Shaping midwifery sustainability: a commentary

In recent decades, the global environmental and financial crisis has linked the concept of sustainability primarily to its continuity dimension, tying its use in healthcare to the cost-effectiveness of care models (Becker, 2012b). It has been demonstrated that midwifery-led models of care are recommended whenever possible because of their sustainability considering healthcare-related costs (Callander et al., 2021). Moreover, midwives, working in midwifery-led models of care, show greater satisfaction than their colleagues in contexts with higher medicalization, resulting in lower levels of work-related stress, burnout (Hanley et al., 2022), and consequently a greater job sustainability (Pace, Crowther, and Lau, 2022). Indeed, the key role of midwives achieving the UN Sustainable Goals stands as strategic and logical (Boukhalfa et al., 2024), meanwhile the value of midwifery knowledge, skills and practices has been recognized by UNESCO as an “Intangible Cultural Heritage of Humanity” (UNESCO, 2023).

On the other hand, however, professional and organizational issues such as staffing levels, the struggle to achieve an acceptable work-life balance, and the difficulty implementing the model while maintaining the right skill mix, may hinder the successful implementation of midwifery-led models (Middlemiss et al., 2024), influencing population health outcomes (Sandall et al., 2024), and, ultimately, midwifery sustainability.