title: Sustainability and resilience in midwifery: A discussion paper.
abstract: BACKGROUND
  midwifery workforce issues are of international concern. Sustainable midwifery practice, and how resilience is a required quality for midwives, have begun to be researched. How these concepts are helpful to midwifery continues to be debated. It is important that such debates are framed so they can be empowering for midwives. Care is required not to conceptually label matters concerning the midwifery workforce without judicious scrutiny and diligence.
  
  
  OBJECTIVE
  the aim of this discussion paper is to explore the concepts of sustainability and resilience now being suggested in midwifery workforce literature. Whether sustainability and resilience are concepts useful in midwifery workforce development is questioned.
  
  
  METHODS
  using published primary midwifery research from United Kingdom and New Zealand the concepts of sustainability and resilience are compared, contrasted and explored.
  
  
  RESULTS
  there are obvious differences in models of midwifery care in the United Kingdom and New Zealand. Despite these differences, the concepts of resilience and sustainability emerge as overlapping themes from the respective studies' findings. Comparison between studies provides evidence of what is crucial in sustaining healthy resilient midwifery practice. Four common themes have been identified that traverse the different models of care; Self-determination, ability to self-care, cultivation of relationships both professionally and with women/families, and a passion, joy and love for midwifery.
  
  
  CONCLUSIONS
  the impact that midwifery models of care may have on sustainable practice and nurturing healthy resilient behaviors remains uncertain. The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking. Resilience may be interpreted as expecting midwives 'to toughen up' in a workplace setting that is socially, economically and culturally challenging. Sustainability calls for examination of the reciprocity between environments of working and the individual midwife. The findings invite further examination of contextual influences that affect the wellbeing of midwives across different models of care.
authors.affiliation: Robert Gordon University, Aberdeen, Scotland, UK. Electronic address: s.a.crowther@rgu.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Crowther
authors.affiliation: School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, United Kingdom. Electronic address: HunterB1@cardiff.ac.uk.
authors.forename: Billie
authors.initials: B
authors.lastname: Hunter
authors.affiliation: Midwifery Department, Auckland University of Technology, New Zealand. Electronic address: jmcaraco@aut.ac.nz.
authors.forename: Judith
authors.initials: J
authors.lastname: McAra-Couper
authors.affiliation: All Wales Midwifery and Reproductive Health Research Forum, Maternal and Child Health School of Healthcare Sciences, United Kingdom.
authors.forename: Lucie
authors.initials: L
authors.lastname: Warren
authors.affiliation: Midwifery Department, Auckland University of Technology, New Zealand.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gilkison
authors.affiliation: Midwifery Department, Auckland University of Technology, New Zealand. Electronic address: mhunter@aut.ac.nz.
authors.forename: Marion
authors.initials: M
authors.lastname: Hunter
authors.affiliation: Centre for Midwifery and Women's Health Research, Auckland University of Technology, New Zeland. Electronic address: afielder@aut.ac.nz.
authors.forename: Anna
authors.initials: A
authors.lastname: Fielder
authors.affiliation: Sheffield Hallam University, United Kingdom. Electronic address: maviskirkham@hotmail.co.uk.
authors.forename: Mavis
authors.initials: M
authors.lastname: Kirkham
mesh_terms: D000328:Adult; D005260:Female; D006280:Health Workforce; D006801:Humans; D007400:Interprofessional Relations; D008427:Maternal Health Services; D008880:Midwifery; D009520:New Zealand; D011247:Pregnancy; D036301:Qualitative Research; D012648:Self Care; D006113:United Kingdom; D017132:Workplace
keywords: Midwifery; Models of care; New Zealand; Relationships; Resilience; Sustainability; United Kingdom