Background:
Healthcare crises such as pandemics disrupt the maternity care landscape, often challenging midwives' ability to provide quality, woman-centred care. This study explores how midwives in Malta navigated care provision during such a crisis, with a focus on preparedness, resilience, and support.

Aim and objectives:
To explore the perspectives of Maltese midwives on the provision of quality midwifery care during a healthcare crisis, using the coronavirus disease 2019 (COVID-19) pandemic as a case study. Objectives included examining midwives’ views on altered care provision and its effects on families; identifying challenges in balancing safety and quality; and exploring strategies to improve future resilience and preparedness.

Methodology:
A quantitative, cross-sectional study using a self-administered questionnaire was conducted. Purposive sampling targeted 117 midwives at Malta’s general hospital, with 81 responses received (69.2% response rate). Data were analysed using descriptive and inferential statistics, alongside thematic analysis of open-ended responses.

Results:
Crisis conditions impacted midwifery care through altered protocols, reduced in-person contact, and limited holistic care. Midwives reported unclear and rapidly changing policies, emotional strain, and moral distress. Organisational challenges included staff shortages, insufficient training, poor management, and lack of professional recognition. Personal difficulties ranged from physical exhaustion to psychological stress. Despite this, some positive outcomes emerged: improved teamwork, increased infection control awareness, and—importantly for families—more peaceful postnatal bonding and more opportunities for honest communication. Midwives advocated for stronger organisational support, focused training, and initiatives supporting their well-being.

Conclusion:
The study underscores the importance of preparedness, midwife-centred support, and clear, evidence-based communication to uphold respectful, family-centred midwifery care in crises. These insights are vital for maintaining care quality and protecting the physiological nature of childbirth amid future healthcare emergencies.