Contexts influencing Italian midwifery care provision: a constructivist grounded theory - strength project

This study aimed to explore the processes shaping the delivery of midwifery care in Italy.

A Constructivist Grounded Theory approach was used. Data were generated through in-depth semi-structured interviews with midwives, midwifery students, and individuals with experience of receiving midwifery care, alongside participant observations conducted within a Midwifery-Led Unit. Data generation and analysis were conducted iteratively using initial and focused coding, constant comparison, and inductive-abductive reasoning.

The analysis identified a complex and interrelated set of processes shaping midwifery care across clinical, educational, and academic contexts. Findings revealed a strong awareness among participants of the principles and conditions enabling high-quality midwifery care, contrasted with lived experiences within standard care settings characterised by hierarchical organisation, biomedical dominance, and limited professional autonomy. These dynamics were reinforced through educational structures and academic practices that marginalised midwifery perspectives and constrained the production and legitimacy of midwifery-generated knowledge. Together, these processes resulted in a persistent mismatch between the physiological nature of midwifery-related processes and the biomedical, intervention-oriented contexts in which they are routinely managed, undermining the provision of appropriate, high-quality midwifery care.

The findings suggest that challenges in midwifery care provision reflect deeply embedded structural and epistemic dynamics rather than isolated local issues. While grounded in the Italian context, the processes identified align with patterns reported internationally, pointing to a broader crisis in contemporary maternity care systems. Addressing this misalignment requires collective and transnational efforts to critically re-examine how midwifery care is conceptualised, organized, taught, and supported within healthcare systems.