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Integrality framework

Learn about the Integrality Framework - a model to implement relationship-based care integrated across health disciplines within the maternity system.
Mother holding child
© Lancet and Mary Renfrew

We know we need a model that can guide us through the practical steps of how to implement the Lancet framework. Professor Mary Renfrew, one of the main authors of the Lancet Series on Midwifery, has created just that. She developed the Integrality Framework – a framework for care based on the evidence that demonstrates the clear need for relationship-based care integrated across health disciplines within the maternity system.

At the centre of this framework is the woman and her baby (and by extension, the members of her family and support team that are important to her).

Woman and child at the center, with the following services surrounding them: Family planning, Pharmacy, Obstetric, Neonatal, Medical, Welfare, Domestic abuse, Nutrition support, Mental health, Physiotherapy and Community support © M.J. Renfrew, 2015

How does it work?

By wrapping the care around the woman, you can ensure her care becomes de-fragmented. Her care can be integrated and supported, with her pregnancy and birth a shared central focus. And yet, someone needs to coordinate and facilitate the various additional care providers that the woman may need to access depending on her unique needs.

A midwife is the ideal person to integrate that care: she travels alongside the woman, journeying through the pregnancy, birth, and the early weeks of parenting. This model might sound familiar – this is precisely what we described last week as midwifery continuity of care.

The midwife acts as a central facilitator for the woman: referring her to other care providers when necessary, while maintaining a clear focus on the woman’s pregnancy and birth, and an awareness of the overall picture of health for this woman and baby. We know that women see all these people – we established that when we explored all the different relationships a pregnant mother may have with various health professionals. And she has individual relationships with each one of them. But a collection of disconnected one-on-one relationships does not lend itself to a healthy overall picture – someone needs to facilitate all of these relationships within a framework of care. This is where a known midwife comes in.

From rhetoric to reality

Clearly, from what we have seen so far, implementing this framework would ensure women were heard, had their needs met, and would enable midwives to provide good care. We need to move from rhetoric to reality and find a way to make this happen for all women.

Professor Renfrew gives us a clear voice for the way forward:

“We need a strategy for midwifery that joins up global, national and local strategies, as the core component of quality maternal and newborn care.

We need an interagency, interdisciplinary taskforce.

We need a public health focus on outcomes, inequalities, and wider culture.

We need to create and use evidence… we need participation, co-creation, processes and relationships.

We need to use existing strengths and opportunities as levers.

We have the potential to wrap care around all women, babies and families.”

(M.J. Renfrew, 10 December, 2015)

There’s a lot at stake in maternity care – future generations are shaped in part by the way they are born. Women’s first experiences of mothering are in pregnancy, birth and early parenting. Using models of care that wrap services and care around the needs of women,their babies and their families – supported by a known midwife and an entire team of specialists as needed – gives each family the best possible start in life.

Over to you

We’ve introduced the Integrality Framework where care is wrapped around the woman, who sits at the centre, supported and facilitated by her midwife.

Thinking in terms of practical details, how would you see this model functioning in practice?


Renfrew, M., McFadden, A., Bastos, M., Campbell, J., Channon, A., Cheung, N., Declercq, E. (2014). Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129-1145. doi:10.1016/S0140-6736(14)60789-3

© Griffith University
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