Following a period of living and working in education practice abroad, Dr Maeve Anne O’Connell, has stepped back into life in Ireland and become Lecturer in Midwifery at University College Cork. She reflects on the policies affecting current practice, as well as her personal experience of receiving care. She challenges whether forecast changes will enhance midwifery practice or dilute it.
Returning to Ireland as a midwife and educator at a time of system reform is both reassuring and unsettling. The vision is compelling—but whether midwifery will be strengthened or diluted within it remains an open question.
The vision set out in Sláintecare positions Ireland firmly on a path towards universal health coverage, grounded in equity, accessibility, and integrated care. For midwifery, this is not a new direction but a long-standing philosophy. Continuity of care, prevention, community-based services, and partnership with women have always been central to midwifery practice. In many ways, midwifery already embodies the principles that Sláintecare seeks to achieve. The challenge is whether the system will fully recognise and enable this, or whether midwifery risks being reshaped to fit structures that were not designed with it in mind.
Re-engaging with Irish maternity policy has brought me back to the National Maternity Strategy and the evolving standards of the Nursing and Midwifery Board of Ireland. The direction is clear: expand community-based care, strengthen midwifery-led models, and support physiological birth wherever possible. Yet policy alone does not change practice. Implementation depends on workforce capability, organisational culture, and—perhaps most critically—confidence in midwifery as a profession that can lead care.
This question of confidence becomes very real when experienced from the other side of care. Last year, I received care through the DOMINO midwifery scheme in Cork. It was not remarkable in the sense of being exceptional—it was remarkable because it worked exactly as it should. Care was accessible, continuous, and grounded in relationship. Outreach clinics brought services closer to home, early discharge was supported safely, and the community midwife provided a reassuring continuity into the postnatal period.
This experience reinforced something important. Ireland does not need to reinvent midwifery care. The foundations already exist. Models such as DOMINO demonstrate what integrated, woman-centred care can look like when midwifery is enabled to function as intended. The challenge is not innovation, but implementation—ensuring that these models are protected, expanded, and not diluted in the process of system reform.
Periods of reform, however, often bring unintended consequences. As services attempt to expand and meet increasing demand, there can be a tendency towards role generalisation. In this context, midwifery education becomes critically important. We must remain focused on preparing midwives who are capable of practising across the full scope of midwifery, not practitioners who are partially skilled across multiple domains but lack depth in physiological care. The International Confederation of Midwives and World Health Organisation are explicit in their position that continuity of midwifery care—delivered by known midwives across the antenatal, intrapartum, and postnatal continuum—is central to safe, high-quality maternity services (ICM, 2021; WHO, 2016; WHO, 2018). This is reinforced in position statements advocating for midwife-led continuity models as a cornerstone of universal health coverage. In this way, continuity of midwifery care is not simply aligned with universal health coverage, it is a key mechanism through which equitable, high-quality maternity care can be delivered.
When midwifery is diluted, the consequences are not neutral. Loss of confidence in physiological care is often followed by an increase in intervention. This is not always driven by clinical need, but by systemic pressures—risk aversion, fragmented care, and reduced continuity. In maternity care, this raises the very real issue of iatrogenic harm, where intervention itself introduces risk. Evidence from The Lancet Series on Midwifery demonstrates that midwife-led continuity models are associated with fewer interventions, improved outcomes, and higher satisfaction among women (Renfrew et al., 2014). The Cochrane review by Sandall et al. (2024) further supports this, showing reduced preterm birth and improved experiences for women receiving midwife-led continuity of care.
Continuity of care is not simply a service model—it is a mechanism through which safety, trust, and relational care are achieved. Position papers across international organisations consistently emphasise that fragmentation of care undermines both outcomes and experience (WHO, 2016; ICM, 2021). Yet despite strong evidence, implementation remains inconsistent. Reports from Health Information and Quality Authority continue to highlight variation in maternity services and the need to embed evidence-based models more systematically (HIQA, 2020).
What is required now is alignment. Education, regulation, and service delivery must work together to support midwifery practice at full scope. This includes preparing student midwives for autonomous roles, investing in community services, and embedding continuity models as standard rather than supplementary. It also requires a cultural shift—one that values midwifery knowledge and leadership as central to maternity care, rather than peripheral.
Returning to Ireland has reminded me that midwifery, at its best, is both simple and complex. Simple in its commitment to supporting normality, and complex in the expertise required to recognise and respond to deviation. It is found not in policy documents, but in everyday moments of care—in a home visit, a conversation, a sense of being supported rather than managed.
As reform progresses, the question is not whether maternity services will change. They will. The question is whether that change will strengthen midwifery or dilute it. Protecting the essence of midwifery—its philosophy, its scope, and its autonomy—will be central to ensuring that Ireland’s move towards universal health coverage delivers not only efficiency, but truly woman-centred care.
References
Department of Health. (2016). National Maternity Strategy 2016–2026. https://www.gov.ie/en/department-of-health/publications/national-maternity-strategy-creating-a-better-future-together-2016-2026/
Department of Health. (2017). Sláintecare Report. https://www.gov.ie/en/department-of-health/campaigns/sl%C3%A1intecare/
Health Information and Quality Authority. (2020). Overview report of HIQA’s monitoring programme against the National Standards for Safer Better Maternity Services https://www.hiqa.ie/reports-and-publications/key-reports-and-investigations/maternity-overview-report
International Confederation of Midwives. (2021). Essential Competencies for Midwifery Practice. The Hague: ICM https://internationalmidwives.org/wp-content/uploads/EN_ICM-Essential-Competencies-for-Midwifery-Practice-1.pdf
Nursing and Midwifery Board of Ireland. (2025). Registered Midwife Programme Standards. 5th Edition NMBI – Education standards and requirements: NMBI
Renfrew, M. J., et al. (2014). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129–1145.
Sandall, J., et al. (2024). Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 4, CD004667.
World Health Organisation. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. https://www.who.int/publications/i/item/9789241549912
World Health Organisation. (2018). WHO recommendations: intrapartum care for a positive childbirth experience. https://www.who.int/publications/i/item/9789241550215
Dr Maeve Anne O’Connell is a Lecturer in Midwifery at University College Cork, with research interests in woman-centred care, midwifery education, and fear of childbirth
April 2026