Background: In the midwife profession and occupation, it is important to differentiate between the normal and the abnormal conditions during pregnancy and childbirth. When it starts to deviate towards the abnormal, it is important that the midwife can detect symptoms and make an adequate assessment of the women’s condition. The midwife may face challenging or/and facilitating factors when striving to differentiate between normal and abnormal. Aim: The aim of this study is to explore challenges and facilitating factors in differentiating between the normal and the abnormal conditions during pregnancy and childbirth from the perspective of midwifery students in The Gambia. Method: The authors interviewed 15 midwifery students individually at an education institution in The Gambia. A thematic analysis in six different steps was used, to analyze the data. Results: Tree main themes and seven sub-themes were used and identified. The main themes were: lack of recourses, available tools for daily work, challenges with referring system and assessment as a facilitating factor. Together with a presentation of the seven sub-themes: lack of human resources, lack of material recourses, guidelines, other tools, health system challenges, community based challenges, findings and investigation and assessment. Conclusion: The midwife was faced with several challenges and it was important for the midwives to do their assessment right from the start to be able to differentiate the normal and abnormal conditions. With points to the need to ensure that the midwives have the right prerequisites to perform their duties. Clinical applicability: Based on the results of the study more research is needed and knowledge. By drawing attention to this result and this study leads to more discussions which can be used in the clinical practice. This can lead to improvements in the area in clinical workplaces which can contribute to better conditions for midwives and midwifery students’ when it comes to differentiate between normal and abnormal conditions in pregnancy and childbirth.