Asia-Pacific psychiatry : official journal of the Pacific Rim College of PsychiatristsLucy Charlotte Broughton, Natalie Hughes, Jiaxu Zeng, Alesha Smith
PURPOSE: Perinatal mood disorders are associated with adverse maternal and neonatal outcomes and affect 15%-20% of pregnant people. Guidelines recommend SSRIs when non-pharmacological therapies are ineffective, yet antenatal depression remains undertreated. This study aimed to assess the attitudes, knowledge, and practices of general practitioners (GPs) and midwives on SSRI use in pregnancy. METHODS: A knowledge, attitudes, and practice survey was developed in QualtricsXM and distributed to New Zealand-registered GPs and midwives between May 2023 and October 2024 using convenience sampling. RESULTS: Responses from 119 GPs and 62 midwives were analyzed. Discomfort managing antenatal depression was reported by 11% of GPs and 36% of midwives. Knowledge of SSRI risks in pregnancy varied among respondents. Average concern regarding the use of SSRIs in pregnancy and the risk of adverse outcomes was low, but there was considerable variation. In the case vignette, recommended actions differed: 53% advised maintaining treatment, 13% suggested dose reduction, and 24% recommended switching antidepressants. Patient counseling was limited, and appropriate written patient information was rarely provided. CONCLUSIONS: This study highlights variability in knowledge, attitudes, and practices among GP's and midwives regarding SSRIs during pregnancy. Further training, improved access to patient information, and decision aids could enhance patient-centered care and ensure pregnant people receive balanced, evidence-based guidance on SSRI use.
International nursing reviewBarry McBrien, Frances O' Brien, Shobha Rani Shetty, Sinead Keogh, Jessica Eustace-Cook, Gobnait Byrne
AIM: To map the available evidence on the assessment of migrant nurse and midwife workplace integration in global healthcare settings. BACKGROUND: Globally, migrant nurses and midwives are important resources in mitigating workforce shortages. Existing evidence focuses on the orientation stages of migrant nurse and midwife transition into the healthcare setting rather than their long-term workplace integration. DESIGN/METHODS: The nine databases searched were CINAHL, Medline, Web of Science, Embase, PsycINFO, ASSIA, SicELO, Maternity & Infant Care and Global Index Medicus. An initial search was performed in December 2021 and updated in December 2025. RESULTS: A total of 91 articles were included, comprising qualitative (n = 48), quantitative (n = 13), mixed-methods (n = 6), others (n = 23) and one book chapter. Multiple definitions of workplace integration were found, and 23 tools were identified. CONCLUSIONS: Workplace integration, a multidimensional, time-dependent process, requires collaboration among stakeholders. A standard definition will help to clarify their responsibilities. Key factors ensuring successful integration include promoting effective communication, supporting knowledge advancement, facilitating career development and skill utilisation. The development of standardised interventions with flexibility for local adaptation will support successful workplace integration. IMPLICATIONS FOR NURSING/HEALTH POLICY: Findings highlight the need for policy developers to support migrant nurses and midwives with interventions focused on linguistic challenges, cultural competence and differing care models, that are key to successful integration. Future research must include host stakeholders' perspectives to fully understand the dynamics of workplace integration.
Health services researchE Brie Thumm, Amy H Goh, Elizabeth G Phillips, Zachary Giano
OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce. STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who maintained certification but reported not working in the discipline of midwifery (n = 1994) to understand why individuals left the workforce and the likelihood of returning. Data were analyzed with ANOVAs, chi-squares, t-tests, and thematic analysis. DATA SOURCES AND ANALYTIC SAMPLE: Administrative data from the American Midwifery Certification Board (n = 9704) and an online survey from a national sample of currently and previously certified nurse-midwives and certified midwives who had left the workforce (n = 646; response rate of 33.8%). PRINCIPAL FINDINGS: The most endorsed reasons for leaving were work-life balance (50.3%, n = 325), unsupportive work environment (34.7%, n = 224), and schedule (32.0%, n = 207). Participants from restrictive regulation states reported lack of opportunities for career advancement, state-level regulation restricting ability to practice, and lack of employment opportunities at higher rates. Respondents of color more frequently reported inadequate compensation, lack of opportunity for advancement, and workplace discrimination at higher rates. Themes included barriers to re-entry to practice and compensation. CONCLUSIONS: Work-life balance and work environment drive midwifery workforce attrition. Individuals of color and those living in states with restrictive regulation face unique challenges. Challenges re-entering the workforce after leaving create barriers to remaining in the workforce, especially with inequitable compensation.
