PURPOSE:
The purpose of this presentation is to highlight how historical interprofessional tensions between midwives and obstetricians have constrained the development of pluralistic identities within the midwifery profession, limiting internal differentiation and critical reflection.

DISCUSSION:
The ideal of ‘normal birth’ has long been central to midwifery identity and is prominently reflected in the position statements of the International Confederation of Midwives. Midwives may gain symbolic capital by upholding core narratives and values—particularly advocacy for normal, physiological birth. However, such ideals may generate tensions, not only with medical models of care, but also within midwifery itself. To illuminate these dynamics, a conceptual framework outlining three professional roles is introduced: The Guideline Adherent Midwife, who prioritises clinical protocols and safety, yet may align more closely with institutional than individual needs; The Holistic Midwife, who upholds non-interventionist care, but may at times be in tension with patient preferences or clinical realities; The Deliberative Midwife, who seeks to integrate evidence, experience, and the woman’s autonomy, but may struggle with persistent uncertainty, dependence on peer validation, and a heightened risk of burnout due to overthinking and emotional fatigue. Although the Holistic Midwife role aligns with core professional narratives, it often clashes with the realities of resource-constrained and medically driven environments. Meanwhile, the Guideline Adherent Midwife faces ingroup criticism despite her practical alignment with institutional norms.

EVIDENCE WHERE RELEVANT:
The conceptual framework has been developed for teaching in the Master's programme in Midwifery Science at the University of Southern Denmark

KEY MESSAGE:
Advancing maternity care requires moving beyond binary distinctions such as ‘normal’ versus ‘medical’ birth. The paper advocates for the legitimisation of diverse midwifery roles and the cultivation of second-order reflection as a route to professional renewal. Embracing internal disagreement can foster a more adaptive and inclusive midwifery practice responsive to contemporary care contexts. Workforce - professional identity