BACKGROUND:
The immediate postpartum period (first 24 hours after birth) is critical for mothers and newborns. Almost half of the maternal and neonatal deaths occur during this time. Barriers and facilitators to immediate postpartum and newborn care by midwives have received little attention, especially in developing countries.

OBJECTIVES:
The study explored the barriers to, and facilitators of immediate postpartum and newborn care within the first 24 hours after birth by midwives in Uganda.

METHODS:
This was a qualitative descriptive study conducted among 15 purposively sampled midwives and four midwifery ward managers at a District Hospital in central Uganda. Three focus group discussions and four key informant interviews were conducted. Data were analysed using Colaizzi’s inductive thematic approach.

RESULTS:
All participants were females aged between 23 and 59 years. Two themes emerged: (1) Overwhelming experience highlighting barriers (sub-themes: disabling work environment, demotivating conditions, and an uninformed practice), and (2) Comprehensive support system describing facilitators (sub-themes: enabling work environment, effective leadership and management, and professional competence). An overarching theme emerged, "Contradictions in Perspectives", which highlighted the inconsistencies between the viewpoints of frontline midwives, who deal with daily realities, and midwifery managers, whose perspectives seemed more aspirational.

CONCLUSIONS:
Specific interventions are needed to address barriers, strengthen facilitators, and promote open communication between midwives and managers to enhance the overall quality of maternal and newborn care.

KEY MESSAGE:
The novel concept, "Disabling Practice Environment", highlights how the different perspectives between midwives and managers contribute to suboptimal care. Midwives are actively being disabled by their work environment, even though they might be professionally capable to provide care. Maternal mortality