Attitudes, interest and involvement of midwives in an RCT: A qualitative study with a phenomenological approach

In order to improve evidence-based, woman-centered care, research is an essential component of midwifery professional practice. The active involvement of clinical midwives in randomized controlled trials (RCTs) remains modest, despite its acknowledged relevance. The study aims to explore attitudes, interest, and involvement of midwives in an RCT. A qualitative study informed by descriptive phenomenology was conducted in a second-level maternity unit in Northern Italy. Twenty-one clinical midwives participated in four focus groups prior to the implementation of an RCT evaluating a non-pharmacological intrapartum intervention. Data were audio-recorded, transcribed verbatim, and analyzed using thematic analysis supported by NVivo software. Four themes were identified: 1) Using research to inform practice; 2) Challenges related to RCT design features; 3) Challenges related to midwives’ involvement; and 4) Strategies to support midwives’ involvement. Midwives perceived research as essential for improving care, strengthening professional identity, and advancing midwifery within the scientific community. Evidence generation was closely linked to their commitment to woman-centered care and professional advocacy. However, RCT participation generated tensions between protocol adherence and individualized care. Increased workload, procedural complexity, and cognitive demands within busy clinical settings were described as key barriers. Facilitators included supportive leadership, the presence of a dedicated reference person, peer collaboration, preparatory and ongoing meetings, and alignment between research topics and clinical practice. Midwives’ engagement in RCTs is shaped not only by organizational factors but also by professional identity and relational values. Supportive research environments and structured mentorship may enhance meaningful participation and contribute to a sustainable research culture within midwifery practice.