Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry

Sally Pezaro, Gila Zarbiv, Jude Jones, Mariama Lilei Feika, Laura Fitzgerald, Sanele Lukhele, Jacquelyn McMillan-Bohler, Olivia B. Baloyi, Ksenija Maravic da Silva, Christine Grant, Lisa Bayliss-Pratt, Pandora Hardtman

Research output: Contribution to journalArticlepeer-review

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Objectives: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally.
Design: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022.
Setting: Responses were received from many countries (= 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya.
Participants: An international population (= 429) of English-speaking, and ethnically diverse midwives (= 211) and nurse-midwives (= 218).
Measurements: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics.
Findings: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives’ clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy.
Key conclusions and implications for practice: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.
Original languageEnglish
Article number103982
Number of pages9
Early online date29 Mar 2024
Publication statusE-pub ahead of print - 29 Mar 2024

Bibliographical note

This is an open access article under the CC BY license (


  • Midwives
  • Midwifery
  • Leadership styles
  • Appreciative inquiry
  • Qualitative
  • Leadership theory


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