NÄR DET NATURLIGA BLIR ERSATT En systematisk litteraturöversikt om barnmorskors erfarenheter i sitt arbete att främja fysiologisk förlossning

Sammanfattning

Background: Contemporary maternity care is increasingly characterized by medicalization, with interventions such as oxytocin infusion and cesarean section used even in low-risk births. At the same time, research shows that the majority of women are physiologically capable of giving birth without interventions. Routine interventions may disrupt the natural process, reduce women’s autonomy, and negatively affect the birth experience. The WHO and the ICM emphasize the importance of respectful, woman-centered care and the central role of the midwife in promoting physiological birth.Aim: The aim was to describe midwives’ experiences in their work to promote physiological childbirthMethod: This study was a systematic literature review with a qualitative approach. The databases PubMed and CINAHL were used. The material was analyzed using Bettany Saltikov’s and McSherry’s (2016) nine-step inductive content analysis.Results: The results were based on 16 qualitative studies published between 2015 and 2025 and were organised into three main categories: Physiological birth as a professional point of departure, Structural and cultural constraints, and Midwives’ practical strategies. Midwives promoted physiological birth through trust in the body’s capacity, professional restraint and relational safety, with undisturbed environments and continuity supporting physiological labour processes. At the same time, this work was constrained by a risk-oriented, intervention-driven and hierarchical care culture, reduced autonomy, resource shortages and high workload; nevertheless, midwives developed strategies to protect and promote physiological birth through presence, communication, environmental facilitation and clinical responsiveness.Conclusion: The findings show that midwives’ experiences of promoting physiological birth are shaped within a tension between medical control and physiological support, where organisational and cultural structures constrain professional autonomy. Sustainable and evidence-based maternity care requires trust in the body’s capacity, relational safety and continuity, as well as organisational changes that strengthen midwifery autonomy and midwife led models of care.