MedicineNuray Kurt, Osman Tayyar Çelik, Esra Sabanci Baransel, Tuba Uçar
INTRODUCTION: Midwifery, which used to be practiced with knowledge passed down from generation to generation, has now gained a professional identity through education. This study examines global trends in midwifery education research using bibliometric methods. METHODS: In the study, we analyzed 1029 studies published in the Web of Science database on midwifery education between 1993-2023. Bibliometric and visualization analyses revealed the general structure of the literature by determining important trends, thematic research areas, the most influential publications, journals, and countries in midwifery education. RESULTS: According to the results of the analysis, studies on midwifery education have increased significantly in recent years. The increase in publications appears to coincide with the growing prominence of topics such as digitalization, simulation-based learning, and distance education in the literature. Australia stands out as one of the most influential and productive countries in the field of midwifery education. In addition, the continuing care model and simulation-based learning in midwifery were among the most frequently studied topics. DISCUSSION: The study identifies research trends, priority research areas, and areas for development in midwifery education. The findings provide important insights for the development of midwifery education programs, the support of policymakers' decision-making processes, and the identification of future research priorities.
BMC medical educationKatharina Averdunk, Nikoloz Gambashidze, Angela Klein, Matthias Weigl
BACKGROUND: Interprofessional collaboration is fundamental to high-quality and safe care - particularly in perinatal care. Interprofessional education (IPE) for students in healthcare professions has significant potential for enhancing interprofessional competencies and patient safety. However, current evidence on effectiveness of IPE is limited, particularly due to various methodological constraints in evaluation studies such as a lack of prospective data, structured outcome measures, and student involvement. METHODS: In our project SiGerinn, students from nursing, midwifery, and medicine received IPE on patient safety. We employed a prospective, multi-method evaluation study over a two-year implementation period. Structured surveys on self-reported competency levels among program participants were collected at baseline and follow-up, complemented by in-depth interviews with stakeholders to assess the project's implementation status. RESULTS: Prospective statistical analyses revealed highly significant improvements in competency levels for interprofessional collaboration, communication with patients and relatives, and interprofessional communication techniques. Competency gains varied across student groups, being highest among midwifery students. Moreover, survey and interview statements revealed strong acceptance and perceived benefits from the IPE patient safety intervention. Interview findings further emphasised the uptake of a disseminating role among participating students by peer knowledge sharing. CONCLUSION: Our results show positive effects on skill development and encouragement through an IPE intervention on patient safety in perinatal care. Despite several methodological limitations such as small sample sizes, consensus-based outcome measures, and self-reported skill level assessments, our findings provide a starting point for future IPE attempts on patient safety education in clinical settings. Furthermore, obtained insights suggest the value of integrating IPE into health professionals' curricula to initiate sustainable learning.
British journal of nursing (Mark Allen Publishing)Sinead O'Neill
BACKGROUND: The Nursing and Midwifery Council (NMC) updated the nursing and midwifery preregistration proficiencies in 2018 and 2019 respectively, and both contain requirements for safe staffing principles to be taught and assessed through academia and clinical placements of BSc degree programmes. AIM: To ascertain how higher educational institutions (HEIs) are preparing the 'future nurses' and 'future midwives' in terms of adequate knowledge on the principles of safer staffing, in line with four specific NMC proficiencies, ahead of entering the NMC register. METHODS: A Freedom of Information request was made to 21 HEIs, complemented with an online survey of undergraduate preregistration students from five HEIs in England, to determine the level of safer staffing principles within the current curriculum. FINDINGS: Reliance on clinical placements to support attainment of safer staffing knowledge was noted, with variation in curriculum content, acquisition of knowledge and assessment methods across HEIs; 86% of students declared that NMC proficiency 7.12, related to business case planning, was addressed the least. CONCLUSION: Implementing bespoke simulation learning, use of Chief Nursing Officer Safer Staffing Fellows, and integrating 'Fundamentals of Safer Staffing' e-learning will strengthen safer staffing knowledge related to four NMC proficiencies across HEIs and healthcare settings for future generations of nurses, midwives, practice and academic educators.
