Exploring midwifery role and scope in acute early pregnancy care: a survey of midwives and midwifery students in Australia

TL;DR

This study explores how midwives in Australia can better support women with urgent pregnancy complications under 20 weeks, finding that midwives are often not involved due to system and training gaps.

Contribution

The study identifies gaps in midwifery education and service models for acute early pregnancy care in Australia.

Findings

Midwives and students believe midwives should provide acute early pregnancy care but face challenges like limited clinical exposure.

Emergency departments and early pregnancy assessment services are common settings for this care, but midwives are not always employed there.

Current education programs may not prepare midwives adequately for acute early pregnancy complications.

Abstract

The scope of practice of the contemporary midwife encompasses a range of sexual and reproductive healthcare, including care throughout pregnancy. Midwives are experts in pregnancy care, but many do not provide care for women with unexpected (acute) complications in early pregnancy (< 20 weeks) in Australia. Women experiencing acute pregnancy complications < 20 weeks usually attend an emergency department rather than a maternity unit. These settings do not typically employ midwives and may not meet women’s need for timely and informed physical care and psychosocial support. A gap in evidence exists in relation to the role and scope of practice of the midwife in acute early pregnancy care provision in Australia.

Midwives and midwifery students in Australia were purposively sampled and invited to complete an online cross-sectional survey exploring midwifery practice in acute early pregnancy care. Data were collected from July 1st to September 30th, 2024. Quantitative data were analysed using descriptive and inferential statistics. Free-text responses were analysed using inductive content analysis.

Responses from 294 midwives and 46 midwifery students (n = 340) were analysed. Participants recognised that midwives should provide acute care in early pregnancy, and many had knowledge, confidence or experience in this area. The most reported setting for acute early pregnancy care provision was the general emergency department; early pregnancy assessment service models were also common. Some settings prioritised the employment of registered nurses over midwives in acute early pregnancy services. Challenges to midwives providing acute early pregnancy care included inadequate clinical exposure as qualified midwives, and women being placed in non-maternity settings.

Participants supported midwives providing acute care in early pregnancy, confirming that midwives’ professional scope should not be impacted by pregnancy gestation or outcome. However, current midwifery education programs may not be adequately preparing midwives to provide comprehensive care for women with acute early pregnancy complications. Those midwives who are providing care may not be fulfilling professional scope. Findings have utility in supporting policy, education and service review, and highlight further gaps in evidence for future research.

The online version contains supplementary material available at 10.1186/s12884-025-07567-3.

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