The adoption of Virtual Maternity Care (VMC) in antenatal settings is increasing, propelled by technological advancements that facilitate remote communication and telemonitoring. A spectrum of care models exists globally, ranging from fully virtual to hybrid approaches. This review seeks to synthesise the qualitative evidence on women’s experiences of antenatal VMC in high-income countries, developing a conceptually rich understanding of factors that facilitate or hinder engagement and perceived safety. In June 2025, four databases were searched for peer-reviewed literature published in English between January 2010 and June 2025. After screening for quality and eligibility, 21 articles were included. Four core themes were identified: Virtual Care Worked Well, Seeking Good Connections, Empowerment and Safety Through Virtual Care Monitoring, and Feeling Disconnected and Unsafe. Women described feeling empowered through active participation and shared responsibility in their care (Empowerment and Safety Through Virtual Care Monitoring), particularly when relational care and continuity were present (Seeking Good Connections). Flexibility, convenience, and access to daily telehealth and reliable technologies were highly valued (Virtual Care Worked Well). Hybrid models were generally preferred; in contrast, exclusively remote models sometimes inhibited quality care and heightened feelings of insecurity (Feeling Disconnected and Unsafe), particularly for women with previous pregnancy loss, experiences of intimate partner violence, mental health concerns, or those facing language barriers, digital poverty, financial hardship, or low health literacy. In conclusion, women’s perspectives underscore priorities for designing and scaling high-quality, accessible virtual midwifery care: relational continuity, technological reliability, flexible delivery, and hybrid models integrating virtual and in-person care.

PROBLEM:Global and national strategy directives identify continuity of midwifery carer (CoMC) models as important priorities for workforce development. There are concerns about the impacts of working in CoMC on the midwifery workforce in Australia. BACKGROUND:CoMC models enable care across the childbearing continuum from a single midwife or small group of midwives known to the pregnant woman, improving perinatal outcomes. Potential impacts on midwives working in these models include work-life balance, retention, professional progression, professional satisfaction, burnout and attrition. AIM:To review and synthesise research reporting the impact of working in CoMC models on midwives in Australia, and identify knowledge gaps to guide future research. METHODS:This review adopted the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR check list. A search strategy was developed using keywords relating to the midwifery profession, location (Australia) and CoMC models. Four databases were searched, relevant papers were identified, data extracted and synthesised. FINDINGS:Thirty-two papers met the inclusion criteria for this review. Impacts were identified under the following themes: positive partnerships with women, improved professional satisfaction, work-life balance, impact on professional relationships and positive psychological health and wellbeing. DISCUSSION:These impacts are mostly positive, with evidence of lower levels of intention to leave the workforce and reduced levels of burnout, compared to those working in shift-based models. CONCLUSION:The effect of variations in on-call arrangements were identified as an aspect of work-life balance for future research. Findings are relevant for health service design reform and strategic national workforce planning.

OBJECTIVE:To explore Australian Clinical Midwifery Educators' perceptions of the barriers and enablers to facilitating midwifery students' clinical learning experiences in perinatal loss and grief care. METHOD:A qualitative descriptive design was used. Ten Clinical Midwifery Educators participated in semi-structured Zoom interviews. Data were analysed using thematic analysis. RESULTS:Seven themes emerged, five barriers and two enablers. Barriers included the low prioritisation of perinatal loss education, protective attitudes toward students and women, the emotional and practical challenges of teaching this sensitive topic, and the impact of busy clinical environments. Enablers included students' emotional readiness and the role of universities as safe spaces to initiate learning and discussion. These findings highlight the complexity of preparing students for perinatal grief care and the need for systemic educational reform. CONCLUSION:Graduating midwifery students often lack the knowledge, skills, and confidence to provide evidence-informed, woman-centred care in the context of perinatal loss and grief. Limited clinical exposure contributes to this gap, leaving students underprepared for emotionally complex care situations. Midwifery students require structured, supported exposure to perinatal loss care to build emotional resilience and clinical competence. A shift in mindset is needed to balance protection with preparation. Strengthening university curricula, enhancing collaboration with clinical settings, and prioritising mental preparedness are essential. Future research should examine the impact of pre-registration exposure on graduate midwives' readiness to provide bereavement care.

