Perception, Enablers and Barriers to the Practice of Physiologic Birth among Midwives in Birthing Facilities in Bayelsa State, Nigeria

Despite global advocacy for physiologic birth as a safe and empowering alternative to routine medicalized childbirth, its implementation remains limited across many regions, including Nigeria. In Bayelsa State, where maternal health indicators remain suboptimal, the rising tension between ideal midwifery practices and institutional realities warrants critical attention. The problem lies in the inconsistent application of physiologic birth, largely due to midwives’ perceptions, inadequate institutional support, and hierarchical decision-making structures. This study explored the perceptions, enablers, and barriers to the practice of physiologic birth among midwives in public birthing facilities across Bayelsa State, Nigeria. A qualitative cross-sectional design was employed, utilizing a 32-item unstructured interview guide to conduct focus group discussions with 27 licensed midwives across tertiary, secondary, and primary health facilities. The data were analyzed using Hsieh and Shannon’s five-step content analysis method. Findings revealed that while midwives held strong positive perceptions of physiologic birth as spontaneous, empowering, and woman-centered, their ability to implement it was hindered by restrictive hospital policies, inadequate antenatal education, medicalized training, and physician-dominated leadership. Conversely, midwives’ confidence, women’s birth preferences, and supportive birthing teams were identified as key enablers. The study concludes that the gap between belief and practice is shaped by both systemic and psychosocial factors. Applying the Health Belief Model clarified how midwives’ behavior is shaped by perceived benefits, barriers, self-efficacy, and institutional cues. Hence, it is essential for the Ministry of Health to institutionalize midwife-led care models by enacting policies that promote autonomy, equip facilities, and reframe midwifery as central to safe, respectful maternal healthcare