BACKGROUND:
Despite international consensus advocating for physiological birth and continuity of care (CoC) models, educational institutions lack sufficient data to inform student professionalization during CoC placements, understood as a comprehensive process encompassing culture, competencies, and professional identity.

OBJECTIVES:
1) To describe the learning experiences related to physiological birth, as well as the transformations required to become a midwife who supports physiological birth during CoC placements in freestanding birth centres; 2) To analyze, from a systemic perspective, the barriers and facilitators influencing the professionalization of midwifery students as they learn to support physiological birth.

METHODS:
A descriptive-interpretive approach, based on the student professionalization framework was used. Data were collected through individual audio diaries (n=126) from students and preceptors (n=14) during placements in birth centers; discussion groups (n=2) with participating students; and individual interviews with key policy informants (n=5). The data were analyzed thematically.

RESULTS:
Objective 1: Three key themes were identified: Appropriating culture: relational autonomy; Developing competencies: acknowledging attitude, enabling behaviours and narrative skills; Constructing identity: between coherence and resistance. Objective 2: Nine barriers and seven facilitators, spanning sociopolitical, professional, interdisciplinary, educational, and interpersonal contexts, offered a systemic perspective on the factors influencing midwifery students’ professionalization regarding physiological childbirth.

CONCLUSIONS:
This research initiates a typology of invisible competencies essential for learning to support physiological birth, shaped by a relational perspective of autonomy. CoC placements and continuity of preceptorship in birth centres were crucial to the professionalization of midwifery students regarding physiological birth. However, the demanding intrapartum working conditions, combined with on-going caseload and academic duties, foster a devalued culture of self-care, significantly impacting students' professionalization. This should be critically considered when implementing CoC placements.

KEY MESSAGE:
Attitudes are crucial to support physiological birth and should be integrated into Essential Competencies for Midwifery Practice. Self-care competencies and team-care strategies must be included into curricula to enhance CoC models sustainability. French - professional identity