Organizing precense: How Caseload Shapes Embodied Quality in Birth Care

Background: Caseload midwifery is associated with improved outcomes and greater relational continuity, but less is known about how midwives themselves experience quality in care within different organizational frameworks.
Aim: This study explores how midwives experience quality in childbirth through the lens of Heidegger’s existential ontology and Merleau-Ponty’s phenomenology, focusing on how organizational structures shape the conditions for relational presence and meaningful engagement.
Methods: Based on phenomenological interviews with Danish midwives working in both caseload and standard models, supplemented with empirical material from a Danish evaluation report, the study employs a Heideggerian and Merleau-Pontian framework to examine how quality is lived, remembered, and embodied. The analysis is delimited to explore midwives’ experiences of entering the birth room, to better understand how presence and embodied responsiveness emerge as conditions for quality.
Findings:
Midwifery practice around birth emerges as a continuum of embodied relational presence shaped by organizational form. Caseload midwifery fosters a mode of professional being that supports continuity, familiarity, and a richly embodied form of engagement. In standard care, the embodied dimension appears less fully expressed, with presence often shaped by procedural demands and institutional tempo. Yet across both models, midwives seek ways of grounding their presence. In caseload settings, this takes the form of tacit coordination, where shared attunement replaces verbal instruction, revealing an embodied expertise that remains under-recognized. In standard care, midwives likewise strive for connection, often through more observational or interpretive practices. Notably, midwives also recall and describe their experiences of entering the birth room differently depending on the organizational model—suggesting that memory itself is shaped by the conditions for embodied presence. This continuum highlights how midwifery practice involves a balancing of bodily, relational, and institutional orientations in the moment of care. These findings are limited to the perspectives of midwives themselves and reflect their lived experiences within their respective organizational settings.

Conclusion: Organizational form configures the existential conditions of care—not merely in terms of presence, but in terms of what kinds of embodied practicing become possible. Caseload midwifery enables a mode of caregiving that is not only relationally attuned but corporeally integrated, allowing midwives to inhabit the birth space as a lived field of practice. This shapes how professional meaning is enacted and how quality is experienced from within.