Exploring views on normal birth in the Nordic and Baltic regions: a cross-national qualitative study with midwives working in hospital birth settings

IntroductionMidwifery knowledge, education and training in practice are challenged in contemporary maternity care by the growing trend towards interventions during childbirth, a dominant risk perspective and medicalised care. There is an ongoing debate about the definition of normal birth, however, midwives continue to advocate for normal birth.ObjectiveTo explore midwives’ views and definitions of normal birth, and how they work to promote it, in a hospital setting.MethodsA qualitative cross-national study was conducted in the Nordic and Baltic regions by student midwives (n = 35) and their university-based supervisors from midwifery education programs, (n = 10). A total of 145 midwives were interviewed individually or in groups. A comprehensive thematic analysis was employed.ResultsMidwives’ views on normal birth revealed a midwifery identity shaped by the guiding philosophy of the profession. Definitions of normal birth varied among midwives, influenced by their working environment, individual perspectives, and cultural and socio-political backgrounds. Regardless of these differences, midwives emphasized the importance of meeting women’s expectations and maintaining a supportive presence during childbirth, fostering effective communication with both women and healthcare colleagues to advocate for physiological birthing processes.ConclusionOur findings illustrate midwives’ dedication to promote healthy, physiological birthing processes, which stands as a core value of their profession. Hindrances exist in the hospital birth setting that impact healthy outcomes. The widespread use of the term normal birth is challenging. This study invites rethinking birth narratives supporting exploration of other terms, such as healthy birth, to better capture the philosophy and practice of midwifery.