“Place matters”: Midwives’ interprofessional relations in rural and urban institutional contexts

In the past, research highlighted interprofessional conflict among health professions over authority and practice rights in healthcare fields with advanced divisions of labour. More recently, scholarly attention has turned to interprofessional collaboration; however, there is evidence that inter-professional conflict persists. Moreover, there are signs that internal heterogeneity within professions is rendering interprofessional conflicts more complex than in the past. This article explores interprofessional relations in the midwifery profession in Ontario, Canada, across rural-urban locale and hospital setting. It finds that interprofessional relations differ across locale. While urban midwives struggle with hospital settings that are not ‘midwifery friendly’, rural midwives face tensions with some family physicians who do not recognize their expertise. Hospital size, policies, and leadership also shape interprofessional conflict and collaboration. A rural lens highlights the ways in which rurality frames professional experiences. Furthermore, attention to variations in interprofessional relations across place underscores the importance of context, policy and leadership in shaping professionals' work environments. •Locale and institutional context shape midwives' work and interprofessional relations.•Midwives experience professional relationships along a continuum of collaboration to conflict.•Urban midwives struggle with hospital settings that are not ‘midwifery friendly.’.•Rural midwives face tensions with some family physicians who do not recognize their expertise.•Among midwives, hospital policies and leadership can exacerbate or ameliorate interprofessional relationships.