A balancing act: Primary care midwives screening for fetal growth restriction- a focus group study.

Background: Fetal growth restriction in low-risk pregnancies often remains undetected, despite its association with perinatal morbidity and mortality. While technical improvements in screening have been widely studied, little is known about how autonomous midwives in primary care settings navigate screening for fetal growth restriction in daily practice. Aim: To better understand how midwives in low-risk settings navigate the screening process for fetal growth restriction, and to identify opportunities for improvement. Methods: An interpretative qualitative study was conducted based on five online focus groups with 21 participants, including midwives and senior midwifery students across the Netherlands. Reflexive thematic analysis was carried out by a multidisciplinary team. Findings: Midwives described screening for fetal growth restriction as a balancing act shaped by diagnostic uncertainty, ambiguous guidelines, interprofessional mistrust and moral responsibility. Five themes were identified: managing screening uncertainty, adapting to women's care needs, coping with a lack of trust in collaboration with secondary care, balancing tradition and innovation within professional identity, and maintaining professional confidence. Conclusion: Screening for fetal growth restriction is not only a technical act but also a relational and value-laden practice. Midwives' practices reflect a continuous negotiation between societal reliance on technology, the limitations of current tools and guidelines, interprofessional tensions, and the relational and moral responsibilities of care. Improving screening therefore requires more than technical solutions: it calls for clear guidelines, respectful collaboration, and supportive structures that enable midwives to practice with confidence and trust.