Australian Midwives Research Articles

P39 - Exploring moral distress with Australian midwives

P39 - Exploring moral distress with Australian midwives

O36 - Introducing the Barometer of Moral Distress in Midwifery to determine levels of moral distress in Australian midwives

O36 - Introducing the Barometer of Moral Distress in Midwifery to determine levels of moral distress in Australian midwives

‘It was horrible to watch, horrible to be a part of’: Midwives’ perspectives of obstetric violence

BackgroundObstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations. AimTo explore Australian midwives’ perspectives of obstetric violence. MethodsThematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research. FindingsInterviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: ‘the operationalisation of obstetric violence’, ‘the impact of obstetric violence’ ‘the historical and situational context’ and ‘hope for the future’. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women. ConclusionsObstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.

Ascertainment of Aboriginal and Torres Strait Islander status for assessment of perinatal health outcomes: Reported versus derived maternal ethnicity in Western Australian pregnancy data.

Under-identification of Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) people can result in inaccurate estimation of health outcomes. Data linkage has improved identification of Aboriginal people in administrative datasets. To compare three methods of ascertainment of Aboriginal status using only pregnancy data from the Western Australian Midwives Notification System (MNS), to the linked Indigenous Status Flag (ISF) derived by the Department of Health. This retrospective population-based cohort study utilised logistic regression to determine which demographic characteristics were associated with under-identification, and the effect of ascertainment method on perinatal adverse outcomes. All methods identified a core group of 19 017 (83.0%) Aboriginal women and the ISF identified 2298 (10.0%) women who were not identified using any other method. Under-ascertainment was lowest when a woman's Aboriginal status was determined by ever being recorded as Aboriginal in the MNS data, and highest when taken as it had been recorded for the birth in question. Maternal age <20 years, smoking during pregnancy, pre-existing diabetes, a history of singleton preterm birth and being in the lowest 20% of Socio-Economic Indexes for Areas score were all associated with a higher chance of being identified by the methods using only the MNS. These methods were less likely to identify nulliparous women, and those with maternal age ≥35 years. The method of ascertainment of Aboriginality did not make a significant difference to the adjusted predicted marginal probabilities of adverse perinatal outcomes. Unlinked pregnancy data can be used for epidemiological research in Aboriginal obstetric populations.

Midwives’ experiences with PPE during the COVID-19 pandemic: The Birth in the Time of COVID (BITTOC) study

BackgroundThe COVID-19 pandemic resulted in rapid changes aimed at reducing disease transmission in maternity services in Australia. An increase in personal protective equipment (PPE) in the clinical and community setting was a key strategy. There was variation in the type of PPE and when it was to be worn in clincial practice. AimThis paper reports on Australian midwives’ experiences of PPE during the pandemic. MethodsThis sequential mixed methods study was part of the Birth in the Time of COVID-19 (BITTOC 2020) study. Data were obtained from in-depth semi-structured interviews with midwives in 2020 followed by a national survey undertaken at two time points (2020 and 2021). Qualitative open-text survey responses and interview data were analysed using content analysis. Findings16 midwives were interviewed and 687 midwives provided survey responses (2020 n = 477, 2021 n = 210). Whilst midwives largley understood the need for increased PPE, and were mainly happy with this, as it was protective, they reported a number of concerns. These included: inconsistency with PPE type, use, availability, quality, fit and policy; the impact of PPE on the physical and psychological comfort of midwives; and the barriers PPE use placed on communication and woman centred care. This at times resulted in midwives working outside of policy. ConclusionThese findings highlight the need for future comprehensive pandemic preparedness that ensures policy and procedure recommendations are consistent and PPE is available, of approriate quality, and individually fitted in order to ensure that Australian maternity services are well placed to manage future pandemics.

