midwife-led outpatient clinics. Surveys were distributed to 68 clinics nationwide, yielding 81 responses and 53 valid responses for analysis.",{"name":119,"@type":110,"acceptedAnswer":120},"Which factors were associated with perceived sustainability?",{"text":121,"@type":113},"Before establishment, the factor was empowering women to take an active role in pregnancy and birth. After establishment, the factor was the ability to engage deeply with pregnant women.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},445172,1790762774,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962090894170,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Review began 11/12/2025  \nReview ended 11/26/2025  \nPublished 12/07/2025  \n© Copyright 2025  \nMaeda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98652  \nOpen Access Original Article  \nPre-and Post-establishment Factors Affecting the Perceived Sustainability of Midwifery Outpatient Clinics: An Exploratory Cross-Sectional Study in Japan  \nAyuka Maeda 1, Hisao Nakai 1  \n1. Faculty of Nursing, University of Kochi, Kochi, JPN  \nCorresponding author: Hisao Nakai, [nakaihisao@gmail.com](nakaihisao@gmail.com)  \nAbstract  \nBackground  \nIn 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.  \nAim  \nThis study aimed to identify factors associated with the perceived sustainability of midwife-led outpatient clinics, considering both pre-and post-establishment periods.  \nMethods  \nThis 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.  \nResults  \nThe 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) .  \nConclusion  \nOur 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.  \nCategories: Other, Obstetrics/Gynecology, Public Health  \nKeywords: japan, midwife, midwife led care, midwifery outpatient clinics, perceived sustainability  \nIntroduction  \nPerinatal care in Japan has recently faced significant challenges. A primary issue is the shortage and  \ngeographical maldistribution of obstetricians, which has a considerable impact on the stability of perinatal medical services [1] . This shortage has created a vicious cycle in which deteriorating working conditions for the remaining physicians lead to further resignations from the specialty [2,3] . A direct consequence of this physician shortage is the closure of obstetric wards. This situation severely affects expectant mothers and  \ntheir families by undermining their ability to give birth and raise children securely within their own  \ncommunities. The impact is particularly acute in rural regions, where the decline in facilities that handle  \ndeliveries directly affects the health and well-being of local mothers and infants [3] .  \nIn response to these challenges, policies initiated around 2008 by Japan’s Ministry of Health, Labour and Welfare and the Japanese Nursing Association have promoted the establishment of in-hospital midwifery systems and midwife-led outpatient clinics. These initiatives aim to counteract the shortage o","cbCaisKWn5QXcicn","https://ap.wps.com/l/cbCaisKWn5QXcicn","pdf",195973,14,"English","# Background\n# Aim\n# Methods\n# Results\n# Conclusion","[{\"question\":\"What problem motivated this study?\",\"answer\":\"A shortage of obstetricians in Japan has reduced delivery facilities, creating a need to understand whether midwife-led outpatient clinics can remain sustainable over time.\"},{\"question\":\"Who participated in the study and how was data collected?\",\"answer\":\"The study targeted midwives and nurse managers in Japan who were involved in both establishing and managing midwife-led outpatient clinics. Surveys were distributed to 68 clinics nationwide, yielding 81 responses and 53 valid responses for analysis.\"},{\"question\":\"Which factors were associated with perceived sustainability?\",\"answer\":\"Before establishment, the factor was empowering women to take an active role in pregnancy and birth. After establishment, the factor was the ability to engage deeply with pregnant women.\"}]","Pre-and Post-establishment Factors Affecting the Perceived Sustainability of Midwifery Outpatient Clinics - An Exploratory Cross-Sectional Study in Japan | PDF",1790710517,35]