BACKGROUND:Midwives are the largest professional group in Australian maternity services. Understanding the current midwifery workforce and the issues midwives face is important for workforce planning. AIM:Provide detailed understandings of the current Australian midwifery workforce, including potential attrition rates. METHOD:Descriptive cross-sectional online survey of registered midwives. FINDINGS:3286 midwives contributed to the data. Respondents most commonly reported their gender as woman, were aged 40 - 59, worked part-time, and practised in a metropolitan setting. Only 11.8 % of midwives worked in roles where they might provide continuity of midwifery care, yet 37.5 % expressed an interest in working in midwifery group practice. One third (36.6 %) were considering leaving midwifery, for reasons mostly related to their workplace. Poor workplace culture, understaffing, over-medicalisation, and being unable to provide safe midwifery care were commonly reported concerns. DISCUSSION:This is the largest survey of the Australia midwifery workforce. While most midwives worked in clinical roles in the public sector, the range of roles was extremely diverse. Potential attrition rates are high, which would have a devastating impact on safe maternity care provision in Australia. More midwives want to work in continuity of midwifery carer models than are currently doing so. CONCLUSION:Urgent action to improve midwifery workplaces is required to retain midwives and encourage greater workforce participation. Increasing midwifery student intakes, removing barriers to employment in flexible continuity of midwifery carer roles, and improving working conditions will contribute to a stronger future for the Australian midwifery workforce.

AIM:To understand students' views on and experiences of their pre-registration midwifery education in Australia, including continuity of care experiences and clinical practice placements and their preferences for future employment. BACKGROUND:Increasing the number of midwifery student enrolments and improving student experience are suggested solutions to shortages in the Australian midwifery workforce. DESIGN:An anonymous online survey. METHODS:Open to students currently enrolled in an education programme leading to Australian midwifery registration or who had recently completed such a programme but had not yet commenced employment. Quantitative data were analysed through descriptive statistics and chi-squared tests. Frequency counts and inductive content analysis were used to analyse qualitative data. This research was undertaken as part of the national Midwifery Futures project. RESULTS:A total of 303 eligible responses were received. While most students felt their midwifery education prepared them well for future practice, a third (n = 93/281, 33.1 %) had taken or were considering leave and more than half (n = 161/281, 57.3 %) had considered withdrawing. Continuity of care experiences were highly valued by students as an educational experience. Nearly all students (n = 257/278, 92.4 %) preferred future employment in a clinical midwifery role and most (n = 206/257, 80.2 %) wished to work in midwifery group practice or team midwifery service in a public hospital. CONCLUSIONS:Midwifery students in Australia felt well-prepared by their education programmes to practice midwifery. However, many students also found meeting the requirements of their degree challenging. Further research and efforts are required to support students to complete their midwifery education.

BACKGROUND:Burnout, stress, trauma and other psychological health issues are major drivers of attrition, absenteeism, and reduced workplace engagement for midwives. Given the central roles midwives play in providing quality maternity care, it is important to monitor the mental and emotional health of midwives and to understand factors that are associated with a higher or lower incidence of problems. The aim of this review was to report on empirical literature pertaining to the psychological impact of midwifery work for midwives working in Australia. METHODS:The Joanna Briggs scoping review methodology was used. MEDLINE, Embase, Emcare, Maternity & Infant Care Datacare, CINAHL and SCOPUS were searched to identify research pertaining to the psychological impact of midwifery work for Australian midwives. RESULTS:A total of 26 papers met inclusion criteria. Midwifery work in Australia carried a significant psychological burden, with high rates of burnout, emotional exhaustion, depression, anxiety, and stress. Most midwives had witnessed traumatic events. Working in continuity of midwifery carer models was associated with lower rates of mental health concerns, while younger midwives and those with fewer years in the workforce were negatively impacted. DISCUSSION:Midwives in Australia are impacted significantly by their work; especially by burnout, the impact of witnessing traumatic events, depression, stress and anxiety, and moral distress. Midwifery continuity of carer models were protective for psychological impacts. CONCLUSIONS:Effective workplace interventions to better support the midwifery workforce, including access to continuity models, are required to sustain Australia's high quality maternity care system.

