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Background: Midwifery-led care is a proven model for improving maternal and neonatal health. Despite its advantages, scaling up midwifery-led, evidence-based practices (MLEBPs), in low-resource settings like The Gambia, Malawi, and Ethiopia remains a challenge. This study would address barriers to promoting equitable and quality maternal care. Aim: To explore the healthcare-related challenges that affect the scaling up of midwifery-led, evidence-based practices in labour and childbirth in The Gambia, Malawi, and Ethiopia. Methodology: This study employed a qualitative design using online focus group discussions (FGDs) with 24 midwives and public health professionals from the three countries. Discussions were facilitated online, recorded, transcribed, and analysed using an inductive content analysis. Results: The participants identified multi-level interconnected barriers including limited awareness and cultural acceptance of midwifery-led care, infrastructural and geographical access challenges, policy and leadership constraints, midwife shortages, and inadequate resources for professional development and evidence-based practice. Conclusion: Barriers to scaling up MLEBPs are complex and exist across community, institutional and policy levels. Overcoming these requires a multi-level approach/multisectoral strategies, supportive leadership, community education, and sustained investment in midwifery workforce development.