BACKGROUND:
Clinical reasoning is a fundamental cognitive process by which healthcare professionals collect information, generate and test hypotheses, implement interventions, and evaluate outcomes. While widely researched in medicine and nursing, the development of clinical reasoning in midwifery particularly in neonatal care remains underexplored.In Chile, approximately 80% of neonatal care is led by midwives, who are direct-entry professionals trained from the direct entry model. Despite their central role, the specific strategies that support the development of clinical reasoning skills in neonatal midwifery are not yet well-defined in the literature. As neonatal care becomes increasingly complex, there is a pressing need to enhance these competencies through structured educational approaches.

OBJECTIVES:
To explore the structure and perception of clinical reasoning among neonatal midwives, and to identify educational strategies that effectively support its development as a core professional competency.

METHODS:
This qualitative study employed grounded theory. Thirteen neonatal midwives from Hospital Luis Tisné Brousse (Santiago, Chile) participated in "think aloud" interviews. The data were analyzed using open, axial, and selective coding.

RESULTS:
Eleven non-linear stages of clinical reasoning were identified—eight core stages consistently applied and three context-dependent. Reflection emerged as a pivotal component, reinforcing the cyclical nature of decision-making. Experienced midwives emphasized mentorship and vicarious learning, while less experienced colleagues benefited more from active strategies such as clinical simulations, case-based learning, and structured feedback.

CONCLUSIONS:
Clinical reasoning in neonatal midwifery is best understood as a cyclical competency developed through intentional, structured educational approaches. Strengthening this competence—through mentorship and active teaching—empowers midwives to deliver high-quality neonatal care, often in low-resource contexts, by relying on their cognitive skills rather than infrastructure alone.

KEY MESSAGE:
In resource-limited environments, a well-trained midwife with strong clinical reasoning is often the most valuable tool available. Investing in this core competency is not only educationally sound it is a matter of equity and impact in global neonatal care. Spanish - professional development (including three-minute presentation competition)