Objective Quality maternity service provision relies on having a robust midwifery workforce. Although previous models suggested future growth of the workforce, this is at odds with recent reports of staffing shortfalls and difficulties in recruitment. We developed an updated model to provide long-term projections of supply and demand for the Australian midwifery workforce. Methods A dynamic stock and flow model was built from baseline data from 2022, with projections through to 2030. It was assumed that 79% of the midwifery workforce would provide clinical care, working 20h per week to meet a workload of 40 pregnancies per full-time equivalent midwife per year. Results If recruitment and attrition remain stable, both headcount and full-time equivalent numbers of midwives will increase by 2030, exceeding demand. The average annual workload per full-time equivalent midwife would fall to 34 pregnancies. However, if voluntary attrition rose by 10%, there would be a rapid and devastating decrease in numbers. The average workload for a full-time equivalent midwife would rise to 66 pregnancies per year by 2030. Conclusions The Midwifery Futures model demonstrated the sensitivity of the Australian midwifery workforce to a small change in attrition. Preventing midwives' exit from the workforce by improving their experiences in the workplace and increasing access to midwifery continuity roles would build workforce resilience. Minimising attrition, enhancing midwives' engagement, and matching student intake to attrition can assist in maintaining a robust Australian midwifery workforce.

Aim To explore the literature and determine what is known about midwifery students’ experiences with perinatal loss. Background Perinatal loss requires midwives to provide empathetic care that addresses the physical, emotional and psychological needs of women and their families. Despite its importance in education, limited exposure to perinatal loss care leaves many midwifery students and graduates underprepared to support grieving families. Design An integrative literature review was conducted, guided by the Whittemore and Knafl methodology. Methods A systematic search of CINAHL, Medline (OVID), Scopus and PubMed databases was conducted in January 2024. The full text of included studies was analysed and synthesised, with themes relevant to the study identified via meta-ethnography and narrative synthesis. Results Eight studies were included. Four themes emerged: 1) My early perinatal loss experiences were unexpected and disturbing, 2) My education was piecemeal, 3) I was left feeling anxious and ill-equipped to provide perinatal loss care, 4) As students, we need support. Conclusion This review examined midwifery students' experiences with perinatal loss, highlighting their theoretical and clinical unpreparedness and the dual role of registered midwives as knowledge conduits and gatekeepers. Further research involving registered midwives is essential to develop strategies that bridge the clinical experience gap for students in perinatal loss care.

BACKGROUND:The authority to prescribe medications has been extended to midwives in many countries. Understanding how midwifery prescribing is used, whether it is effective, and how it is regulated can inform the development of midwifery prescribing. AIM:To describe regulatory standards for midwifery prescribing in high-income English-speaking countries and identify insights from research regarding midwife prescribing. METHODS:A scoping review using the Joanna Briggs Institute methodology. Literature searches targeted 1. Grey literature relating to professional standards, regulations, and / or legislation regarding midwifery prescribing in selected high-income countries; 2. Peer-reviewed empirical research regarding midwifery prescribing. FINDINGS:In some jurisdictions, educational preparation for midwifery prescribing is completed in the primary midwifery degree, with all midwives having prescribing authority; in others, a separate course provides the entry point for a subset of the midwifery workforce. Models of midwifery prescribing have moved to more autonomous prescribing over time. Midwives used their prescribing authority in diverse ways. No research directly examined safety and effectiveness. However, approaches expected to produce safe and effective prescribing were demonstrated. Access to care was improved when independent midwifery prescribing was available. DISCUSSION:Midwifery prescribing is well embedded around the world but has not been as comprehensively evaluated as other forms of non-medical prescribing. Non-medical prescribing by other health professionals has expanded over time, with evidence of better outcomes compared to medical prescribing. Barriers to midwifery prescribing reflect those impacting other non-medical prescribers. CONCLUSION:Addressing barriers to midwifery prescribing offers an effective means to enhance maternity care provision.

