City Research Online

Abstract

INTRODUCTION Midwives play a critical role in improving maternal and neonatal outcomes, with midwifery-led care proven to reduce unnecessary interventions and empower women. Yet, across Europe, systemic and cultural barriers continue to hinder midwives’ ability to fully adhere to global standards such as the International Confederation of Midwives (ICM) essential competencies.

METHODS A qualitative study captured the perspectives of ten midwives from five European countries: UK, Germany, Belgium, Bulgaria, and Italy. Purposive sampling captured diverse representation from midwives working within national regulatory frameworks and practicing independently. Semi-structured interviews provided rich insights into essential competencies adherence, with thematic analysis revealing key trends.

RESULTS Participants identified shared challenges, including societal undervaluation of the midwifery profession, workforce strain, and restrictive legislations, alongside regional differences including governance barriers and lack of regulation of out-of-hospital births. Benefits to adherence to ICM competencies included enhanced autonomy and opportunities for international collaboration. Overarching themes were structural and cultural as external dynamics, and professional as internal dynamics. The former included medicalization, subordinate role of midwives, and regulatory barriers, whereas at a professional level emerged relationship-centered care and theory-practice gap, as key subthemes. Proposed strategies included strengthening adherence, fostering academic and institutional support, and enhancing professional standing.

CONCLUSIONS This study highlights that essential competencies are not fully implemented across Europe. Urgent collaboration among academic and health institutions, as well as midwifery associations, is essential to create enabling environments and strengthen essential competencies’ adherence in Europe. Ultimately to fostering professional identity and improving maternal and neonatal health outcomes.

Publication Type:	Article
Additional Information:	Published by European Publishing. © 2026 Valentini C. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0. International License (https://creativecommons.org/licenses/by/4.0/).
Publisher Keywords:	Europe, ICM essential competencies, midwife-led care, midwifery autonomy, professional identity
Subjects:	R Medicine > RG Gynecology and obstetrics
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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