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Problem Little is known about what midwifery leaders need to effectively contribute to maternity services reform. Background Despite evidence establishing midwifery continuity of care as the gold standard of maternity care, implementation of these models has been slow. Midwives in health service leadership roles are in an ideal position to re-orientate maternity services to midwifery continuity of care. Question What do midwives in leadership positions need in order to be effective in contributing to the reform of maternity services in Australia? Methods This qualitative descriptive study used purposive sampling to recruit 13 midwifery leaders from across Australia. Individual telephone interviews were conducted and analysed through line-by-line coding and identification of themes. Findings Five main themes emerged from the data: ‘core leadership skills and education are essential’; ‘motivation and commitment to implementing evidence-based maternity care’; ‘ability to create and sustain strategic relationships’; ‘bringing the vision to life’ which contained two sub-themes of ‘changing the culture’ and ‘reaching midwifery’s full potential’; and, ‘organisational support and commitment are key to maternity reform’. Discussion This study echoes findings from previous research emphasising the importance of leadership attributes and development opportunities for midwifery leaders. Additional needs of midwifery leaders were also revealed, which have not yet been extensively explored in the literature, including a strong commitment to continuity of care, effective relationships with key stakeholders and support from healthcare executives. Conclusion Midwifery leaders need to be equipped to contribute to maternity care reform through leadership development opportunities, effective relationships and support from healthcare executives.