The Relationship Between Clinical Autonomy and Infection Prevention and Control Outcomes in Maternity Services: A Cross-Sectional Study

Abstract

Infection Prevention and Control (IPC) is fundamental to safe maternity care, directly safeguarding maternal‑neonatal safety and supporting neonatal immunological resilience. Infections acquired during childbirth compromise neonatal immune defence and contribute to preventable morbidity and mortality, underscoring the critical importance of effective IPC measures. Clinical autonomy—the ability of midwives and nurses to make independent, evidence‑based decisions—plays a pivotal role in ensuring timely and consistent implementation of IPC protocols. When autonomy is supported, practitioners can act decisively in high‑risk scenarios, applying current guidelines to protect both mother and newborn. This study aimed to assess the level of clinical autonomy among maternity care providers, evaluate their adherence to IPC protocols, and examine the relationship between autonomy and infection prevention outcomes. A descriptive cross‑sectional design was conducted among 45 midwives and maternity nurses. Data were collected using the Dempster Practice Behaviors Scale (DPBS) and a structured IPC adherence checklist. Descriptive statistics, Pearson’s correlation, and linear regression were employed for analysis. Results showed that autonomy increased with experience, with 91% of providers with more than two years of practice reporting moderate to high autonomy. IPC scores ranged from 42 to 96, with a mean of 71.2 (SD = 12.6). A strong positive correlation was observed between autonomy and IPC adherence (r = 0.68, p = 0.0001). Regression analysis confirmed autonomy as a significant predictor of IPC outcomes (β = 0.58, p < 0.001), explaining 46% of the variance. Conclusion: Clinical autonomy significantly enhances IPC performance, reducing infection‑related complications and promoting maternal‑neonatal safety and immunological health. Strengthening autonomy through mentorship, institutional support, and evidence‑based practice training is essential to optimize maternity care outcomes.