Primary Birth Trauma in Australian Midwives: A Correlational Study

BACKGROUND:The Australian Health Practitioners Registration Agency (AHPRA) records 98.7% of the 32,000 registered midwives as female. In 2021, Australia recorded 309,996 births, and one in three women experienced birth trauma. While the exact proportion of midwives who have given birth is unknown, it is likely the majority. As a consequence, 5,000–11,000 midwives may have experienced primary birth trauma (PBT). Little is known about midwives’ personal experience of birth trauma and its relationship to factors that affect their experience of the maternity workplace setting.AIMS:This study aimed to explore mental health morbidity and factors associated with the severity of PBT in Australian midwives and the relationships between these factors and professional quality of life.METHODS:Australian registered midwives 12 months post birth trauma experience and having returned to the maternity workplace without restrictions to their AHPRA registration were included. Data were collected via an online survey with four validated tools and general demographic information.FINDINGS:Midwives who have experienced PBT have symptomology for posttraumatic stress disorder, depression, anxiety, and burnout. Midwives with these symptomologies work within maternity settings with little known about the implications of accumulative symptoms, their impact on care provision or clinical decision-making, and overall long-term personal and professional well-being and health.CONCLUSION:This study found that midwives experience psychological, professional, and personal issues and trauma symptomology associated with their own primary birth trauma. Further research exploring simplified symptomatology identification and appropriate interventions both inside and outside the work environment is required to improve midwives’ mental health, rates of retention in the workplace, and job satisfaction.

The MidPIC study: Midwives’ knowledge, perspectives and learning needs regarding preconception and interconception care

Preconception and interconception care improves health outcomes of women and communities. Little is known about how prepared and willing Australian midwives are to provide preconception and interconception care. The aim of this study was to explore midwives’ knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care. We conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey measured midwives’ self-rated knowledge; education needs and preferences; attitudes towards pre and interconception care; and views on barriers, enablers; and, future service and workforce planning. Quantitative data were analysed descriptively and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and interconception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis. We collected responses from (n = 338) midwives working across all models of care (full survey completion rate 96%). Most participants (n = 290; 85%) rated their overall knowledge about pre and interconception health as excellent, above average or average. Participants with over 11 years of experience were more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). Online e-learning was the most preferred format for education on this topic (n = 244; 72%). Most (n = 257; 76%) reported interest in providing pre and interconception care more regularly and that this is within the midwifery scope of practice (n = 292; 87%). Low prioritisation in service planning was the most frequently selected barrier to providing preconception and interconception care, whereas continuity models and hybrid child health settings were reported as enablers of pre and interconception care provision. Findings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives’ provision of pre and interconception care.

Perineal repair performed by midwives in Australia: A cross-sectional survey study of education and practice

ProblemPerineal repair is generally not a widely practiced skill amongst Australian midwives, the reasons for this are uncertain and may result in technique variations. BackgroundMany birthing women experience perineal tears that require suturing. As midwives attend the majority of vaginal births, they would be ideally placed to undertake perineal repair. AimTo describe the current level of midwifery perineal repair skill acquisition, knowledge, techniques and utilization by Australian midwives. MethodsAn online survey was distributed to Australian College of Midwives members and shared via social media. Data on demographics, suturing techniques, reasons why midwives did or did not suture and barriers to skill acquisition were collected. Descriptive statistics were calculated for all variables including percentages, mean, standard deviation, median and range as appropriate. Findings375 completed surveys were received between April and May 2023. 197 midwives indicated current suturing practice and 178 did not suture. Contributing to continuity of care was the most common motivating factor. The use of a continuous suturing technique for all layers of a perineal injury was reported by the majority of suturing midwives. There was greater variation in the management of labial tears. Low numbers of skilled midwives to support attaining competency and high workloads were the main barriers to attaining suturing skills. DiscussionAustralian midwives view perineal suturing as a valid midwifery skill that can contribute to continuity of care. Largely organisational barriers exist to skill development and greater utilisation. ConclusionPerineal repair should be prioritised as a fundamental midwifery skill.

