BACKGROUND:
The U.S. maternity care system is grounded in white supremacist policies dating to early 20th century. Consequently, the current U.S. midwifery workforce is small, overwhelmingly white, and inhospitable to midwives of diverse backgrounds. The U.S. needs more midwives from underrepresented groups to improve health disparities; therefore, understanding how to retain underrepresented midwives in the workforce is a priority.

OBJECTIVES:
To explore the lived experiences of individuals who reported withdrawing from the midwifery profession due to racism and discrimination.

METHODS:
A hermeneutic phenomenological approach and thematic analysis was applied. The team conducted in-depth semi-structured interviews with 35 individuals who reported withdrawing from midwifery due to racism and discrimination. Participants were interviewed by a midwife and offered racially congruent interviewers. Transcripts were open coded. Codes were discussed by the team and synthesized into themes in weekly meetings and a 2-day intensive retreat in which team members engaged in ongoing reflexivity. Transcripts were reviewed to refine themes. Themes were member checked with three participants.

RESULTS:
Midwives withdrew in four distinct ways: from clinical practice, from employers, from the profession entirely, or emotionally while remaining physically present. A gradual erosion of well-being and absence of unconditional positive regard were commonly described. Five themes emerged: 1) daily experiences of racism, 2) being the only underrepresented provider, 3) witnessing discriminatory care, 4) harms caused by well-intentioned white midwives, and 5) guilt. Both institutional systems and individual behaviors, especially those of white midwives, contributed to these outcomes.

CONCLUSIONS:
Underrepresented midwives are disengaging from the workforce in nuanced ways not captured by traditional metrics. Racism is experienced as both overt and subtle, and while institutions are complicit, individual midwives play a significant role. Intersectionality of race, gender, and professional identity compounds marginalization.

KEY MESSAGE:
To retain underrepresented midwives in the U.S. workforce, both systemic and interpersonal racism must be addressed, especially by white midwives. Marginalized - racism