Reimagining Midwifery

After experiencing burnout twice myself, I am always struck—though no longer surprised—to see the subject prioritized in midwifery journals. Nearly every journal in the last five years has included some study on midwifery burnout, sometimes framed more gently as “the reasons midwives are leaving the profession.” The subject is an important one: 30% of midwives leave within the first five years of practice, and half leave by ten. The research confirms what anyone who has worked a shift already knows—high stress and poor working conditions are unsustainable.

I was recently contacted to help mentor students and new graduates as part of a statewide retention initiative. I declined. I couldn’t get behind a program that placed more responsibility on midwives to solve this problem while continuing to subject themselves to the very conditions causing the harm. I remember telling a friend, “I could never tell someone in an abusive relationship to stay in it, so I would make a lousy mentor.” She replied, “Or you’d make a really good one.”

It has become clear to me that the answer is not trying to make people fit the job, but to make the job fit the people.

Midwifery is a beautiful model of care, but in many ways, we have contorted it to fit large, efficiency-driven systems in exchange for professional legitimacy and access to patients who need us most. In doing so, we have diluted some of our greatest strengths: time, presence, continuity, and relationship. When care is reduced to short visits, productivity metrics, and liability pressures, no amount of resilience training can compensate for what is lost.

For those who can endure these conditions, there is no judgment—large systems do work for some. But for many, they do not. And it is long overdue that we expand our vision of what midwifery can be, and where and how it can exist.

What might it look like to broaden midwifery beyond its current confines?

Midwives are uniquely positioned to contribute across the lifespan—not only in birth care, but in primary care, menopause, geriatrics, psychiatry, palliative care, and other life transitions. Patients are already dissatisfied with long wait times and fragmented, impersonal care. Midwifery offers an alternative: longer visits, individualized care, and an emphasis on listening and relationship-building. We reduce unnecessary interventions, improve outcomes, and do so in a cost-effective way.

But expanding midwifery is not just about adding more roles within existing systems—it is also about reimagining entirely new ones.

We need pathways that allow midwives to evolve over time, rather than forcing them out when they can no longer sustain the physical or emotional demands of traditional roles. This could include remote or hybrid work, consulting, teaching, politics, mentorship, telehealth, or community-based care models. It could mean smaller patient panels, team-based care, or cooperative practice structures that redistribute workload more sustainably.

We also need to build bridges for those who have already left. So many skilled, experienced midwives have been lost—not because they lacked dedication, but because the system lacked flexibility. Some were injured. Some needed to care for themselves or their families. Others simply reached a point where the cost was too high. These midwives still carry immense wisdom, and we have yet to create meaningful ways for them to remain connected to the profession.

And perhaps most importantly, we need to expand our understanding of midwifery beyond healthcare altogether.

At its core, midwifery is not just about clinical care—it is about witnessing, guiding, and supporting people through transition. Birth is one such transition, but so are burnout, grief, loss, aging, and identity shifts. There is a profound need in our world to slow down and redefine what we consider “care.” If we believe that people are their own most powerful healers, how might we midwife them into that knowing?

What would it look like to midwife the creativity process? To midwife someone’s relationship with their body without immediately pathologizing it? To support one another through life’s thresholds with presence rather than prescription? To midwife communities into being.

Many of us in midlife are waking up to the reality that what we’ve been doing for decades no longer works, and no longer serves. Hustle culture has caused deep and lasting harm. We have lost brilliant, skilled midwives by trying to force them into systems they were never meant to fit—and perhaps systems that midwifery itself was never meant to belong to in the first place.

I might argue that those who have left are not failures, but, in some ways, the truest midwives—those who chose to midwife themselves first, rather than remain in conditions that were unsustainable.

At the same time, I want to honor those who did not leave by choice. Those whose bodies gave out. Those who had to tend to their own health or their families. Those who aged out of long hours and demanding schedules, only to find there was no place for them to land. They gave their time, their energy, and often their bodies to this work, and we have not built the structures to support them in return.

We can do better than this.

If we are serious about addressing burnout, then retention cannot simply mean helping people endure harmful conditions for longer. It must mean transforming those conditions—and creating alternatives.

This might look like mentorship that includes honest conversations about boundaries and exit options, not just perseverance. It might look like networks for former midwives to re-engage in flexible roles. It might look like pilot programs that prioritize longer visits, smaller caseloads, and shared responsibility. It might look like entirely new, community-based offerings that exist outside traditional healthcare systems.

There is a difference between imagining a better world and beginning to build one. Even small experiments matter.

May 5th is The International Day of the Midwife and I call on all of us to take the time to ask ourselves how we can build a new vision of midwifery together—one that prioritizes the midwives as much as the patients, and recognizes that there are countless ways to contribute to the health of individuals, communities, and our planet that we have not yet fully explored.

It doesn’t have to be this way.