Background: Women seeking a vaginal birth after a caesarean section (VBAC) frequently want to keep their subsequent labour and birth free from intervention. Water immersion (WI) during labour is potentially an effective tool for women having a VBAC for its natural pain-relieving properties. However, negotiating access to WI can be difficult, especially in the context of VBAC.Aim: To explore women's experiences of negotiating WI for labour and birth in the context of VBAC.Methodology: This Grounded Theory study followed Strauss and Corbin's framework and analytic process. Twenty-five women planning or using WI for their VBAC labour or birth were recruited from two midwifery practices and a social media group across Australia. Participants were interviewed during pregnancy and/or postnatally.Findings: 'Taking the reins', the core category explaining the women's experiences of assuming authority over their birth, comprised five categories: 'Robbed of my previous birth experience'; 'My eyes were opened'; 'Water is my tool for a successful VBAC'; 'Actioning my choices and rights for WI', and 'Empowered to take back control'. 'Wanting natural and normal' was the driving force behind women's desire to birth vaginally. Two mediating factors: Having someone in your corner and Rules for birth facilitated or hindered their birth choices, respectively.Conclusion: The women became active participants in their healthcare by seeking information and options to keep their birth experience natural and normal. Support from other women and advocacy in the form of con-tinuity of midwifery care was crucial in successfully negotiating WI for their VBAC when navigating the complex health system.

BACKGROUND:International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women's decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors.AIM:To examine impacts of policy and research texts on midwives' and obstetricians' work with labouring women related to intrapartum fetal monitoring decision-making.METHODS:We used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives' and obstetricians' work with the fetal monitoring system. Textual mapping was used to explain how midwives' and obstetricians' work was organised to happen the way it was.FINDINGS:CTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour.DISCUSSION AND CONCLUSION:Guidelines structured midwives' and obstetricians' work in a manner that undermined women's participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.

BACKGROUND:Just over 300,000 women give birth in Australia each year. It is important for health care providers, managers, and policy makers know what women want from their care so services can be provided appropriately. This review is a part of the Midwifery Futures Project, which aims to prepare the midwifery workforce to best address the needs of women. The aim of this review was to describe and analyse current literature on the maternity care needs of women in Australia.METHODS:A scoping review methodology was used, guided by the Joanna Briggs Institute framework. A systematic search of the literature identified 9023 studies, and 59 met inclusion criteria: being peer-reviewed research focusing on maternity care needs, conducted in Australian populations, from 2012 to 2023. The studies were analysed using inductive content analysis.RESULTS:Four themes were developed: Continuity of care, being seen and heard, being safe, and being enabled. Continuity of care, especially a desire for midwifery continuity of care, was the central theme, as it was a tool supporting women to be seen and heard, safe, and enabled.CONCLUSION:This review highlights that women in Australia consistently want access to midwifery continuity of care as an enabler for addressing their maternity care needs. Transforming Australian maternity care policy and service provision towards continuity would better meet women's needs.

BACKGROUND:The capacity for midwifery to improve maternity care is under-utilised. Midwives have expressed limits on their autonomy to provide quality care in relation to intrapartum fetal heart rate monitoring.AIM:To explore how the work of midwives and obstetricians was textually structured by policy documents related to intrapartum fetal heart rate monitoring.METHODS:Institutional Ethnography, a critical qualitative approach was used. Data were collected in an Australian hospital with a central fetal monitoring system. Midwives (n=34) and obstetricians (n=16) with experience working with the central fetal monitoring system were interviewed and observed. Policy documents were collected and analysed.FINDINGS:Midwives' work was strongly structured by policy documents that required escalation of care for any CTG abnormality. Prior to being able to escalate care, midwives were often interrupted by other clinicians uninvited entry into the room in response to the CTG seen at the central monitoring station. While the same collection of documents guided the work of both obstetricians and midwives, they generated the expectation that midwives must perform certain tasks while obstetricians may perform others. Midwifery work was textually invisible.DISCUSSION AND CONCLUSION:Our findings provide a concrete example of the way policy documents both reflect and generate power imbalances in maternity care. Obstetric ways of knowing and doing are reinforced within these documents and continue to diminish the visibility and autonomy of midwifery. Midwifery organisations are well placed to co-lead policy development and reform in collaboration with maternity consumer and obstetric organisations.

