Problem: Continuity of midwifery care models are the gold standard of maternity care. Despite being recommended by the Australian Health Ministers’ Advisory Council, few women in Australia have access to such models. Background: Extensive research shows that if all women had access to continuity of midwifery care, maternal and neonatal outcomes would improve. Hospital accreditation, the main national safety and quality system in Australia, aims to encourage and enable the translation of healthcare quality and safety standards into practice. Aim: This paper explored the realities and possibilities of a health care accreditation system driving health service re-organisation towards the provision of continuity of midwifery care for childbearing women. Methods: A scoping review sought literature at the macro (policy) level. From 3036 records identified, the final number of sources included was 100:73 research articles and eight expert opinion pieces/editorials from journals, 15 government/accreditation documents, three government/accreditation websites, and one thesis. Findings: Two narrative themes emerged: (1) Hospital accreditation: ‘Here to stay’ but no clear evidence and calls for change. (2) Measuring and implementing quality and safety in maternity care. Discussion: Regulatory frameworks drive hospitals’ priorities, potentially creating conditions for change. The case for reform in the hospital accreditation system is persuasive and, in maternity services, clear. Mechanisms to actualise the required changes in maternity care are less apparent, but clearly possible. Conclusions: Structural changes to Australia's health accreditation system are needed to prioritise, and mandate, continuity of midwifery care.