Midwifery Services during the COVID-19 pandemic

Abstract

The COVID-19 pandemic placed unprecedented pressure on health systems worldwide, disrupting essential care services. Sexual and reproductive health services were among the most affected, yet the specific challenges faced by midwifery services remain underexplored. This dissertation examines how the pandemic affected midwifery care in Lima Metropolitana, Peru, and the Greater Toronto Area, Canada, situating these experiences within broader social, institutional, and historical contexts.

Using a qualitative multiple case study design, the study employed trauma-informed, intersectional, and postcolonial feminist perspectives to interpret the relational, ethical, and structural dimensions of midwifery practice during the crisis. Findings indicate that midwives were vulnerable to fear as a manifestation of trauma, that resilience often took the form of resistance, and that the capacity to sustain care depended on access to structural supports, professional autonomy, and organizational flexibility. Core values and the philosophy of midwifery, such as relational continuity, autonomy, and respect, were both tested and upheld, while the systemic positioning of midwifery within each health system shaped these responses. The study highlights that midwifery is not only a service, but a relational and ethical practice embedded in historical and structural realities.

This research contributes to knowledge by explaining how midwifery’s adaptive capacity during crises is shaped by broader structural, institutional, and social factors rather than by individual effort alone. It underscores the importance of understanding and addressing the systemic conditions that enable midwives to provide equitable, compassionate, and resilient care. By situating midwifery within the interplay of trauma, ethics, and power, this dissertation advances conceptual understanding of health service provision in crises and informs strategies to strengthen midwifery services in diverse sociopolitical contexts.