‘Going the extra mile’: Midwives’ advocacy for woman-centred care during childbirth amid the COVID-19 pandemic: a qualitative study

Background : The COVID-19 pandemic posed unprecedented challenges to maternity care, disrupting practices that promote respectful and woman-centred care during childbirth. Midwives play a critical role in fostering humanised care; however, restrictive policies and rapidly changing protocols during the pandemic constrained their ability to uphold these values. Although previous research has explored midwives’ experiences during the pandemic, their role in navigating the ethical dilemmas that emerged remains underexamined. This study aimed to explore the experiences and perceptions of midwives who cared for women diagnosed with COVID-19 during childbirth. Methods : A qualitative study with an ethnographic approach was conducted in two Spanish tertiary hospitals. Data were collected through two focus groups with fourteen labour ward midwives who provided care between March 2020 and May 2021. Inductive thematic analysis guided data interpretation. Results: Two themes emerged from the data analysis. The first, ‘systemic barriers to woman-centred care’, highlights the structural and organisational barriers that limited midwives’ ability to provide woman-centred care, such as hierarchical tensions, the silencing of the midwifery voice, and the loss of previously achieved gains in the humanisation of childbirth. The second, ‘upholding humanised care amid ethical dilemmas’, reflects both their commitment to defending more humanised care and the ethical dilemmas they faced when prioritising compassionate care over strict adherence to protocols. Conclusions: Midwives faced structural barriers and ethical dilemmas that limited their ability to provide woman-centred care during the COVID-19 pandemic. Despite these challenges, they continued to advocate for women’s wellbeing in line with the principles of their International Code of Ethics, striving to provide humane and respectful care while safeguarding the rights of women and their families.