Midwives demonstrated high agency, leveraging informal networks to access preferred continuity models, achieving elevated normal vaginal birth rates, and high satisfaction with maternity care provision. However, postnatal care emerged as a neglected ‘Cinderella’ service, intensifying isolation, breastfeeding challenges, and unmet needs. Professional knowledge provided reassurance but amplified anxiety, unrealistic expectations, and dissonance when outcomes diverged, with 12.5% reporting negative/traumatic births linked to coercion, interventions, and poor support. Self-reported postnatal depression (12.5%) and posttraumatic stress disorder (3–6%) were elevated compared with typical community rates reported in the literature.

Childbearing reshaped practice ambivalently: positive experiences boosted empathy and advocacy, while negative ones risked projection, bias, emotional overload, burnout, trauma re-triggering upon return-to-work, and identity strain.