A national survey of Australian midwives’ birth choices and outcomes

Published:August 01, 2022DOI:



      Maternity care in Australia is predominantly provided by midwives, many who give birth. There is a paucity of research on midwives’ own childbearing preferences and experiences.


      To explore midwives childbirth preferences and outcomes when giving birth to their first child in Australia, after qualifying as a midwife.


      An online national survey. Data were analysed using descriptive statistics.


      447 midwives responded, with the majority of midwives indicating a preference for a normal vaginal birth with a known care provider under a continuity of midwifery care model. For midwives who were first time mothers, 66% had normal vaginal births, 16.3% had an instrumental birth, and 16.8% had caesarean births. Over 85% of midwives received the model of care they wanted and 45% had continuity of midwifery care. While a quarter of midwives wanted a homebirth,11.2% achieved this. Over three quarters (75.4%) of midwives were cared for by a care provider of their choosing.


      There was a difference in models of care accessed and birth outcomes between midwives and other women giving birth for the first-time in Australia. Australian midwives appear to have the advantage of clinical and scientific knowledge to navigate the maternity care system to get the birth care and outcomes they want.


      It is possible that professional experience, insider knowledge, and existing relationships with other midwifery friends and colleagues, affords midwives a higher degree of agency and autonomy when it comes to getting the maternity care and birth outcomes that they want.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yuill C.
        • McCourt C.
        • Cheyne H.
        • Leister N.
        Women's experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research.
        BMC Pregnancy Childbirth. 2020; 20: 343
        • Coates D.
        • Thirukumar P.
        • Spear V.
        • Brown G.
        • Henry A.
        What are women's mode of birth preferences and why? A systematic scoping review.
        Women Birth. 2020; 33: 323-333
        • McKinnon L.
        • Prosser S.
        • Miller Y.
        What women want: qualitative analysis of consumer evaluations of maternity care in Queensland, Australia.
        BMC Pregnancy Childbirth. 2014; 14: 1-14
        • Perriman N.
        • Davis D.L.
        • Ferguson S.
        What women value in the midwifery continuity of care model: A systematic review with meta-synthesis.
        Midwifery. 2018; 62: 220-229
      1. Australian Government Department of Health, Department of Health Australia’s Future Health Workforce Report – Midwives. In: Government A, editor. Australia, 2019.

        • Sullivan K.
        • Lock L.
        • Homer C.S.E.
        Factors that contribute to midwives staying in midwifery: A study in one area health service in New South Wales, Australia.
        Midwifery. 2011; 27: 331-335
        • Madden K.L.
        • Turnbull D.
        • Cyna A.M.
        • Adelson P.
        • Wilkinson C.
        Pain relief for childbirth: The preferences of pregnant women, midwives and obstetricians.
        Women Birth. 2013; 26: 33-40
        • Dickson M.J.
        • Willett M.
        Midwives would prefer a vaginal delivery.
        BMJ: Br. Med. J. 1999; 319: 1008
        • Turner C.
        • Young J.
        • Solomon M.
        • Ludlow J.
        • Benness C.
        • Phipps H.
        Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians.
        BJOG: Int. J. Obstet. Gynaecol. 2008; 115: 1494-1502
        • Church S.
        Midwives’ personal experiences of pregnancy and childbirth: Exploring issues of autonomy and agency in relation to the use of professional knowledge.
        Hum. Fertil. 2014; 17: 231-235
        • Redwood T.
        Exploring changes in practice: when midwives and nurses become mothers. British Journal of Midwifery.
        . 2008; 16: 34-38
        • Simpson M.
        • Schmied V.
        • Dickson C.
        • Dahlen H.G.
        Postnatal post-traumatic stress: An integrative review.
        Women Birth. 2018; 31: 367-379
        • Toohill J.
        • Fenwick J.
        • Sidebotham M.
        • Gamble J.
        • Creedy D.K.
        Trauma and fear in Australian midwives.
        Women Birth. 2019; 32: 64-71
        • Leinweber J.
        • Creedy D.K.
        • Rowe H.
        • Gamble J.
        A socioecological model of posttraumatic stress among Australian midwives.
        Midwifery. 2017; 45: 7-13
        • Battersby S.
        Midwives embodied knowledge of breastfeeding.
        MIDIRS Midwifery Dig. 2002; 12: 523-526
        • Hinsliff S.
        • Fielder A.
        Midwives as mothers, mothers as midwives.
        Essent. Midirs. 2011; 2: 17-21
        • Jackson M.
        • Dahlen H.
        • Schmied V.
        Birthing outside the system: Perceptions of risk amongst Australian women who have freebirths and high risk homebirths.
        Midwifery. 2012; 28: 561-567
        • McMulkin S.
        • Malone R.
        Breastfeeding-midwives’ personal experiences.
        Mod. Midwife. 1994; 4: 10-12
        • Berkley A.
        A reflection on a home birth: thoughts of a midwife becoming a mother.
        Midwifery Matters. 2002; 94: 4-6
        • Burlow T.
        A Midwife to Myself. AIMS.
        Journal. 1999; 11: 16-18
        • Constable C.
        Switching off the 'Midwife.'.
        Midwifery Matters. 2011; 130: 15-16
        • Cooke H.
        A better midwife?.
        Pract. Midwife. 2010; 13: 62
        • Duggan J.
        Professional: how will it change your practice?.
        Mod. Midwife. 1997; 7: 23-26
        • Hinsliff S.
        Torn in two: birth decisions after a third degree tear.
        Essent. Midirs. 2010; 1: 47-49
        • Jennings C.
        Midwife as mother, midwife as client.
        Midwifery Matters. 2005; 106: 18-21
        • Knapp E.
        Midwifery Today Int Midwife. 2013; 107: 59-60
        • Lee-Ribas K.
        Face to face: a midwife’s birth story.
        Midwifery Today Int. Midwife. 2008; 85: 26-27
        • Moes D.
        Giving birth: a midwife’s faith in birth is reborn.
        Midwifery Today Int. Midwife. 2004; 76: 30-31
        • Neiger D.
        Choices and changes.
        Midwifery Matters. 2004; 102: 13-15
        • South L.-M.
        Birthing Instincts or a Midwife's Intuition?.
        Midwifery Matters. 2016; 148: 13-15
        • Tennant S.J.
        Never the same again.
        Midwives Chron. 1982; 95: 438-439
        • Wilde E.
        Only connect.
        Midwifery Matters. 2004; 103
        • Watson K.
        • White C.
        • Hall H.
        • Hewitt A.
        Women’s experiences of birth trauma: A scoping review.
        Women Birth. 2021; 34: 417-424
        • Simpson M.
        • Catling C.
        Understanding psychological traumatic birth experiences: A literature review.
        Women birth: J. Aust. Coll. Midwives. 2016; 29: 203-207
      2. Hill E., Firth, A. Positive birth experiences: a systematic review of the lived experience from a birthing person’s perspective, 2018.

