Exploring Australian midwives’ approaches to labour pain and workplace realities: Philosophies in practice

Objective: This study explored midwives’ views and experiences of supporting women to manage labour pain. This paper specifically examines midwives’ philosophical underpinnings and the organisational factors that influence their ability to enact these approaches in practice. Methods: A national cross-sectional survey of Australian midwives was undertaken, incorporating both open- and closed-ended questions. Closed-ended questions were analysed using descriptive analysis, while open-ended responses were examined through thematic analysis. Results: Of the 557 respondents, the majority reported a ‘working with pain’ philosophy in their approach to supporting women during labour. Perceived workplace support for practicing, in alignment with this philosophy, was more likely when working in a continuity of care model. Workplace context and structural positioning were critical to feeling supported. Many midwives described healthcare settings as constraining, often requiring them to relinquish their philosophical approach due to systemic factors – an experience that was frequently associated with distress. Conclusion: Midwives commonly prefer to support women to work with pain during labour, aligning with a philosophy that honours the physiological process of birth. However, system factors, particularly fragmented models of care, high intervention rates, and a culture that prioritises pain relief, pose significant barriers to practising in this way. Enhancing access to tools to facilitate birth physiology, as well as addressing unhelpful cultural beliefs surrounding labour pain, may not only improve women’s birth experiences but also contribute to greater midwifery job satisfaction and retention.