Characteristics of Strong Midwifery Leaders: An International Appreciative Inquiry 

By Dr Sally Pezaro 

The World Health Organization’s Global strategic directions for 2021-2025 includes the strengthening of leadership throughout health and academic systems. The strengthening of Midwifery leadership is a particular priority in pursuit of reduced perinatal morbidities and mortalities. Indeed, evidence shows that high-quality, midwife-led care can significantly reduce preventable perinatal injuries and deaths worldwide. Yet the provision of such care requires strong midwifery leadership, and despite its potential, investment in midwifery leadership has been low. Alongside reductions in poor perinatal outcomes, studies demonstrate that strong leadership in healthcare leads to increased staff satisfaction, and improved safety cultures. Conversely, weak leadership in midwifery has been linked to a range of negative outcomes.  A key barrier is the lack of a clear definition of what “strong” leadership looks like in this context. Driven by the above, a midwifery-led international team of researchers set out to conduct an international appreciative inquiry. In this two-part series we explore their findings in relation to 1) characteristics of strong midwifery leaders and 2) enablers of strong midwifery leadership. 

The project was launched via an international Nursing Now Challenge webinar held with a global online audience of 146 midwives and nurse-midwives joining from 46 countries including Argentina, Jamaica, Kenya, Guinea, Spain, Italy, Slovenia, Mexico, Ghana, Brazil, Trinidad and Tobago, Albania, Denmark, Russia, Qatar, Ethiopia, United Kingdom (UK), United States of America (USA), Poland, Nigeria, Uganda, Saudi Arabia, Jordan, Pakistan, Japan, UAE, Grenada, Somalia, Colombia, India, Korea, Egypt, Nepal, Tanzania, Bahamas, South Africa, Taiwan, Indonesia, Kuwait, Sudan, Malaysia, Philippines, Botswana, and Lesotho. Three follow up webinars were held throughout the data collection period to maximise recruitment efforts and maintain global engagement. Overall, 429 participants (211 midwives and 218 nurse-midwives) from a total of 76 countries offered their perspectives. We are grateful to all who took part. 

Ten characteristics of strong midwifery leaders were identified from the data. These are presented below and can be linked to transformational, situational and servant leadership theories along with collaborative, authentic, and compassionate leadership styles.  

The strong midwife leader is… 

• Mediator: Participants identified that the strong midwifery leader must be able to engage in effective conflict resolution with fairness and impartiality. The strong leader does this with the use of respectful and effective communication skills.  
• Dedicated to the profession: Love for and dedication to the midwifery profession was seen as an essential characteristic of the strong midwifery leader. Yet whilst selflessness in giving themselves to the profession was also a notable characteristic observed in the strong midwifery leader, it is also important to remember that an overly strong professional identity can be unhealthy. 
• Evidence-based practitioner: Midwives see strong midwifery leaders as those who are constantly learning and improving. This involves research, applying evidence to practice, and being well-rounded across different areas of midwifery, from teaching, research, and academia to clinical work. These strong leaders are also described as eager to learn more and improve outcomes for both patients and staff.  
• Effective decision maker: Effective decision-making is a key characteristic of the strong midwifery leader. This includes being able to remain calm and collected under pressure, thinking critically, and involving the team throughout. Strong midwifery leaders also ensure that they have a broad range of knowledge and skills to inform their choices. 
• Role model: Strong Midwifery leaders are seen as role models. They are professional, inspiring, and exemplify who midwives aspire to be. They work collaboratively with their teams rather than acting in a dictatorial way. Moreover, they embody honesty, integrity, and a positive attitude. 
• Advocate: Strong midwifery leaders are advocates, both for the midwifery profession itself and for those they care for. These leaders fight for what is right and empower others to succeed along the way. 
• Visionary: Being a visionary and proactive are key characteristics of the strong midwifery leader. These leaders are described as visionaries who can plan, implement, and champion changes that improve perinatal healthcare. They take initiative, innovate, and aren’t afraid to challenge the status quo or find new solutions. 
• Resilient: Whilst we must acknowledge concerns that “resilience” can be misused to pressure healthcare workers, strong midwifery leaders must be able to cope with problems, setbacks, and challenges. This includes learning from mistakes, building a strong support network through mentors and colleagues, and prioritizing self-care.  
• Empathetic: Empathy is a key characteristic in strong midwifery leaders. These leaders understand and share the feelings of their colleagues (peers) and those they care for. They actively listen to everyone on their team and show respect for their opinions and value their well-being. 
• Compassionate: Midwives view strong midwifery leaders as being deeply compassionate. These leaders are seen as friendly, understanding, and sensitive to the emotional, social, and cultural needs of those around them. This compassion fosters a safe and supportive work environment. They understand positive workplace cultures as being essential for midwives’ empowerment. Strong midwifery leaders are approachable and kind. They prioritize the well-being of their staff in a genuine way. 

These characteristics may well not be exhaustive. Yet they offer a framework to guide the cultivation the strong midwifery leaders the profession urgently needs from the perspective of midwifery followers. The International Confederation of Midwives (ICM) has been facilitating leadership development for young midwives for over a decade through the Young Midwifery Leaders (YML) programme. Indeed, the ICM recognises that such investments may strengthen the profession for the future. These findings offer important insights to this pursuit and provide all midwives with an opportunity to reflect upon their own leadership behaviours and qualities in everyday practice, fostering an environment where everyone can flourish. 

Presently, the ICM are developing a wider leadership plan which will encompass midwives of all ages and settings. These international findings may inform future endeavours of this kind as they somewhat echo those presented on national, regional, and local levels, and thus so go some way toward providing a global perspective on strong midwifery leadership. The best of midwifery leadership is yet to come.