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Midwife
A pregnant woman receives an ultrasound examination from a midwife sonographer
Occupation
NamesMidwife[1]
Occupation type
Professional
Activity sectors
Midwifery, obstetrics, newborn care, women's health, reproductive health
Description
CompetenciesKnowledge, professional behaviour and specific skills in family planning, pregnancy, labour, birth, postpartum period, newborn care, women's health, reproductive health, and social, epidemiologic and cultural context of midwifery[2]
Education required
  • Bachelor of Midwifery
  • Master of Midwifery
Fields of
employment
hospitals, clinics, health units, maternity units, birth facilities, private practices, home births, community, etc.
Related jobs
obstetrician, gynecologist, paediatrician

A midwife (pl.: midwives) is a health professional who cares for mothers and newborns around childbirth, a specialisation known as midwifery.

The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; concentrating on being experts in what is normal and identifying conditions that need further evaluation. In most countries, midwives are recognised as skilled healthcare providers. Midwives are trained to recognise variations from the normal progress of labour and understand how to deal with deviations from normal. They may intervene in high risk situations such as breech births, twin births, using non-invasive techniques[citation needed]. For complications related to pregnancy and birth that are beyond the midwife's scope of practice, including surgical and instrumental deliveries, they refer their patients to physicians or surgeons.[3][4] In many parts of the world, these professions work in tandem to provide care to childbearing women. In others, only the midwife is available to provide care, and in yet other countries, many women elect to use obstetricians primarily over midwives.

Many developing countries are investing money and training for midwives, sometimes by retraining those people already practicing as traditional birth attendants. Some primary care services are currently lacking, due to a shortage of funding for these resources.

Definition and etymology

[edit]

According to the definition of the International Confederation of Midwives, which has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics:[1]

A midwife is a person who has successfully completed a midwifery education programme that is recognised in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice[2] and the framework of the ICM Global Standards for Midwifery Education;[5] who has acquired the requisite qualifications to be registered or legally licensed to practice midwifery and use the title midwife; and who demonstrates competency in the practice of midwifery.

The word derives from Middle English mid, "with", and wif, "woman", and thus originally meant "with-woman", that is, a woman who is with another woman and assists her in giving birth.[6][7] The term "male midwife" is common parlance when referring to males who work as midwives.

In English, the noun midwife is gendered, and in most countries, the corresponding noun and practice is historically used for women (sometimes banned for men), while in English, the verb midwifery is also applied to men (e.g. Havelock Ellis is said to have midwifed bigamist Howard Hinton's aka John Weldon's twins in 1883;[8] historically, assistance was done by relatives, even only husbands, while male midwifery, excluding relatives, being common in some cultures, dates back to the mid 1900's; for Semelai people women also practised it up to 1980, while by 1992 some areas had only male midwives, and later most areas had only male midwives[9]).

The older Semelai word for midwife, mudem, "itself provides insight into the ritual role a midwife is expected to play. Mudem also meant, and continues to mean, 'circumcisor'."[9]

Scope of practice

[edit]
The 112 countries containing member associations of the International Confederation of Midwives (ICM) in 2017[10]

The midwife has a certification and can either be a certified nurse midwife (CNM) or a certified professional midwife (CPM) and is recognized as a responsible and accountable professional who works in partnership with women to give necessary support preconception, during pregnancy, labor, and the postpartum period. When using a midwife preconception all the way through postpartum they give the best chance of increasing the mother and the infants health. They also provide care for the newborn and the infant up to a month after birth; this care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, perventing disease, the accessing of medical care and proscribing medicinces when needed or other appropriate assistance, and the carrying out of emergency measures.[11]

The midwife has an important task in health counselling and education, not to be easily mistaken as a doula who also helps with education but mainly focuses on supporting the women both physically, with certain positions that make delievery more comfortable, or emotionally helping them remain calm and collected. Midwife's don't only educate the woman giving birth, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to the pregnant's health, sexual or reproductive health, and child care.

A midwife may practice in any setting, including the home, community, hospitals, clinics, or health units.[1] Specific midwifery guides are made to help instruct midwives, which include material relating to prenatal and postnatal care. Midwifery guides are also written to be accessible to everyone, not just midwives.

