Care in the presence of absence: Midwives navigating widowed pregnancy

Childbirth is conventionally framed as a site of emergence and continuity; however, for women who are widowed during pregnancy, it unfolds within an ongoing encounter with death. This study explores how midwives make sense of and enact care in this context, drawing on interviews with 14 midwives participating in the Israeli "By Your Side" program, a continuity-of-care model developed following the October 7, 2023 war. Using thematic analysis, we examine care not as a set of interventions, but as a situated, relational practice shaped within conditions of loss, ambiguity, and existential disruption. Findings conceptualize care as an ongoing process of navigation across tensions rather than their resolution. Midwives described practices of attunement, restraint, and boundary negotiation through which they moved within, rather than resolved, coexisting realities of life and death, presence and absence, and hope and despair. We interpret these practices through a relational lens, proposing "holding" as the underlying mechanism through which navigation is enacted-an orientation that sustains a shared space in which contradictory experiences can remain unresolved yet bearable. The study challenges resolution-oriented clinical paradigms and contributes to qualitative health scholarship on care in contexts of liminality. We argue that, in situations marked by profound loss, care is not directed toward restoring coherence, but toward sustaining the conditions in which meaning may remain unstable. This reframing extends conceptualizations of care as an ongoing ethical and relational commitment to remain with what exceeds resolution.