Our study shows an urgent need for systemic changes to better support midwives in this demanding aspect of reproductive healthcare. We provide practical recommendations for institutions to implement as first steps to improve midwives' wellbeing.
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Midwives reported a range of self-care strategies although these did not provide enough respite. Despite these difficulties, we found that midwives are deeply committed to providing compassionate and woman-centred care, viewing it as integral to their professional identity.

Our findings highlight significant challenges faced by these midwives, including a lack of adequate training and institutional support, leading to feelings of being "failed by the system". Midwives reported experiencing considerable grief, moral distress, and abortion stigma.

We analysed open text responses from a survey of Australian and New Zealand midwives to explore experiences and challenges of midwives who care for women undergoing TOP after 14 weeks' gestation. Data were grouped into 4 categories.