BMC health services researchMasumeh Ghazanfarpour, Hadis SHahrahmani, Sara Najibi, Zahra Saedi, Katayon Alidoosti, Farzaneh Ashrafinia, Nasim SHahrahmani, Firoozeh Mirzaee
BACKGROUND: The rate of cesarean delivery in Iran has increased substantially in recent decades, exceeding World Health Organization recommendations and influenced by multiple individual and systemic factors. This study explored factors influencing nonclinical cesarean section from the perspectives of healthcare providers in southeast Iran. METHODS: This qualitative study used a conventional content analysis approach and included 16 participants (nine midwives and seven obstetricians). Data were analyzed using Krippendorff's analytical framework and managed with MAXQDA software. RESULTS: The main theme identified was cultural, legal, educational, health system and economic influences on the choice of delivery method. Eleven subthemes were grouped into four interrelated domains: sociocultural and informational factors, health system and professional influences, legal and policy contexts, and educational and economic determinants. CONCLUSIONS: Nonclinical cesarean section is a multidimensional phenomenon; therefore, multifaceted interventions at individual, professional, and policy levels are required to reduce its prevalence.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansYing Guo, ZhiYun Zhang, YanHua Zhang, JiMei Cong, Li Li, Wei Yi, Min Chang
OBJECTIVE: To evaluate the association between integrated midwife-led continuous labor support with postpartum care and maternal and neonatal outcomes, psychological resilience, and labor pain in primiparous women. METHODS: Medical records of 150 nulliparous women who delivered at Beijing Ditan Hospital between October 2023 and July 2025 were retrospectively reviewed. The observation group received continuous midwife-led support during labor with extended postpartum care, while the control group received standard obstetric care. Outcomes were assessed using the Labor and Delivery Efficiency and Quality Index (LBDI), Connor-Davidson Resilience Scale (CD-RISC), Delivery Pain Assessment System (DPAS), and Pain Tolerance-Recovery Response Index (PTRR). Relevant clinical data were analyzed to explore associated factors. Data were analyzed using SPSS 26.0 and AMOS 24.0. RESULTS: Compared with the control group, the observation group showed higher composite LBDI scores (8.43 ± 0.57 vs. 7.77 ± 0.65, p < 0.001, Cohen's d = 1.09), higher spontaneous vaginal delivery rates (95% vs. 76%, p < 0.001), and higher 5-minute Apgar scores (9.4 ± 0.4 vs. 8.8 ± 0.6, p < 0.001), along with reduced postpartum hemorrhage and lower incidence of fetal distress (all p < 0.05). Psychological resilience and labor pain responses were better in the observation group (p < 0.05). CONCLUSION: Integrated midwife-led labor support with postpartum continuity of care was associated with better delivery outcomes and higher psychological resilience scores in primiparous women. Prospective studies are needed to confirm causality.
Revista da Associacao Medica Brasileira (1992)Özlem Koç, Şule Gökyıldız Sürücü
OBJECTIVE: The aim of this study was to examine the effects of midwife-led continuity education on fear of childbirth, mode of delivery, and postpartum trauma among primiparous women. METHODS: A single-blind randomized controlled trial was conducted at Adana City Hospital, Turkey, between December 2023 and November 2024. Ninety-two primiparous pregnant women were enrolled and randomized to an intervention group (n=46) or a control group (n=46). Inclusion criteria were age 18-35 years, singleton low-risk pregnancy, Turkish literacy, and no medical or obstetric contraindications to vaginal birth. Women with high-risk pregnancies, psychiatric disorders, systemic diseases, or prior structured childbirth education were excluded. The intervention group received a four-module education program based on the Midwife-Led Continuity of Care Model, while the control group received routine antenatal care. RESULTS: Baseline childbirth fear scores were comparable between groups. Following the intervention, mean childbirth fear scores were lower in the intervention group than in the control group. One month postpartum, mean City Birth Trauma Scale scores were 5.43±5.69 in the intervention group and 22.93±9.92 in the control group. Vaginal birth occurred in 69.6% of women in the intervention group compared with 24.4% in the control group. Among women who had vaginal births, postpartum fear scores remained lower in the intervention group. CONCLUSION: Midwife-led continuity education is associated with reduced fear of childbirth, lower postpartum trauma symptoms, and higher vaginal birth rates among primiparous women. These findings support the integration of continuity-based midwifery education into routine maternity care.
