Abstract
This perspective and policy reflection explores the evolving role of midwifery care within contemporary healthcare systems, highlighting the need to reorient maternity care interventions toward models aimed at promoting and safeguarding physiological processes, centred on the person, and grounded in a rights-based approach. In the context of increasing chronic conditions, psychosocial stress, and the medicalisation of pregnancy and childbirth, the promotion of physiology — particularly during the first 1,000 days — emerges as a strategic public health priority with long-term implications for maternal, neonatal, and societal well-being. The paper examines organisational models such as the Low Obstetric Risk (LRO) framework and the Italian Community Health Centres, emphasising their capacity to enhance continuity of care, reduce unnecessary interventions, and address social and health inequities. Special attention is given to the midwife’s role as case manager, including in non-physiological scenarios such as labour with epidural analgesia, where interdisciplinary collaboration and emotional, relational, and informational support remain essential. The article further discusses the competencies required of the 21st-century midwife, underscoring continuous education, advanced clinical skills, community engagement, and participation in research and innovation — including the ethical integration of artificial intelligence. The work advocates for a paradigm shift toward an integrated, holistic, and salutogenic model of maternity care, positioning midwives as key agents in promoting individualised, safe, and sustainable birth pathways.