BACKGROUND:
The COVID-19 pandemic exacerbated longstanding reproductive injustices and disrupted the delivery of midwifery care globally. While midwifery is grounded in values of respect, autonomy, and relational care, the crisis revealed how these values were challenged and unevenly enacted. This study critically examines how the philosophy and values of midwifery care—conceptualized through the International Confederation of Midwives (ICM) and Quality Maternal and Newborn Care (QMNC) frameworks—were impacted during the pandemic in Lima Metropolitana (LM), Peru, and the Greater Toronto Area (GTA), Canada.

OBJECTIVES:
To explore how midwifery values and philosophies were upheld, adapted, or compromised during COVID-19, and how these processes were shaped by intersecting structures of power, privilege, and marginalization.

METHODS:
A qualitative multiple-case study design was employed, guided by Stake’s approach. Data sources included 45 semi-structured interviews, photographs, grey literature, and demographic reports in English and Spanish. A two-stage analysis was conducted: axial coding grounded in midwifery values, followed by reflexive thematic analysis using an intersectional lens. Ethics approval was obtained in both countries. All participants provided informed consent. The study was supported by a Mentored Midwifery Research Grant from the Association of Ontario Midwives. The author declares no conflicts of interest.

RESULTS:
Midwifery values were expressed through four distinct stances: resistance, privilege, constrained relational care, and erosion of core values. These stances were shaped by midwives’ and service users’ social and professional identities, institutional constraints, and broader systemic inequities.

CONCLUSIONS:
The enactment of midwifery values is not only an ethical commitment but a political act. The pandemic exposed the need to re-evaluate midwifery models of care: for whom, by whom, under what conditions, and with what consequences for justice, equity, and dignity in care.

KEY MESSAGE:
Expanding midwifery model of care is not enough. Without confronting systemic power imbalances and structural inequities, core midwifery values cannot be fully realized, especially for marginalized communities. Labour and birth - PPH (including three-minute presentation competition)