European journal of obstetrics, gynecology, and reproductive biologyClément Bourdel, Lucie Guilbaud, Violaine Peyronnet, Paul Berveiller, Alexandre J Vivanti, Thomas Schmitz, Jean-Marie Jouannic, Gilles Kayem, Aude Girault, Yoa…
OBJECTIVE: To assess healthcare professionals' opinions, counseling practices, and personal preferences regarding mode of delivery for term breech presentation, and to explore variations according to gender, professional status, experience, and institutional policy. METHODS: We conducted a multicenter cross-sectional survey in six tertiary maternity units in the Paris area between September 2025 and January 2026. Obstetrics residents, senior obstetricians, and midwives were invited to complete an anonymous electronic questionnaire exploring counseling practices, reported neutrality of information, and personal preferences regarding mode of delivery. Comparisons were performed according to gender, professional status, experience, and institutional policy. RESULTS: A total of 242 healthcare professionals responded (response rate, 46.1%). Overall, 81.4% reported a personal preference for planned vaginal breech delivery. Most respondents considered that, in cases of breech presentation, the final decision regarding mode of delivery should belong to the patient (88.8% vs 57.9% for cephalic presentation;p < 0.01). Only 54.1% reported providing neutral counseling. Male professionals were more likely than female professionals to support planned vaginal delivery in nulliparous women (90.9% vs 72.2%;p = 0.01) and in women with a previous uterine scar (69.7% vs 50.2%;p = 0.04). Support for planned vaginal breech delivery differed according to professional status (p = 0.04), with lower rates among midwives with more than 5 years of experience (69.1%). Institutional policy had a major influence: professionals working in centers favoring planned vaginal breech delivery were more likely to support this option than those working in centers with elective cesarean policies (84.9% vs 61.1%;p < 0.01), and counseling was more often oriented toward cesarean delivery in the latter group (47.2% vs 2.4%;p < 0.01). CONCLUSIONS: This study showed that reported counseling practices for term breech presentation are frequently non-neutral and that healthcare professionals' opinions and reported counseling practices vary according to professional characteristics and institutional setting. These findings highlight the heterogeneity of counseling practices and emphasize the importance of promoting balanced information and shared decision-making to support women's informed choice regarding mode of delivery.
African journal of reproductive healthSara Alaoui, Kamal Takhdat, Widad Lahmini, Saloua Lamtali, Mohamed Loukid
Neonatal mortality remains a critical public health issue, particularly in resource-limited settings. Simulation-based programs such as Helping Babies Breathe (HBB) have proven effective in strengthening midwives' knowledge and skills in neonatal resuscitation, yet no study has evaluated their impact among practicing Moroccan midwives. The objective of this study was to assess the effectiveness of HBB training on satisfaction, self-efficacy, theoretical knowledge, one-year knowledge retention, and technical skills among practicing Moroccan midwives. A quasi-experimental pre-post study was conducted with 96 midwives. The intervention included a didactic session, hands-on practice, and formative simulation. Satisfaction, self-efficacy, and knowledge were measured through questionnaires; technical skills were evaluated using OSCE checklists for the Golden Minute and positive pressure ventilation. Satisfaction was 100%, and full self-efficacy increased markedly post-training. Knowledge improved significantly and remained stable at follow-up. Technical skills showed high scores with minimal failure rates. Knowledge moderately correlated with ventilation performance. In conclusion, HBB simulation-based training significantly enhances and sustains neonatal resuscitation competencies among Moroccan midwives, supporting its systematic integration into continuous professional development.
