Background: Increasing intervention rates and decreasing physiological birth rates indicate the continuing medicalisation of childbirth in the United Kingdom (UK). This could reduce access to midwifery-led care, which adopts a ‘with woman’ approach, and support physiology. Medical care is associated with a decline in maternal and neonatal morbidity and mortality but can have significant consequences for physical and psychological health.
It is therefore imperative to understand the driving forces behind this trend.

Aims: This qualitative research sought to explore the extent to which midwives feel they can practise midwifery-led care and identify midwives’ perceived barriers and facilitators to providing midwifery-led care.

Methodology: Three focus groups were conducted with midwives from across the UK. One group was composed of midwives experienced on the obstetric-led unit (n=4); one group included midwives who worked in midwife-led units (n=4); and finally, there was a mixed group of midwives (n=6). Focus groups were conducted via Microsoft Teams, transcribed verbatim and analysed using thematic analysis.

Results: Participants identified a shift in midwifery practice, whereby obstetrics is playing an increasing role in maternity care. They perceived an erosion of midwifery practice, defined by a reduction in physiological practices and the promotion of women’s choice. This was attributed to numerous interconnected structural, cultural, and individual factors. These included but were not limited to: midwife mental health and a perceived lack of experience in promoting physiology; a shift in a perception of maternity care; a change in maternity culture; and the changing epidemiology of the birthing population.

Conclusion: This study concludes that the identified barriers and facilitators to midwifery led care require further exploration to address these issues within practice. As a key theme identified, methods to support midwives’ mental health should also be implemented. In addition, addressing staffing to reduce burnout, incorporating midwifery philosophy into training, developing antenatal and preconceptual education for women, and improving access to midwifery-led birthing units, have been identified as key recommendations from this study.