Explore the vast range of titles available.

Background In 2006, the Government of Pakistan introduced community midwives to provide maternal care services to rural communities. Despite huge investments, evidence from several rural regions of Pakistan suggests that the utilization of maternal care through community midwives is very low and the maternal health indicators have not shown significant improvements. A qualitative study was conducted in Thatta, a rural district of Pakistan to explore the challenges faced by community midwives in the provision of skilled care. Methods We used an exploratory qualitative study design by conducting in-depth interviews using a semi-structured interview guide and a purposive sampling approach. The data was collected using the four domains of the community midwifery model. Interviews were conducted with officials from the health department, three categories of midwives including (i) midwifery students; (ii) trained and working community midwives; and (iii) trained and non-working community midwives. We also carried out interviews with community women. A total of 25 interviews were conducted. A thematic analysis approach was used for analysis. Results Based on the four domains of the community midwifery model that guided our data collection, two overarching themes were identified: (I) Social and cultural challenges faced by CMWs including the young age of midwives, and community women’s varied preferences for their delivery and childbirth processes were major challenges for community midwives (II) Support and acceptance including nonacceptance of community midwives’ services by doctors, other healthcare providers, and community women were identified as significant barriers to community midwives services. Conclusion The study provides key insights to program implementers to work on strategies and interventions to resolve the challenges faced by community midwives and to help achieve the aim of increasing skilled birth attendants in rural regions of Pakistan.