A survey of Australian midwives: Experts in nitrous oxide administration within the peripartum setting

ProblemThere is little documented evidence of midwives’ perspectives regarding the use of nitrous oxide in the peripartum period. BackgroundNitrous oxide is an inhaled gas used widely in the peripartum period; usually offered and managed by midwives. AimExplore midwives’ knowledge, perceptions, and practices of facilitating women’s use of nitrous oxide in the peripartum period. MethodsAn exploratory cross-sectional survey design was used. Quantitative data were analysed using descriptive and inferential statistics; open-ended responses underwent template analysis. FindingsMidwives (n = 121) working in three Australian settings reported regularly recommending the use of nitrous oxide and high levels of knowledge and confidence supporting its use. There was a significant association between midwifery experience, and perspectives on women’s capacity to use nitrous effectively (p = 0.004); and desire for refresher education (p < 0.001). Midwives working in continuity models were more likely to support women using nitrous oxide in any situation (p = 0.039). DiscussionMidwives demonstrated expertise in facilitating nitrous oxide use, citing utility to relieve anxiety and distract women from pain or discomfort. Nitrous oxide was identified as an important adjunct to the provision of supportive care requiring midwifery therapeutic presence. ConclusionThis study provides novel insight into midwives’ support of nitrous oxide use in the peripartum setting revealing high levels of knowledge and confidence. Recognition of this unique expertise held by midwives is important to ensure transfer and development of professional knowledge and skills and emphasises the need for midwifery leadership in clinical service provision, planning and policy.

An analysis of legislation and policies that guide maternity leave decision making in Australian midwifery students.

Objective There are no guidelines to assist midwifery academics or students in determining the optimal time to return to their educational programs following pregnancy. Rather, students need to navigate balancing new motherhood with the pressures of returning to their clinical midwifery placement and completing their statutory requirements to meet the Australian Midwife Accreditation Standards before the end of their program. The aim of this study was to seek best practice information that provides guidance to academics supporting midwifery students returning to study after maternity leave. Methods An analysis of contemporary Australian legislation, workforce guidelines, professional association statements, and university policies was undertaken to determine what guidance is available to assist midwifery academics in providing advice to midwifery students about the optimal time to return to their studies following birth. This document analysis was performed during 2021-2022 and followed Altheide and Schneider's 12 step process divided into five stages to clarify best practice advice for midwifery academics to provide guidance to students returning to study after maternity leave. Results Policy documents that refer to pregnancy confirm women have legal rights, and there is clear guidance on maternity leave; however, advice for midwifery students on the optimum time to return to study and clinical placements after birth is missing from the result of this document analysis search. Conclusion Transition to motherhood during the postnatal period is an important time. Clear national guidelines are needed to provide support and recommendations regarding a safe and optimal time to return to study and placement.

“I didn't feel like I could trust her and that felt really risky”: a phenomenographic exploration of how Australian Midwives describe intrapartum risk

ObjectiveConcepts of intrapartum risk are not well explored in the Australian context. In response to an increasing focus on risk in maternity care, we sought to obtain insight into what Australian midwives conceptualised as intrapartum risk. DesignThe research was conducted using a phenomenographic approach. Following ethical approval, in-depth semi-structured interviews were used to determine the qualitatively different ways midwives conceptualise intrapartum risk. SettingThis project was undertaken across different midwifery practice settings in Australia. ParticipantsAustralian midwives (n=14) with expertise in caring for women in the intrapartum period volunteered to participate in the study. FindingsWhen discussing their experience of intrapartum risk, midwives focused on the external horizon of the woman as the risk, that included the internal horizons of being labelled as clinically high risk, working relationships within transdisciplinary risk and institutional risk. Risks were orientated toward the woman as well as to the midwives. Key conclusionsThe midwives in this study conceptualised that intrapartum risk was associated with the woman including being labelled as high risk in addition to certain challenges within the midwife-woman relationship, particularly if there was a lack of reciprocal trust. Implications for practiceThis study supports current evidence that improved collaborative professional relationships are integral to safety in maternity care. It reinforces continuity of midwifery care as important, and particularly as a way of mitigating intrapartum risk. Further research is required to inform what challenges experienced in the midwife-woman relationship contribute to concepts of risk.

Causal links behind why Australian midwifery care is missed.