African journal of reproductive healthThabani M Noncungu, Thandi Sibindi, Jennifer Chipps, Talitha Crowley
Midwives are uniquely positioned to implement health literacy programmes, yet there is limited synthesis of existing midwife-led health literacy programmes for pregnant women in Africa. This scoping review maps the evidence on health literacy programmes to improve the self-care of pregnant women in Africa. Eight articles, published between 2015 and 2025, were included across African countries from six electronic databases, such as MEDLINE and one search engine: Google Scholar. Maternal health literacy programmes varied in mode of delivery, duration, components, and outcomes. Most programmes used a group antenatal care model, a combination of face-to-face and digital health tools, and focused on improving functional, interactive, and critical health literacy. Maternal health literacy programmes in African countries seem to be under-researched. More research is needed to strengthen the outcomes of programmes such as usability and acceptability, knowledge and awareness, and clinical outcomes. In addition, longer-term research is necessary to assess the implementation and sustained impact of these programmes.
This qualitative study explored midwifery students' experiences with a virtual reality (VR) simulation designed to teach immediate newborn care. A total of 34 students participated in an immersive VR environment where they performed essential newborn care procedures. Data were collected through semistructured interviews and analysed using thematic analysis. Three main themes emerged: VR as a realistic and safe learning environment, emotional and cognitive interaction, and the role of innovative technologies in education. Students reported increased self-confidence, motivation, and clinical readiness, while also noting initial anxiety and some technical challenges. Overall, VR was perceived as an effective and engaging educational tool that supports skill acquisition and preparation for clinical practice. These findings suggest that VR can be sustainably integrated into midwifery education.
British journal of nursing (Mark Allen Publishing)James Faraday, Linda Tinkler
Research led by nurses, midwives and allied health professionals has welldocumented positive effects for patients, staff and organisations. Significant gaps remain, however, between the generation and the implementation of research evidence. In this context, three national research-focused strategic plans have been launched in recent years, representing all nurses, midwives and allied health professions between them. This article is intended to aid awareness of the three strategies, while promoting their translation into practice in a synergised way. Thematic synthesis was used to analyse and compare the aims and aspirations of the three documents. Four themes were generated: linking research to practice; equal access to research opportunities; celebrating research and raising awareness; and research leadership and influencing. This synthesis demonstrates and explores several similarities and shared intentions in the research strategies, and shows how they provide a catalyst to take nurses, midwives and allied health professionals' research capacity-building to the next level.
Frontiers in public healthBeatrice Erastus Mwilike, Ruchius Philbert, Martha Rimoy, Lucy Mabada, Nicodem Komba, Tom Okade, Feddy Mwanga, Rashid Gosse, Joel Ambikile
BACKGROUND: The Tanzanian Midwives Association (TAMA), in collaboration with development partners, implemented the 50,000 Happy Birthdays project (2018-2020) to improve healthcare providers' knowledge and skills in saving lives at birth through the Helping Mothers Survive (HMS) and Helping Babies Survive (HBS) training modules. Despite large-scale implementation of HMS and HBS training in Tanzania, limited evidence exists on long-term retention of knowledge and skills across multiple modules and on contextual determinants influencing sustainability. METHODS: A mixed-methods cross-sectional design was used to assess knowledge and skills retention by comparing post-test and follow-up test scores among providers in selected health facilities in the Tanga, Geita, and Katavi regions. Four knowledge areas were evaluated using written tests, and five skill areas were assessed using observational checklists. Quantitative data were analyzed using IBM SPSS version 25, employing descriptive statistics, t-tests, and one-way ANOVA, with significance set at p < 0.05. Thematic analysis was applied to qualitative data to identify factors influencing knowledge and skills retention. RESULTS: A total of 210 respondents participated; over half held diplomas (n = 116; 55.2%) and worked in urban areas (n = 123; 58.6%). The largest knowledge decline was observed in pre-eclampsia management (-21.0 points), followed by essential care for small babies (-14.7), controlling bleeding after birth (-12.5), while helping babies breathe showed the smallest decline (-7.7). Skills also showed significant reductions across all domains, with the greatest decline in administration of magnesium sulfate (-17.1) and active man-agement of the third stage of labor (-17.0). Rural providers showed greater declines in key obstetric skills: manual removal of the placenta and active management of the third stage of labor (p < 0.05). One-way ANOVA showed that professional education level was significantly associated with knowledge retention only for pre-eclampsia management [F(2, 205) = 6.919, p = 0.001, Ω2 = 0.049]. A significant difference in skills decline was also observed for nasogastric tube feeding across education levels [F(2, 205) = 3.601, p = 0.029, Ω2 = 0.020]. CONCLUSIONS: Knowledge and skills retention declined significantly over time. Regular refresher training is recommended, particularly for rural healthcare providers and those with lower educational qualifications.
