A Concept Analysis of the Dynamics of Risk, Midwifery Agency and the Maternity Early Warning Tool

AIM: To examine the concept of midwifery agency when using Maternity Early Warning Tools. DESIGN: Concept analysis using Rogers' evolutionary method. METHODS: Data were collected from interviews with midwives working in various Australian maternity settings. A subset of the dataset was collected and analysed (2021-2022) to examine how agency functions when midwives use Maternity Early Warning Tools. RESULTS: Three conceptual attributes fundamental to agency were identified: considered judgement, reasoned clinical decision-making, and collaborative action. These attributes reveal how midwives navigate the interface between structured risk management tools and relational, woman-centred care. CONCLUSIONS: Maternity Early Warning Tools can either limit or enhance professional agency. When used reflexively, they become artefacts that support learning, communication, and sound clinical judgement. Viewing these tools as enablers rather than enforcers sustains midwifery expertise and strengthens interdisciplinary collaboration. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT: Sustaining midwifery agency protects both professional integrity and the quality of woman-centred care. IMPACT: What problem did the study address? How the use of Maternity Early Warning Tools influences midwives' agency.