The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it. Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched. A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling. Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted. Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed. While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

Psychological wellbeing and mental health outcomes in Australian Nurses and Midwives

Aim: To examine the intrapersonal and organizational factors that contribute to pathogenic and salutogenic psychological outcomes in Australian nurses and midwives. Design: The conceptual framework Factors associated with Salutogenic and Pathogenic Outcomes in Australian Midwives and Nurses was used as a guide for this exploratory, cross-sectional study. Method: Participants were recruited from public, private, and community settings throughout Australia. Six hundred and fifteen participants completed an online survey assessing job satisfaction, professional quality of life, ways of coping, resilience, psychological distress, and the impact of the worldwide coronavirus pandemic on psychological health and well-being. Results: Analyses showed that workplace environmental factors were strong predictors of Secondary Traumatic Stress, and Burnout. Results also showed that workplace factors and adaptive coping were predictive of the salutogenic outcomes of compassion satisfaction and resilience. Conclusion: Adopting a salutogenic approach, focused on maximizing individual and organizational contributors to psychological health and wellbeing, provides a new way for organizations to develop strategies to decrease adverse psychological outcomes, promote well-being and better equip nurses and midwives to cope with the challenges of the healthcare environment. Impact: The findings will be of interest to Chief Nurses, Midwifery Officers, healthcare organizations, and universities to target workplace, individual and interpersonal factors that promote health and wellbeing amongst nurses and midwives.

O21 - Irrevocably connected to Australia and Australian midwives, and running on the proverbial smell of an oily rag, this low-resource Kenyan Birth Centre consistently shows remarkable outcomes. Here is its story

This is the vision of the Birth Centre, established in 2011 in an informal settlement on the outskirts of Nairobi in Kenya. Women served by the centre are of meagre means, often living without electricity, water, or toilet facilities, suffering food insecurity, severe anaemia, positive HIV status, or previous haemorrhage. Respect for cultural, emotional, and physical safety is the leading force, aiming for Women’s agency over their own lives and bodies • Companionship for the birth journey from women-folk and/or partners • Knowledge/faith in the wisdom of women’s bodies and their abilities • Kindness/compassion • Nutrition/hydration • Movement/positioning • Early recognition of variations from normal with resolution where possible and transfer to advanced facilites when appropriate and available. The Centre has no operating theatre, no advanced care for mothers or babies, and limited staff. Even so, in the ten years it has been running, these simple measures have led to • zero maternal deaths • no major maternal morbidity including catastrophic bleeds • low neonatal death rates – well below the national average • normal birth rate of 96% including twins, breech presentation, and vaginal birth after caesarean. The Birth Centre is a powerful example of how focused maternity care can positively impact not only the lives of women and their families, but an entire community. In this presentation I would like to share the story of the Centre: as an illustration of determination, grit, and commitment to better birth, as an example of innovative midwifery practice, and as a cost effective, successful model of care for remote/low resource centres around the world.

W4 - Building Australian midwives’ connection with Ukrainian refugee women: An interactive creative workshop

A pregnant woman on a stretcher guarding her baby in utero whilst smoke billows from a maternity hospital in the background or a mother swaddling her infant, face fixed with vacant expression. The whole world has seen these images, but they do not tell the full story of the women and children caught in the largest humanitarian crisis in Europe since World War II. As Ukrainians seek refuge in Australia, we will start to see the true toll of trauma, abuse and exploitation that occurs through displacement due to war. This all bears a significant impact upon the health and wellbeing of refugee women and children within the Australian community and in the healthcare services we provide. As a first generation Australian- Ukrainian midwife I understand how certain customs and traditions play a pivotal role in Ukrainian culture which directly impacts upon the treatment of women during the perinatal period. Through the making of traditional Ukrainian ‘Motanka’ (Folk dolls) that symbolise fertility and unity, the aim of this workshop is to explore the culture and customs of Ukraine to better understand how midwives can work with Ukrainian refugee women in a culturally respectful and safe manner. Throughout this hand on interactive workshop, you will: • Utilise evidence-based information about Ukraine and its people to highlight potential and actual healthcare needs, disparities, and priorities. • Explore strategic and sustainable solutions to potential problems faced by Australian midwives when working with Ukrainian refugee women and children. • Work together to create priority goals for the provision of culturally safe and respectful midwifery care to Ukrainian refugees This hands-on interactive workshop will suit healthcare providers who would like to experience creating a traditional Ukrainian doll whilst connecting with the Ukrainian people through the exploration of their culture, spiritual beliefs, and maternity healthcare needs.

