**Background**
Quality of care in maternal and neonatal health is a core issue, yet most quality indicators focus on disease or adverse event prevention rather than health promotion. Midwifery care, grounded in a salutogenic approach, is associated with improved outcomes for mothers and newborns, but there is no standardized classification of midwifery interventions in Italy. The Italian Midwifery Core Outcomes Set (M-COS) was previously developed, but which interventions benefit each core outcome remains unknown. This protocol aims to develop a Midwifery Interventions Classification (MIC)—an evidence-based, standardized taxonomy—for the Italian context, with potential for international transferability. The classification will cover healthy women with low-risk pregnancies and their newborns, from antenatal through postnatal care, drawing on the Donabedian framework, the salutogenic framework, and the Quality Maternal and Newborn Care framework.
**Methods**
The study uses a multi-method, multi-phase approach designed between June and September 2022, following the COMET Handbook and CREDES guidance. The study will run from February 2023 to February 2024. Stage 1 (Developmental phase, completed) involved a literature review following PRISMA guidelines, searching PubMed, CINAHL, and Scopus for studies describing midwifery interventions during pregnancy, childbirth, and the postnatal period within a physiological framework. Inclusion criteria were English or Italian language, full-text availability, any study design, and studies describing midwifery interventions in any care setting. The search identified 338 records; after removing 35 duplicates and screening, 90 articles were retrieved. Of these, 64 were not relevant, 4 focused solely on maternal or neonatal diseases, and 10 were part of the same project (only the first was included). Two articles were excluded for language. Ten articles from the queries and 4 from manual reference searching were eligible, added to 2 from a previous review, yielding 16 included articles (11 observational studies, 5 literature reviews). From these, 164 midwifery interventions were extracted. Stage 2 (Consensus process, planned) will use a Delphi technique with three stakeholder panels: healthcare professionals (midwives with ≥1 year experience), healthcare researchers (experts in Delphi methodology), and service users (healthy women with physiological pregnancy/birth within the last 5 years). Target group sizes are 50–100 for healthcare professionals and 20–40 for service users. Two Delphi rounds are planned, with a possible third round. A 9-point Likert scale will be used (1–3 = little significance, 4–6 = essential but not critical, 7–9 = crucial), with an "unable to score" option. Consensus is defined using the "70/15%" method: >70% scoring 7–9 and <15% scoring 1–3 for retaining interventions. An additional criterion carries forward interventions scored 7–9 by >90% of one panel regardless of other panels' ratings. Attrition and attrition bias will be evaluated by comparing average scores between completers and dropouts.
**Key Results**
The developmental phase produced a preliminary MIC with interventions organized into domains and classes. The 16 included studies came from multiple countries (distribution shown in Figure 3). The preliminary classification covers categories including maternal outcomes (physiological and behavioral interventions from antenatal to postnatal periods), newborn care (interventions for healthy and sick babies), and birth center/primary care and hospital/physician care categories emphasizing interdisciplinary collaboration. The specific domains, classes, and interventions are detailed in Table 2 and Supplementary file S1. The protocol notes that 10 studies from the same project had identical midwifery interventions, so only the first study was included to avoid duplication.
**Clinical Implications**
The MIC provides a standardized taxonomy to organize and evaluate midwifery interventions, supporting audit, quality improvement, education, and comparable data collection for research. It makes midwifery contributions to maternal and newborn health more tangible, potentially boosting public recognition of the profession. The classification is designed to be context-specific for Italy but based on international literature, allowing for potential international scaling. The authors acknowledge limitations: the Delphi process may be time-consuming for participants, the method does not allow in-depth exploration of expert views, and consensus does not guarantee the best possible classification. Future validation studies (e.g., criterion-related validity) are needed to corroborate the MIC against measurable patient-level outcomes and the previously developed M-COS.