Nurse education in practiceMichelle Gray, Kristina Vogel, Annette Bernloehr, Terri Downer, Melanie Welfare, Nicola H Bauer
AIM: To produce an updated synthesis of digital learning and teaching approaches in midwifery education since 2021. BACKGROUND: Globally, there is an increasing trend towards using digital technologies in midwifery education with little examination of trends, terminology or impact by midwifery academics. DESIGN: A comprehensive literature review. METHODS: Ten databases were searched (2021-March 2025) guided by JBI methodology and PRISMA-ScR reporting, resulting in 36 empirical studies focusing on digital technologies used with midwifery students. The review mapped recent technological developments, associated benefits and emerging challenges. RESULTS: Digital innovations were in 15 countries and ranged from immersive virtual reality, augmented and mixed reality and mobile applications to 2D/3D animations, tele simulation and digital books. Most studies highlighted positive outcomes, including enhanced knowledge acquisition, increased confidence and self-efficacy, reduced anxiety and improved clinical skill performance. Digital resources were also valued for supporting engagement, independent learning and bridging the theory-practice gap. Despite predominantly favourable results, challenges were identified, including cybersickness, technological barriers, insufficient digital literacy and high equipment costs. Concerns also emerged around the lack of pedagogical alignment, limited long-term knowledge retention, scalability constraints and inconsistent terminology, particularly the variable use of the term "virtual reality". CONCLUSIONS: Digital technologies are increasingly shaping midwifery education yet remain best positioned as supplementary tools rather than replacements for hands-on clinical learning. Findings identify the need for clearer terminology, stronger theoretical frameworks, sustainable implementation strategies and further research into long-term educational impact, resource demands and environmentally responsible use.
INTRODUCTION: South Asia continues to face significant challenges in maternal and neonatal health, particularly in rural and remote regions where healthcare access is limited. While governments and organisations have increasingly recognised the importance of deploying professionally trained midwives to address these disparities, the documented experiences of midwives working in these challenging environments remain limited. This scoping review aimed to explore the existing literature on the experiences of midwives practising in rural and remote areas of South Asia, with the goal of identifying key themes, gaps and opportunities for future policy and practice. METHODS: A scoping review was carried out using the Scopus, CINAHL, Web of Science and PubMed databases. A search was conducted using keywords for articles published between 2000 and May 2025. Abstracts were screened based on eligibility criteria, and common themes were identified and categorised for analysis. Data were assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 21 studies met the inclusion criteria including case study (n=1) quantitative (n=9), qualitative (n=8) and mixed-method studies (n=3). The included studies spanned seven South Asian countries: Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka. Seven themes were identified across published literature: commitment to clinical care, scope of practice, education, resources and workforce, technology, society and culture, and environment and weather. Midwives face challenges in providing care, including limited resources, sociocultural barriers related to gender roles and adverse weather conditions. The integration of technology, enabling midwives to practise to their full scope, enhancing education and fostering community acceptance could enhance midwifery practice in limited-resource settings. DISCUSSION: Available literature documents resilience and dedication of midwives in rural South Asia, while also highlighting the systemic barriers they face. The findings suggest that strengthening midwifery education, improving working conditions and promoting community engagement are essential for allowing midwives to provide effective and culturally appropriate care. Moreover, greater investment in infrastructure, workforce planning and technology integration is needed to address ongoing gaps. As countries in South Asia continue to build midwifery capacity, context-specific strategies that account for social, cultural and environmental realities will be critical. CONCLUSION: This review contributes valuable insight to the limited body of literature on rural midwifery in South Asia and offers a foundation for future research, policy development and program implementation aimed at improving maternal and neonatal health outcomes in these underserved regions.