Exploring Dutch midwives' attitudes to promoting physiological childbirth: A qualitative study

to describe Dutch midwives’ attitudes toward, and motivations for, the promotion of physiological childbirth and to identify factors associated with those attitudes and motivations. exploratory, qualitative design using focus groups. The Netherlands. hospital- and community-based midwives. four themes emerged: physiological birth as a continuum, navigating the settings, woman-centeredness and competence and confidence. Midwives view the safeguarding and promotion of physiological childbirth as central to their role. They define physiological childbirth along a continuum that is related to the context of their practice. Hospital culture is seen as an inhibitor of practices that promote physiological birth. Midwives believe that woman-centred ways of working and challenging practices that are not evidence-based will promote physiological childbirth. in order to become competent and confident practitioners of physiological childbirth midwives need to be aware of the factors that inhibit and encourage practices that support this way of giving birth. midwives should consciously employ strategies that promote physiological birth in both home and hospital settings. Midwifery education and midwifery science research should focus on developing strategies that support midwives in this endeavor. •Midwives in both hospital and community settings in the Netherlands view the safeguarding and promoting of physiological childbirth as central to their role.•The hospital setting and the other maternity care professionals in it are viewed as inhibitive for physiological birth.•Women-centred ways of working and shared decision-making empower women and midwives to use practices that support physiological childbirth.•Clinical competence and confidence are important factors in using strategies that promote physiological childbirth.