The process of overcoming challenges faced by midwives providing perinatal mental health care in obstetric facilities in Okinawa, Japan: A qualitative study

AIM: This study aimed to clarify how midwives overcome challenges in providing perinatal mental health (PMH) care in clinical settings and to inform feasible, context-sensitive educational support. METHODS: We used an interpretivist-constructivist qualitative design with a sequential two-stage approach. Thirteen midwives working at five obstetric facilities in Okinawa, Japan, each with more than 2 years of PMH care experience, participated in one focus group discussion (FGD) and one in-depth interview (IDI). FGD transcripts were analyzed descriptively to clarify key challenges and concerns and to inform the development of IDI questions. IDI transcripts were analyzed using reflexive thematic analysis to explore how midwives navigated and overcame these challenges, thereby generating an interpretive account aligned with the study aim. RESULTS: Five themes were generated, from which we constructed a dynamic thematic map illustrating how challenges were overcome: contextual challenges triggered action; team-based support, reflective practice, and feedback from clinical cases interacted recursively; and motivational substrates underpinned these processes and were reinforced through ongoing practice, sustaining midwives' involvement in PMH care under conditions of uncertainty. Reported barriers included limited opportunities for reflective dialogue within shift-based workflows and limited visibility of post-discharge outcomes. CONCLUSION: This study clarified the contextual challenges in PMH care and the key elements for overcoming them. These findings inform educational and organizational support combining flexible access to knowledge resources with interprofessional collaborative reflection grounded in psychological safety in emotionally and time-constrained obstetric settings, enabling midwives to sustain engagement in PMH care under conditions of uncertainty.