Midwives' and Nurse Midwives' Autonomy Experience in Caring for Laboring Women in Health Facilities: A Systematic Review With Metasynthesis.

INTRODUCTION: The World Health Organization emphasizes the autonomy of Midwives and Nurse Midwives in physiological care during childbirth. Despite international regulation of competencies, the expression of autonomy isn't consistent, potentially creating inconsistencies in clinical care and professional identity. The objective was to synthesize evidence on the experiences of Midwives and Nurse Midwives regarding autonomy in caring for laboring women in health facilities. METHODS: Systematic review with metasynthesis, according to the methodology of the Joanna Briggs Institute, carried out by meta-aggregation. Nine platforms and databases were searched for primary studies published from 2016/2024 in English, French, Spanish, and Portuguese. The selection of studies followed the PRISMA guidelines. Sixteen articles met the eligibility and methodological quality criteria. Registered protocol in PROSPERO. RESULTS: Three categories emerged: (a) autonomy as a context of safety and confidence, (b) autonomy as a process of strengthening identity, and (c) autonomy as a reflection of expertise. These generated the meta-category: The dynamics of Midwives/Nurse Midwives' autonomy. CONCLUSION: The autonomy of Midwives and Nurse Midwives in "being and doing" affirms their identity, expresses their expertise, and promotes the confidence and safety of laboring women. Autonomous Midwives and Nurse Midwives make childbirth a unique and unrepeatable event while defending physiological care. Recognizing the autonomy of Midwives and Nurse Midwives strengthens global health.