<![CDATA[The midwifery referral system plays an important role in ensuring the safety of mothers and babies, particularly in cases requiring advanced hospital care. Rosela Hospital Karawang has experienced a decline in the number of referrals from midwives. This condition indicates a problem in maintaining the referring midwives’ willingness to recommend the hospital. This study aims to analyze the effect of the quality of midwifery referral services and trust on willingness to recommend, with referring midwives’ satisfaction as an intervening variable. This research used a quantitative approach with a causal research design. The sample consisted of 63 referring midwives, selected using a census technique. Data were collected using a five-point Likert scale questionnaire and analyzed using SEM-PLS. The results showed that the quality of referral services had a positive effect on willingness to recommend (β = 0.277; t = 2.248; p = 0.025) and referring midwives’ satisfaction (β = 0.460; t = 5.933; p = 0.000). Trust also had a positive effect on willingness to recommend (β = 0.372; t = 2.411; p = 0.016) and referring midwives’ satisfaction (β = 0.510; t = 6.769; p = 0.000). Referring midwives’ satisfaction also had a positive effect on willingness to recommend (β = 0.326; t = 2.456; p = 0.014). In addition, referring midwives’ satisfaction mediated the effect of referral service quality on willingness to recommend (β = 0.150; t = 2.275; p = 0.023) and the effect of trust on willingness to recommend (β = 0.167; t = 2.179; p = 0.029). This study found that the quality of midwifery referral services and trust influence willingness to recommend, both directly and indirectly through referring midwives’ satisfaction.]]>
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