Background: Central fetal monitoring systems transmit cardiotocograph data to a central site in a maternity service. Despite a paucity of evidence of safety, the installation of central fetal monitoring systems is common. Aim: This qualitative research sought to explore whether, and how, clinicians modified their clinical safety related behaviours following the introduction of a central monitoring system. Methods: An Institutional Ethnographic enquiry was conducted at an Australian hospital where a central fetal monitoring system had been installed in 2016. Informants (n = 50) were midwifery and obstetric staff. Data collection consisted of interviews and observations that were analysed to understand whether and how clinicians modified their clinical safety related behaviours. Findings: The introduction of the central monitoring system was associated with clinical decision making without complete clinical information. Midwives' work was disrupted. Higher levels of anxiety were described for midwives and birthing women. Midwives reported higher rates of intervention in response to the visibility of the cardiotocograph at the central monitoring station. Midwives described a shift in focus away from the birthing woman towards documenting in the central monitoring system. Discussion: The introduction of central fetal monitoring prompted new behaviours among midwifery and obstetric staff that may potentially undermine clinical safety. Conclusion: This research raises concerns that central fetal monitoring systems may not promote safe intrapartum care. We argue that research examining the safety of central fetal monitoring systems is required. (c) 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:Technologies for fetal heart rate monitoring have been widely introduced despite evidence of no improvement in perinatal outcomes. A significant body of research has raised concerns that healthcare information technologies can have unintended consequences. We sought to describe an unintended consequence of central fetal monitoring technology.DESIGN:The research was conducted as an Institutional Ethnography. Data generated from interviews, focus groups, and observations were analysed to generate an account of midwives' experiences with the central fetal monitoring system.SETTING:The birthing unit of one Australian maternity service with a central fetal monitoring system.INFORMANTS:34 midwives and midwifery students who worked with the central fetal monitoring system.FINDINGS:Midwives described a disruptive social event they named being K2ed. Clinicians responded to perceived cardiotocograph abnormalities by entering the birth room despite the midwife not having requested assistance. Being K2ed disrupted midwives' clinical work and generated anxiety. Clinical communication was undermined, and midwives altered their clinical practice. Midwives performed additional documentation work to attempt to avoid being K2ed.KEY CONCLUSIONS:This is the first report of an unintended consequence relating to central fetal monitoring, demonstrating how central fetal monitoring technology potentially undermines safety by impacting on clinical and relational processes and outcomes in maternity care.IMPLICATIONS FOR PRACTICE:Current evidence does not support implementation or ongoing use of central fetal monitoring systems. Further research is needed to inform scaling down central fetal monitoring systems in a safe and supported way.

Clinical supervision is a strategy supporting nurses, midwives and other healthcare professionals in the provision of quality healthcare. Clinical supervision involves regular, protected time for reflection. Adequately prepared supervisors are essential, however there is limited knowledge about education/training programs and even less about those that are not discipline-specific. This paper 1) describes an eight-day foundational program, Clinical Supervision for Role Development Training as situated within the Spurr Supervisor Training Model and, 2) presents the results from routinely collected evaluation data. Simple descriptive analysis and latent content analysis were used to analyse data from 226 participants who filled out a self-administered questionnaire. Participants reported increased knowledge (87.5%), skills (87%) and confidence to apply the techniques learnt (85.5%); 95% found practice sessions to be useful, and expectations of the training had been met. Qualitative data supported the positive quantitative results. The program was positively assessed by participants, irrespective of professional discipline. The pragmatic nature of the training and the safe learning environment was considered important to the development of skills and confidence as a supervisor. A more robust evaluation process and prospective, longitudinal research is needed to better understand the expectations and learning experience of participants, and implementation in the healthcare environment.