O54 - YourChoice A Decision Aid App for Genomic Prenatal Testing

Decision Aids are interventions that support individuals by making their decisions explicit, providing information about options and the associated benefits/harms, and helping clarify congruence between decisions and personal values. In early pregnancy, women are presented with complex information about screening and diagnostic testing, with studies frequently indicating low levels of understanding. Midwives play a vital role in providing health promotion and health education during pregnancy, yet they often express concerns in presenting prenatal screening information. This presentation will describe the informed decision-making theory that underpins development of the App, demonstrate the App and present the evaluation of the App with a focus on health literacy. A pre/post-test design employing online surveys hosted on Qualtrics software. Both the pre-test and resource were available from a link from websites, social media, and hard copies. The post test was emailed weeks later. Women planning a pregnancy, interested in testing and those in early pregnancy were eligible to participate. There were 103 participants in the evaluation. In the development of the decision aid, the proportion of women who made an informed decision regarding uptake/decline of testing was 65% compared to 76% afterwards. From a baseline of 72% of women having a 'good' level of knowledge, this increased to 88% after using the decision aid. There was no change in measures of decisional conflict nor anxiety. The decision aid was developed by a multi-disciplinary group of researchers at James Cook University, and the Murdoch Children’s Research Institute; it is acceptable to women and feasible to use in primary care. The App is effective in supporting women to make prenatal testing decisions based on balanced, robust evidence with proven decision support. Following its launch later in 2022, the App will be freely available to Australian midwives and women and their partners.

A national survey of Australian midwives’ birth choices and outcomes

BackgroundMaternity 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. AimTo explore midwives childbirth preferences and outcomes when giving birth to their first child in Australia, after qualifying as a midwife. MethodsAn online national survey. Data were analysed using descriptive statistics. Findings447 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. DiscussionThere 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. ConclusionIt 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.

Midwives' recognition and response to maternal deterioration: A national cross-sectional study.

Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n=87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding. Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.

"We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative.

The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding. To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia. In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis. Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation. Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.

Babies born with ambiguous genitalia: Developing an educational resource for Australian midwives

Problem and backgroundThe birth of a baby with ambiguous genitalia is rare and usually unexpected. Parents often receive inconsistent language from health-professionals after the birth. Initial interaction with the birth team has long-term consequences for families with babies born with ambiguous genitalia. AimUnderstand the current practices on the day of birth and explore knowledge gaps for midwives regarding babies born with ambiguous genitalia. Develop educational content that can enable midwives to respond appropriately when the sex of a baby is unclear. MethodsThis study included two phases, utilising qualitative descriptive research design with semi-structured interviews to understand the experiences of midwives caring for babies with ambiguous genitalia and their families. The findings informed the development a midwifery educational resource using these qualitative findings. FindingsOur analysis of 14 interviews with Australian midwives identified that they had no formal education to support families with a baby with ambiguous genitalia. Emotional support, advocacy and medical information translation were areas midwives perceived as essential skills to support these families. DiscussionMidwives provide a unique role in parental birth experiences. Themes that arose emphasised their psychosocial support role but lacked formal education and guidance on this topic. Midwives had learnt from the media about babies born with ambiguous genitalia and wanted evidence-based education to support parents. Midwife education focusing on both psychosocial and clinical care for parents and their baby with ambiguous genitalia is crucial. ConclusionMidwives can play a pivotal role in supporting parents with a baby with ambiguous genitalia. Themes from this qualitative study informed the development of a midwifery education digital resource.