Advocacy, Leadership

Enablers of Strong Midwifery Leadership: An International Appreciative Inquiry – Part 2 

3 July 2024

By Dr Sally Pezaro 

The World Health Organization has a bold vision: to empower health and academic leaders around the globe. Strengthening midwifery leadership is a critical piece of this puzzle, with the potential to dramatically reduce preventable deaths and complications in childbearing. High-quality, midwife-led care can significantly improve perinatal outcomes worldwide. Yet despite its potential, investment in midwifery leadership remains low. Strong leadership in healthcare leads to happier, more satisfied staff and fosters a culture of safety. Conversely, weak leadership in midwifery has been linked to a range of negative outcomes. Considering the above, an international midwifery led research team conducted a global appreciative inquiry in which they identified 10 characteristics of the strong midwifery leader as follows:  

  1. Mediator 
  2. Dedicated to the profession 
  3. Evidence-based practitioner  
  4. Effective decision maker 
  5. Role model 
  6. Advocate 
  7. Visionary 
  8. Resilient 
  9. Empathetic 
  10. Compassionate 

This appreciative inquiry also identified the enablers of strong midwifery leadership from the perspective of midwives themselves. Perspectives were offered from 211 midwives and 218 nurse-midwives from a total of 76 countries, predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. Findings point to seven tangible ways in which such strong midwifery leadership may be enabled from a global perspective. 

Clear professional identity: Whilst a clear professional identity was seen as being key to enabling strong midwifery leadership, there was a difference of opinion among midwives. Some deemed a complete separation from nursing to be necessary, while others advocated for equal standing within the nursing profession. Regardless, a strong call emerged for empowering leadership at all levels. 

Increased societal value placed upon midwifery: Midwife participants envisioned a world where society, governments, and healthcare systems recognize the immense value midwifery brings. They asserted that this recognition would unlock the potential for strong midwifery leadership to flourish and be sustained on a global scale. Such societal value may be achieved via the public instantiation of midwives and the dismantling of patriarchy. 

Ongoing research: Participants highlighted the importance of research in strengthening midwifery leadership. Participants called for dedicated research centres focused on the midwifery workforce and encouraged midwives themselves to actively conduct and share their research findings globally. This focus on research, they believe, will not only empower midwives as leaders but also elevate the overall societal value placed on the profession. As one participant said, “Fostering innovation and improving on evidence-based practice will help raise the profile of midwifery.” 

Professional development in leadership: Strong leadership within the profession may be fostered through ongoing development opportunities. Participants emphasized the need for specialized leadership training to equip midwives with the necessary skills for this. Scholarships were also seen as a way to make this training more accessible. One participant suggested integrating leadership and management skills more directly into university midwifery programs. 

Interprofessional collaboration: It will be important to build collaborations in strengthening midwifery leadership. Participants emphasized the need for strategic partnerships, both within the midwifery profession and across healthcare disciplines. Collaborative working was perceived to bring about meaningful and sustainable change. There was also a call for all healthcare professionals to work together to improve the health and well-being of families around the world. 

Succession planning: Participants highlighted the importance of planning for the future of midwifery leadership. There is a clear need for succession planning and pathways for midwives to reach leadership roles. There must be a focus on cultivating future midwifery leaders, though challenges may arise where leaders leave before their initiatives take root. By creating clear paths to leadership, participants considered that this issue may be addressed, and strong leadership sustained. 

Self-efficacy:  Many midwives have the potential to be strong leaders, but some may lack the confidence to step into those roles. A strong midwifery leader doesn’t necessarily have to be working in a leadership role, but some given leadership roles are simply observed to accept the current situation without thinking about how they can improve it. Midwives can speak up with authority and act as leaders, even when they do not have a formal leadership title. Midwives owning their value is also important. Midwives must value themselves, and each other in order to thrive.  

Of course, every midwifery leader will be influenced by their context and constrained somewhat by the systems and hierarchies in which they are working. One challenge to the development and enablement of strong midwifery leadership is a lack of formal structures for leadership training. We need clear pathways for midwives to develop the skills and experience they need to become effective leaders. This could involve postgraduate programs, mentorship opportunities, or designated leadership roles within healthcare organizations.  

Another hurdle is professional silos. Strong leaders need to collaborate effectively across disciplines. Addressing siloed thinking will require the creation of cultures of teamwork and collaborative working toward shared goals. 

Finally, succession planning is crucial. Strong leadership is more sustainable when there’s a clear path for future leaders to emerge. 

Midwives don’t have to wait for a promotion to make a difference. The characteristics of strong midwifery leadership identified in this research can be practised by every midwife. By embodying these qualities and advocating for your vision, you can be a strong leader in your own right and inspire others to do the same. 

However, it’s important to remember that popularity doesn’t always equal effectiveness. Leaders who prioritize what’s well-liked over what’s actually beneficial can make poor decisions. Similarly, even if midwives desire certain leader traits, those desires can be swayed by actions that contradict those values. For example, someone might follow a leader who lacks integrity simply because it aligns with their own goals. 

Ultimately, the leaders we get reflect the choices we make. As a profession, midwives have the power to choose leaders who demonstrate the characteristics they aspire to (rather than those who lead by bullying and/or dictatorial styles for example). So, the focus now is on empowering the “right” kind of strong midwifery leaders, providing them with the necessary skills and resources, and fostering a restorative and compassionate environment in which all midwives can thrive. By doing this, midwives can unlock their full potential in leadership worldwide. The best is yet to come. 

Read the first part of this series