Background: Efforts to resolve the longstanding and growing staffing crisis in midwifery in the United Kingdom have been hampered by very poor retention rates, with early career midwives the most likely to report burnout and intention to leave the profession. Aims: To establish the key, self-described factors of satisfaction and dissatisfaction at work for early career midwives in the United Kingdom, and suggest appropriate and effective retention strategies. Methods: Thematic analysis was undertaken on a subset of free text responses from midwives who had been qualified for five years or less, collected as part of the United Kingdom arm of the Work, Health and Emotional Lives of Midwives project. Findings: Midwives described feeling immense pressure caused by an unremittingly heavy workload and poor staffing. Where relationships with colleagues were strong, they were described as a protective factor against stress; conversely, negative working relationships compounded pressures. Despite the challenges, many of the midwives reported taking great pleasure in their work, describing it as a source of pride and self-esteem. Midwives valued being treated as individuals and having some control over their shift pattern and area of work. Discussion: These results, which reveal the strain on early career midwives, are consistent with the findings of other large studies on midwives' wellbeing. All available levers should be used to retain and motivate existing staff, and recruit new staff; in the meantime, considerable creativity and effort should be exercised to improve working conditions. Conclusion: This analysis provides a 'roadmap' for improving staff wellbeing and potentially retention. (C) 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Background: Little emphasis has been given to the standardised measurement of midwifery students' perceptions of their clinical learning experiences. Aim: To develop a tool that evaluates students' perceptions of their clinical learning experiences according to environment and impact of preceptors on professional development. Methods: A cross-sectional design was used. Tool development had three phases: item generation; expert review to assess clarity, apparent internal consistency and content validity; and psychometric testing. All Bachelor of Midwifery students at one university in Australia were invited to complete the online survey. Psychometric testing included dimensionality, internal consistency and test-retest reliability. Results: A 74% (n = 279) response rate was achieved. Factor analysis revealed the Clinical Learning Environment Scale and Impact of the Midwifery Preceptor Scale accounting for 53.6% and 71.5% of variance respectively. Both scales were reliable (Cronbach's alpha = .92 and .94) and valid. Overall, students positively rated the clinical learning environment and preceptors' abilities to foster their sense of identity as a midwife. Students were less satisfied with preceptors' understanding of the academic program. Discussion: The new tool consists of two scales that reliably measure midwifery students' perceptions of how the clinical learning environment develops their skills and reflects a midwifery philosophy. Preceptors had a positive influence on students' skills and professional development. Conclusions: The Midwifery Student Evaluation of Practice tool is the first valid and reliable measure of students' perceptions of their clinical learning experiences. Students' feedback provides valuable information to educators and preceptors on how best to optimise clinical learning. (C) 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Background: A clinical environment that provides meaningful and productive learning experiences is essential for students of all health care professions. To support the learning needs of undergraduate midwifery students and facilitate the continuity of care experiences a student led clinic was established in one South East Queensland maternity unit. Aim: This study explored the experiences and learning processes of previous and current midwifery students undertaking clinical practice within a student led clinic. Method: Qualitative descriptive. Ten students that elected to work in the midwifery student led clinic were invited to participate in a one off digitally recorded face to face or telephone interview. Thematic analysis was used to analyse the data set. University ethical approval was granted (NRS/17/15/HREC). Findings: Findings suggest the student led clinic positioned students in the 'driver's seat'. Overwhelmingly students described the clinic as providing them with an array of opportunities to 'lead' care rather than being forced to 'sit and watch'. Students believed the experience of working in the clinic increased their midwifery knowledge, skills, confidence, critical thinking, and the ability to advocate for and empower women. Conclusion: High quality and supportive clinical teaching and learning experiences are vital for ensuring the student midwife develops into a competent practitioner who is fit for registration. The evidence from this small study highlights the benefits afforded to students of working in partnership not only with pregnant women but also with their university midwifery lecturer. The student's continuity of care learning experiences appeared to foster and cultivate their capability, identity, purpose, resourcefulness and connection; all the five senses of success. (C) 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Background: There is growing body of evidence that suggests many midwives are unhappy and as a result are making decisions to leave the profession. Aim: Determine the incidence of midwives indicating their intention to leave the profession and explore the reasons for this decision including what might cause midwives to be dissatisfied. Method: Data analysed was collected as part of the Australian arm of the Work, Health and Emotional Life of Midwives (WHELM) project. Descriptive statistics and latent content analysis was used to analysis the data set. Results: Almost half (42.8%, n = 443/1037) the midwives had considered leaving the profession in the preceding six months. The qualitative and quantitative data aligned with 'dissatisfaction with the organisation of midwifery care' and/or 'dissatisfaction with my role as a midwife' being the two commonest reasons behind the intention to leave. Early career midwives were most likely to consider leaving the profession (p=.05) due to dissatisfaction with their role. Almost half the midwives who had considered leaving the profession were most dissatisfied with managers (p = <.001). Conclusion: Midwives felt their ability to provide quality maternity care was constrained by a fragmented medicalised system that did not work for the women in their care or themselves. The results of this study add to a growing call for policy makers and health careproviders toreorientate maternity services to enable women to build positive longitudinal relationships with midwives. Not only will this improve maternal and neonatal outcomes but provide a satisfying and sustainable way for working for midwives. (C) 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.