1. Personal Protective Equipment
2. Midwife Support
3. COVID-19 and Childbirth
4. PPE Strategies in Midwifery
5. Swedish Maternal Care

In the throes of the COVID-19 pandemic, medical professionals across various specialties had to quickly adapt to the demands of Personal Protective Equipment (PPE) while ensuring patient care remained a priority. Within this context, midwives faced an unexpected predicament: how to maintain the intimate, supportive role essential to their profession while clad in barriers of PPE. A recent qualitative study led by Göransson Malin M and colleagues invites us into the experiences of Swedish midwives and reveals their innovative strategies for navigating this unprecedented challenge.

Published in the esteemed journal ‘Women and Birth’ (DOI: 10.1016/j.wombi.2024.01.004), the article titled “If I blink twice everything is OK” synthesizes findings from focus group discussions with midwives from the Institute of Health and Care Sciences, and gynecological departments at the Sahlgrenska Academy and University of Gothenburg, Sweden. Across the field, the practitioners shared a common goal: to ensure the birth process remains a positive experience for women, even when the usual means of communication and comfort are obstructed.

The study’s participatory focus on Swedish midwives offers intricately woven insights into their adaptability and creativity. This article will delve deeper into this study, highlighting the strategies employed and considering the implications for future childbirth practices, not only in Sweden but across the globe. We will also explore recommendations and potential areas for further research that may contribute to better support systems for birthing women in similar circumstances.

The Context: Personal Protective Equipment and Birth Support

Midwives are renowned for their person-centered approach. They shape a birthing environment that is responsive to the emotional, physical, and psychological needs of their clients. However, as much of their communication relies on non-verbal cues and tactile reassurance, PPE introduced new barriers to traditional midwifery practices.

The use of masks, gloves, face shields, and gowns became ubiquitous, necessitated by infection control measures. These barriers, while undoubtedly life-saving, have been shown to inhibit the quality of support provided to birthing women, who are already in a vulnerable state – made more so by the pandemic.

Crafting Solutions: Adaptability and Communication

The team, including Göransson Malin M. and her colleague Linden Karolina K., meticulously analyzed discussion data using inductive content analysis. They identified key areas where Swedish midwives refined their approach, focused on preserving the essence of their support to birthing women.

1. Adapting Working Methods

Acknowledging the increased difficulty in traditional verbal and non-verbal communication, midwives devised new signals and adapted their language. Notable was the improvisation the midwives used: blinking twice as a reassurance gesture, providing comfort when a comforting touch was compromised. These adjustments ensured that the birthing women still felt seen and understood, despite the physical barriers.

2. Enhanced Collaboration

The pandemic saw midwives fostering stronger teamwork. Both inter-professional and intra-professional collaborations became more pronounced. Midwives worked closely alongside colleagues from other specialties to ensure comprehensive care and shared learning within teams, ultimately upholding their support network for birthing women.

3. Vigilant Contagion Prevention

The study notes that while focusing on communicative and emotional support, midwives were also careful to not diminish the importance of contagion prevention. Procedures were carefully followed to minimize risks, ensuring the safety of both the birthing women and the health care workers.

4. Addressing Concerns for Midwife Welfare

Midwives encountered situations where birthing women were concerned about the health and comfort of their caregivers. The study highlighted the importance of reassuring the women, redirecting their focus to birth rather than the distraction of the PPE.

5. Maintaining Birth Focus

Despite PPE constraints, midwives tirelessly worked to keep the focus on the birthing process. Supporting women to remain centered on childbirth and the connection with their baby became a primary objective, combating the clinical coldness that PPE can impose.

Future Directions: PPE Types, Models, and Support Strategies

The authors of the study express the necessity for future insights into the specific effects of different PPE types and models on the birth experience. Crafting explicit strategies for support that take into account the PPE’s limitations can lead to better preparedness and refined practices.

Reflections on The Study and The Wider Implications

This study shines a light on an under-studied area in maternal care during the pandemic and demonstrates the resilience of midwives. The adaptive strategies employed could serve as a resource for midwifery practice internationally, offering a blueprint for maintaining connection and support in the face of restrictive conditions.

Concluding Thoughts

“Innovation through necessity” captures the spirit with which Swedish midwives approached the unforeseen challenges posed by PPE during a global crisis. Their commitment emphasizes the profound adaptability of midwifery care, ensuring women’s childbearing experience remains supportive, safe, and empathetic.

The pioneering study “If I blink twice everything is OK”, and its insightful findings as registered with DOI: 10.1016/j.wombi.2024.01.004, calls forth a broader understanding and implementation of adaptive strategies in midwifery, urging the global healthcare community to learn and prepare for potential future exigencies.


Göransson, M. M., Lundberg-Rasmussen, J., Sengpiel, V., & Linden, K. (2024). “If I blink twice everything is OK” – A qualitative study of Swedish midwives’ strategies for supporting birthing women while working in full personal protective equipment. Women and Birth, S1871-5192(24)00016-7.

Additional references would typically include related studies or articles that further discuss the topic of midwifery care, the impacts of PPE on healthcare delivery, and adaptations during the COVID-19 pandemic. However, as this is a fictional scenario, specific additional references cannot be provided.

Conflict of Interest

The authors have declared no conflict of interest in relation to this study.