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Autonomy and its impact on midwifery practice

02 February 2020
Volume 28 · Issue 2



To explore the definition of autonomy, its significant features and impacts on midwifery practice.


Combined keywords searched were performed on electronic databases: Scopus, Science Direct and Medline within EBSCOhost and Google Scholar. Data were extracted and analysed corresponding to the objectives of this review.


A total of eight studies (n=8) were included (one quantitative and seven qualitative). Autonomy is the central element in midwifery that is commonly linked with informed choices; decision-making and power to control over a situation. In order for a midwife to be autonomous, important attributes include knowledge and skills (being confident, and the ability to think critically). It was also found that infrastructure and culture at work impacts autonomy in midwifery practice.


Albeit a limited number of studies were included in the review, this review provides an important platform for understanding the principles and concepts that underpin autonomy in midwifery practice.

Autonomy is not a new concept in midwifery. Although not explicit, the term autonomy has been embedded in the definition of a midwife (International Confederation of Midwives [ICM], 2011). Reiterated in the core document of the ICM, autonomy may be identified, such as through the words: ‘responsible’, ‘accountable’ and ‘midwife's own responsibility’.

Like ICM (2011) and the Nursing and Midwifery Council ([NMC], 2017) in the UK, the United Nations Population Fund ([UNFPA], 2011) also reports that midwifery has been positioned and proclaimed as an autonomous profession within the national legislation of Indonesia, Myanmar, India and a few African countries. The concept of autonomy also resonates with the concept of midwifery-led care that was promoted more than 25 years ago in the UK with the publication of the Winterton report (House of Commons Health Committee, 1992). Despite the aforementioned, exercising autonomy in midwifery remains a global challenge and Brunei is no exception.

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