This book about the art, craft and science of expert midwifery care, while focusing on ‘alternative physiological births’ that are those ‘outside’ of guidelines, the contents can be applied to any birthing choices. Drawing upon the findings of a PhD that captured the experiences of midwives who proactively supported alternative physiological births while working in the National Health Service, their practice was conceptualised as ‘skilled heartfelt practice’. Skilled heartfelt practice denotes the interrelationship between midwives’ attitudes and beliefs in support of women’s choices, their values of cultivating meaningful relationships, and their expert practical clinical skills. It is these qualities combined that give rise to what is called ‘full-scope midwifery’ as defined by the Lancet Midwifery Series. This book illuminates why and how these midwives facilitated safe, relational care. Using a combination of emotional intelligence skills and clinical expertise while centring women’s bodily autonomy, they ensured safe care was provided within a holistic framework. Moreover, this book offers insights for midwives to move beyond ‘rule-based’ practice, where the benefits of expert practice are illuminated.

Midwives facilitating ‘alternative’ physiological births epitomise evidence-based practice, which centres the woman or birthing person as the expert in their life, and the midwife meets them where they are with expert skills to support them. But what does this look like in clinical practice, particularly for those employed by institutions, those ‘working within the system’ who have constraints that private or self-employed midwives don’t have? How does a midwife cultivate those skills within a culture and climate that devalues both relationships, midwives and women’s autonomy? This book aims to provide a roadmap for those seeking to cultivate these skills. The core focus will be the midwife-mother relationship from the perspectives of the midwives, rather than the midwives wider working relationships or workplace contexts. This is purposeful so to offer a deep dive into the nuanced and varied ways of delivering this type of care. However, the realities of practice are also firmly embedded with the book, tensions will be explored, limitations acknowledged.