Author Identifier

Annemarie De Leo

Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Nursing and Midwifery

First Supervisor

Sara Bayes

Second Supervisor

Dianne Bloxsome

Third Supervisor

Janice Butt


Evidence-based practice (EBP) is well-established as the gold standard for service delivery of quality healthcare around the world, yet there remains a significant gap between best available evidence and its everyday use in maternity services. The numerous benefits of EBP are therefore never realised and although a considerable body of knowledge has evolved on how to promote the uptake of new EBPs, little is known about midwives’ experience of implementing EBP or leading practice change projects in clinical areas.

The aim of this study was to work collaboratively with midwives towards the co-development of an evidence implementation resource, designed to provide clear direction and support to midwives wanting to implement new EBPs in clinical areas. This led to the design of a blueprint for an eTool(KIT) for midwives, outlining a stepby- step approach to leading practice change projects in clinical areas.

A qualitative approach to the study design was adopted and critical realism employed as the philosophical underpinning for this research inquiry. Seventeen Australian midwives consented to participate in either a focus group discussion or face-to-face interview, which were audio recorded, transcribed and combined with additional field notes to provide a collection of data that was analysed and reported.

Three higher order codes were synthesised from the findings to make overall meaning of the factors that contribute to the adoption of EBP in midwifery: “It’s hard to overcome the resistance towards new EBP, midwives are passionate yet reticent towards leading practice change”, “Inter-disciplinary collaboration and organisations supportive of change are key to improving implementation processes for midwives”, and “ To lead practice change initiatives, midwives require knowledge of system-level change and a clear process for evidence implementation”.

The findings revealed that although midwives are passionate iv about EBP, they express reticence towards leading practice change for numerous reasons. These reasons contribute to the inconsistent and sub-optimal use of EBP in Australian maternity services. As such, this study offers a pragmatic approach to organisational change and demonstrates the potential for midwives to be leader of evidence-based change and key stakeholders in all future practice change projects in Australian maternity services.