        • Sassine H.
        • Burns E.
        • Ormsby S.
        • Dahlen H.G.
        Why do women choose homebirth in Australia? A national survey.
        Women Birth. 2020;
        • Vedam S.
        • Stoll K.
        • Martin K.
        • Rubashkin N.
        • Partridge S.
        • Thordarson D.
        • et al.
        The Mother’s Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care.
        PloS One. 2017; 12 (e0171804-e)
        • Vedam S.
        • Stoll K.
        • Rubashkin N.
        • Martin K.
        • Miller-Vedam Z.
        • Hayes-Klein H.
        • et al.
        The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth.
        SSM - population health. 3. 2017: 201-210 (C)
        • Dencker A.
        • Taft C.
        • Bergqvist L.
        • Lilja H.
        • Berg M.
        Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument.
        BMC Pregnancy Childbirth. 2010; 10: 1-8
      3. Qualtrics. Provo, Utah, USA: Qualtrics; 2020.

      4. Midwives ACo, 2021. [Available from: 〈〉.

      5. StataCorp. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC; 2021.

        • Janczyk P.
        • Gwoździańska S.
        • Ostrogórska P.
        • Humaj-Grysztar M.
        • Nawrot J.
        • Matuszyk D.
        Preferences regarding the mode of delivery in occupational groups of nurses and midwives.
        Probl. Pielęgniarstwa. 2019; 27: 149-154
        • Sahlin M.
        • Andolf E.
        • Edman G.
        • Wiklund I.
        Mode of delivery among Swedish midwives and obstetricians and their attitudes towards caesarean section. Sexual & Reproductive.
        Healthcare. 2017; 11: 112-116
        • Ouyang Y.Q.
        • Zhang Q.
        A study on personal mode of delivery among Chinese obstetrician-gynecologists, midwives and nurses.
        Arch. Gynecol. Obstet. 2012; 287: 37-41
      6. Australian Institue of Health and Welfare. Australia's mother's and babies. Canberra: AIHW; 2021.

      7. Australian Institute of Health and Welfare. Australia’s mothers and babies 2000. In: National Perinatal Statistics Unit, editor. Canberra: AIHW National Perinatal Statistics Unit; 2000.

      8. Li Z.Z.R., Hilder L. & Sullivan E.A.; Australia’s mothers and babies 2010. In: AIHW National Perinatal Epidemiology and Statistics Unit, editor. Canberra: Australian Institute of Health and Welfare; 2012.

        • Lehmann S.
        • Børdahl P.E.
        • Rasmussen S.A.
        • Irgens L.M.
        Norwegian midwives and doctors have increased cesarean section rates.
        Acta Obstet. Gynecol. Scand. 2007; 86: 1087-1089
        • Cluett E.
        • Burns E.
        • Cuthbert A.
        Immersion in water during labour and birth.
        Cochrane Database Syst. Rev. 2018;
      9. Dahlen HGe, Kumar-Hazard Be, Schmied Ve, Taylor, Francis. Birthing outside the system: the canary in the coal mine: Abingdon, Oxon New York, NY: Routledge, an imprint of the Taylor & Francis Group, 2020.; 2020.

      10. Australian Institute of Health and Welfare. Maternity care in Australia: first national report on models of care, 2021 Australian Government 2021.

        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife‐led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016;
        • Davison C.
        • Hauck Y.L.
        • Bayes S.J.
        • Kuliukas L.J.
        • Wood J.
        The relationship is everything: Women’s reasons for choosing a privately practising midwife in Western Australia.
        Midwifery. 2015; 31: 772
      11. Nursing and Midwifery Board of Australia, Code of Professional Conduct for Nurses in Australia. Melbourne, Victoria, 2018.