Barriers to Rural Midwifery: An Integrative Review

Aim: To explore the types of barriers that midwives face when practicing or attempting to practice in rural and remote locations.

Design: An integrative review using the Ecological Systems Theory.

Methods: The review was guided by Whitmore and Knafl. Included studies were appraised using the Mixed Methods Appraisal tool.

Data sources: In January 2024, searches were undertaken in CINHAL, MEDLINE, Science Direct, and Google Scholar.

Results: A total of 470 articles were screened after searches. Fourteen articles published between 1990 and 2023 met all inclusion criteria. They were thematically analysed to explore barriers present at the micro-, macro-, and meso-levels. The mico-level barriers included isolation, financial insecurity due to low volume, and challenges in separating personal and professional life. Barriers at the meso level included discord in interprofessional relationships and challenges in attending continuing education. Lack of midwifery representation, overt medical dominance, and policy acted as barriers at the macro level.

Conclusion: Rural midwives face complex challenges that demand multi-faceted and multi-level solutions. The findings highlight the need for an increase in midwifery representation in healthcare planning, improved policies related to midwifery, and the adoption of a rural model of healthcare planning that accounts for the unique social realities of living and practicing in rural communities.

Implications for the profession and patient care: By illuminating the challenges faced by rural midwives, efforts can be directed toward sustainable solutions to support rural midwifery practices and decrease rural health disparities.

Impact: Increasing midwifery access in rural communities can help reduce maternity care disparities for rural families. By identifying and addressing the barriers experienced by rural midwives, it can strengthen advocacy for targeted policies and support systems that empower midwives.

Reporting method: This review is reported according to the PRISMA guidelines for scoping reviews.

Patient or public contribution: No Patient or Public Contribution.