Written by Chia-Yu Tang.
Image credit: National Taiwan University Hospital and its surroundings by Naoki Nakashima/ Flickr, license: CC BY-SA 2.0.
Introduction
In recent years, Taiwan’s Ministry of Health and Welfare (MOHW) has proposed amendments to the Standards for the Establishment of Midwifery Institutions to expand midwifery services. These changes include guidelines for registering midwifery practices, facility requirements, equipment standards, and supervision mechanisms—reflecting the growing interest in diversifying childbirth options and elevating the role of midwives.
Despite significant reforms, pregnant women in Taiwan still face constraints on their choices due to institutional barriers, information gaps, and a dominant medical model of care. This model—characterised by hospital-based, physician-led, and intervention-focused approaches—prioritises biomedical risk management over holistic, person-centred care. Consequently, maternity services often become fragmented and impersonal, limiting women’s autonomy in their childbirth experiences. In contrast, midwifery-led continuity models provide relationship-based support throughout pregnancy and birth, emphasising physiological birth processes and collaborative decision-making with women. These models can be effectively implemented across various settings—hospitals, dedicated midwifery clinics, or home environments—offering women meaningful choices about their birth experiences.
Birthplace Decisions: Balancing Safety and Autonomy
Women’s choices on where to give birth are shaped by perceptions of risk, trust in medical institutions, and familiarity with midwifery care. Among eight participants—seven first-time mothers and one second-time mother—three viewed hospitals as the safest option due to advanced infrastructure and access to emergency care. One participant described medical technologies such as foetal monitoring and IV drips as uncomfortable but necessary safeguards.
Another participant initially chose a hospital birth out of caution, though aware of alternatives. After learning more about midwifery, she began reconsidering her options for future pregnancies—illustrating how knowledge can shift risk perceptions. The dominant medical model reinforces hospital births as the norm, making alternatives appear risky and emotionally taxing to pursue.
Another participant viewed her choice of midwifery care as a form of “resistance” to medicalised childbirth, though she still weighed safety considerations. Meanwhile, one woman sought a middle ground by giving birth at an obstetrics clinic linked to a hospital, balancing convenience with emergency access.
Taken together, these experiences illustrate the complex and dynamic ways in which women assess not only the location but also the nature of maternity care—balancing safety, autonomy, and personal values in their search for an approach that feels both secure and supportive.
Choice of Care Providers: Navigating Between Expertise and Support
Women’s choice of care provider—physician, midwife, or both—reflects not only their philosophy on childbirth but also practical considerations. Among the eight participants, two patterns emerged. Two participants followed a physician-led model throughout pregnancy, birth, and postpartum, trusting in its professionalism and reliability. The majority, however, adopted a hybrid approach. Some trusted their physicians for delivery but preferred midwives for prenatal and postnatal care. Others relied on midwives for all prenatal education and postpartum support, turning to physicians only for ultrasound scans.
The blending of roles illustrates a growing appreciation for interprofessional collaboration, where medical and midwifery care are seen as complementary. For instance, one participant benefited from prenatal classes led by midwives, which deepened her relationship with them during labour—even as physicians handled medical interventions.
Women navigating complex births found reassurance in this mixed model: physicians provided safety through clinical expertise, while midwives offered continuity, emotional presence, and individualised care. These experiences highlight how women increasingly tailor their provider choices to balance medical security with relational support—underscoring the demand for continuity of care across the childbirth journey.
Continuity of Care: Building Trust Across the Maternity Journey
Continuity of care—having the same provider or team throughout pregnancy, birth, and postpartum—is a key element shaping women’s birth experiences. While often linked to midwifery models, one participant highlighted that physician-led teams can also offer consistent care. Still, many found that midwife-led continuity created stronger emotional bonds and a deeper sense of security.
Another participant observed that hospital-based physicians, limited by time constraints, were less able to provide in-depth consultations. In contrast, midwives typically offered longer, more personalised interactions—particularly valued during labour for their emotional support.
A second-time mother highlighted that for first-time mothers, continuity plays a vital role in reducing uncertainty and offering stability. Another shared that ongoing postpartum care from a familiar midwife eased her transition into motherhood.
Continuity of care is often associated with midwife-led models, yet participants noted that physician-led teams can also provide consistent and reassuring care when conditions allow. This suggests that continuity should be understood less as provider-specific and more as a relational and structural quality of care. Drawing on Maillefer et al., the integration of a midwife-led unit (MLU) into a hospital setting exemplifies how interprofessional collaboration—rather than competition—can enable a more balanced approach between physiological and pathological paradigms. For Taiwan, where obstetric-led care dominates, and midwives are often marginalised, such a model offers a compelling framework. Re-conceptualising childbirth, then, is not only about expanding midwifery services but about transforming how care is delivered—through collaborative structures that ensure safety, personalisation, and continuity within institutional settings.
Conclusion
Taiwan’s evolving regulations on midwifery signal growing recognition of women’s diverse childbirth needs. Yet the dominant hospital-based, physician-led model—centred on biomedical risk management—continues to shape perceptions of safety and normal birth practices. While this model offers technological reassurance, it frequently lacks the relational continuity and emotional support characteristic of midwifery-led care.
In this article, I show that women’s choices around care settings, providers, and continuity are rarely clear-cut. Instead, they reflect complex negotiations of institutional constraints, personal values, and perceived risks. Some participants chose physician-led care for its perceived reliability, valuing medical expertise and institutional resources. Others adopted hybrid models that integrated clinical safety with the more personalised and empowering experience midwives were known to provide.
Rather than framing midwifery and obstetric care as oppositional, this article underscores the value of interprofessional collaboration in creating more balanced and responsive models. As Maillefer et al. demonstrates, integrating midwife-led units within hospitals can blend physiological and medical approaches while ensuring safety and woman-centred care.
To advance such models, I recommend that Taiwan enact structural reforms enabling collaboration and continuity—expanding midwifery training, institutionalising midwife-led units, and strengthening referral systems. Policy support for team-based care and sustained provider relationships, coupled with public education on birth options, can help ensure women receive care that aligns with their needs and values.
In line with the 2025 World Health Day theme, Healthy beginnings, hopeful futures, these policy shifts are essential not only to reduce preventable maternal and newborn deaths but also to ensure that all women and babies can thrive—physically, emotionally, and socially. By broadening its care frameworks, Taiwan can move beyond a one-size-fits-all approach—ensuring all women receive care that is safe, respectful, and aligned with their individual needs.
Chia-Yu Tang is a PhD candidate in the Joint PhD Program in Public Sociology at National Chengchi University and Academia Sinica, Taiwan. Her research focuses on maternity care, body politics, and interpersonal dynamics. She is currently conducting a longitudinal study on pregnant women of childbearing age, examining their medical interactions, bodily experiences, and social connections. This article presents part of her research findings. Email: tang.chiayuyu@gmail.com
Taiwan Insight 