From struggle to strategy: unpacking midwives’ psychosocial workplace stressors and pathways to empowerment

Midwives play a crucial role in maternal and neonatal healthcare; however, they face significant psychosocial challenges that can affect their well-being and professional performance. While global studies have explored the psychosocial aspects of healthcare work, few have focused on the specific experiences of midwives in Iran. This study aimed to investigate the psychosocial workplace stressors affecting midwives in Iran and to identify empowerment strategies that can enhance their psychological well-being and professional resilience. This qualitative study employed a conventional content analysis approach to explore midwives’ psychosocial workplace experiences and empowerment strategies. Data were collected through semi-structured interviews with 25 midwives recruited from maternity wards, postpartum units, and gynecological departments across three major teaching hospitals in Mashhad, Northeast Iran. Although the primary data collection occurred from April to October 2024, the overall study process—including preparatory engagement, participant recruitment, and member-checking—spanned a longer period to ensure data depth and methodological rigor. Participants were selected using purposive sampling to ensure diverse perspectives across different employment statuses and years of professional experience. Trustworthiness was ensured through triangulation, member checking, and peer debriefing. The analysis adhered to the conventional content analysis approach described by Hsieh and Shannon. The main theme, “from struggle to strategy” encompassed three key categories including (1) “managing emotional labor in midwifery”, capturing the emotional strain of systemic inequities like heart echoes, mind waves, unseen burdens and waves of workplace violence (2) “external pressure navigatings”, highlighting systemic challenges of midwifery workplace including winds of change, tides of conflict and job insecurity shadows and (3) “adopting empowerment and coping strategies”, revealing how midwives demonstrated resilience through strategies like ongoing professional development, shield of unity, torch of advocacy, autonomy and innovation, psychological defense mechanisms and external sources of coping. This study provides critical insights into the psychosocial challenges midwives face in Iran, emphasizing the need for systemic changes to improve their work conditions. The findings suggest that empowerment through education, peer support, and innovation can mitigate some of these challenges. Future research should focus on cross-cultural comparisons and explore the long-term impacts of empowerment strategies on midwives’ well-being and client care.