Education, training, regulation and practice

[edit]

Australia

[edit]
Education, training and regulation

The undergraduate midwifery programs are three-year full-time university programs leading to a bachelor's degree in midwifery (Bachelor of Midwifery) with additional one-year full-time programs leading to an honours bachelor's degree in midwifery (Bachelor of Midwifery (Honours)).[12] The postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (Master in Midwifery, Master in Midwifery (Research), MSc Midwifery). There are also postgraduate midwifery programs (for registered nurses or paramedics who wish to become midwives) leading to a bachelor's degree or equivalent qualification in midwifery (Bachelor of Midwifery, Graduate Diploma in Midwifery).[13]

Midwives in Australia must be registered with the Australian Health Practitioner Regulation Agency to practice midwifery, and use the title midwife or registered midwife.

Practice

Midwives work in a number of settings including hospitals, birthing centres, community centres and women's homes. They may be employed by health services or organisations, or self-employed as privately practising midwives. All midwives are expected to work within a defined scope of practice and conform to ongoing regulatory requirements that ensure they are safe and autonomous practitioners.

Professional associations/colleges
  • Australian College of Midwives (ACM).[14]

Canada

[edit]

Midwifery was reintroduced as a regulated profession in most of Canada's ten provinces in the 1990s.[15] Prior to this legalization, some midwives had practiced in a legal "grey area" in some provinces.[16] In 1981, a midwife in British Columbia was charged with practicing without a medical license.[17]

After several decades of intensive political lobbying by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia (regulated since 1995), Alberta (regulated since 2000, fully funded since 2009) Saskatchewan (regulated since 1999), Manitoba (regulated since 1997), Ontario (regulated since 1991), Quebec (regulated since 1999), and Nova Scotia (regulated since 2006), and in the Northwest Territories (regulated since 2003) and Nunavut (regulated since 2008).[17] In 2023, Midwifery is regulated in New Brunswick, Newfoundland and Labrador, Prince Edward Island and Yukon.[18]

Education, training and regulation

The undergraduate midwifery programs are four-year full-time university programs leading to bachelor's degrees in midwifery (B.H.Sc. in Midwifery, Bachelor of Midwifery).[19]

In British Columbia, the program is offered at the University of British Columbia. Mount Royal University in Calgary, Alberta offers a Bachelor of Midwifery program. In Ontario, the Midwifery Education Program (MEP) is offered by McMaster University and Toronto Metropolitan University and previously by Laurentian University. In Manitoba, the program is offered by the University of Manitoba and previously at the University College of the North.[20] In Quebec, the program is offered at the Université du Québec à Trois-Rivières.[21] In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities.[22] There is also a programme for aboriginal midwives in Ontario.[23] In Ontario, the Midwifey Act exempts Indigenous people from obtaining a four-year midwifery degree or registering with the College of Midwives of Ontario if they practice as midwife in their own community.[24]

There are also three "bridging programs" for internationally educated midwives. The International Midwifery Pre-registration Program (IMPP) is a nine-month program offered by Toronto Metropolitan University in Ontario. The Internationally Educated Midwives Bridging Program (IEMBP) runs between 8 and 10 months at the University of British Columbia. At the Université du Québec à Trois-Rivières, French-speaking internationally trained midwives may earn the Certificat personnalisé en pratique sage-femme.

Midwives in Canada must be registered, after assessment by the provincial regulatory bodies, to practice midwifery, and use the title midwife, registered midwife or, the French-language equivalent, sage-femme.

Practice

From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice is offered in a variety of ways within regulated provinces: midwives offer continuity of care within small group practices, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care. When women or their newborns experience complications, midwives work in consultation with an appropriate specialist. Registered midwives have access to appropriate diagnostics like blood tests and ultrasounds and can prescribe some medications. Founding principles of the Canadian model of midwifery include informed choice, choice of birthplace, continuity of care from a small group of midwives and respect for the mother as the primary decision maker. Midwives typically have hospital privileges, and support the woman's right to choose where she has her baby.[citation needed]

The legal recognition of midwifery has brought midwives into the mainstream of health care with universal funding for services, hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients and full consultation access to physicians. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place, informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution.

Prior to legislative changes, very few Canadian women had access to midwifery care, in part because it was not funded by the health care system. Legalizing midwifery has made midwifery services available to a wide and diverse population of women and in many communities, the number of available midwives does not meet the growing demand for services. Midwifery services are free to women living in provinces and territories with regulated midwifery.

Professional associations/colleges
  • Canadian Association of Midwives (CAM).[25]

British Columbia

[edit]

On 16 March 1995, the BC government announced the approval of regulations that govern midwifery and establish the College of Midwives of BC. In 1996, the Health Professional Council released a draft of Bylaws for the College of Midwives of BC, which the Cabinet approved on 13 April 1997. In 1998, midwives were officially registered with the College of Midwives of BC.[26]

In BC, midwives are primary care providers for women in all stages of pregnancy, from prenatal to six weeks postpartum. Midwives also care for newborns. The approximate proportion of women whose primary birth attendant was a midwife in British Columbia has been evaluated.[27]

Midwives in BC can deliver natural births in hospitals or homes. If a complication arises in a pregnancy, labour, birth, or postpartum, a midwife consults with a specialist such as an obstetrician or paediatrician. Core competencies and restricted activities are included in the BC Health Professions Act Midwives Regulation. As of April 2009, the scope of practice for midwives allows them to prescribe certain prescription drugs, use acupuncture for pain relief, assist a surgeon in a caesarean section delivery and to perform a vacuum extraction delivery. These specialized practices require additional education and certification.

As of November 2015, the College of Midwives of British Columbia[28] reported 247 General, 2 Temporary, 46 Non-practicing Registrant midwives. There were 2 midwives per 100,000 people in BC in 2006.[29]

A midwife must register with the College of Midwives of BC to practice. To continue licensure, midwives must maintain regular recertification in neonatal resuscitation and management of maternal emergencies, maintain the minimum volume of clinical care (40 women), participate in peer case reviews and continuing education activities.[26]

The University of British Columbia (UBC) has a four-year Bachelor of Midwifery program.[30] The UBC midwifery program is poised to double in size thanks to an increase in government funding. Graduation of students will increase to 20 per year.

In terms of professional associations, BC has both the College of Midwives of BC[26] and the Midwives Association of BC.[31]

European Union

[edit]

The qualification of midwife in the European Union is regulated by Directive 2005/36/EC.[32]

France

[edit]
Two French midwives (sages-femmes)

Midwives (sage-femmes, literally meaning "wise-woman," or maïeuticien/maïeuticienne) are independent practitioners, specialists in birth and women's medicine.

Midwife studies last a minimum of five years.[33]

Midwives in France must be registered with the Ordre des sages-femmes[34] to practice midwifery and use the title sage-femme.

Professional associations/colleges:

  • L'Ordre des Sages-Femmes, Conseil National (CNOSF).[35]
  • Collège National des Sages-Femmes de France (CNSF).[36]
  • Société Française de Maïeutique (SFMa).

Ireland

[edit]
Education, training and regulation

The undergraduate midwifery programs are four-year full-time university programs, with an internship in the final year, leading to an honours bachelor's degree in midwifery (BSc (Hons) Midwifery).[37] The postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (MSc Midwifery, MSc Midwifery Practice). There are also postgraduate midwifery programs (for registered general nurses who wish to become midwives) leading to a qualification in midwifery (Higher Diploma in Midwifery).

Midwives must be registered with the Nursing and Midwifery Board of Ireland (NMBI) to practice midwifery, and use the title midwife or registered midwife.

Netherlands

[edit]
Education, training and regulation

The undergraduate midwifery programs are four-year full-time university programs leading to a bachelor's degree in midwifery (HBO-bachelor Verloskunde).[38] There are four colleges for midwifery in the Netherlands: in Amsterdam, Groningen, Rotterdam and Maastricht. Midwives are called vroedvrouw (knowledge woman), vroedmeester (knowledge master, male), or verloskundige (deliverance experts) in Dutch.

Practice

Midwives are independent specialists in physiologic birth. In the Netherlands, home birth is still a common practice, although rates have been declining during the past decades. Between 2005 and 2008, 29% of babies were delivered at home.[39] This figure fell to 23% delivered at home between 2007 and 2010 according to Midwifery in the Netherlands, a 2012 pamphlet by The Royal Dutch Organization for Midwives.[40] In 2014 it has dropped further to 13.4%. perined.nl/jaarboek2104.pdf.

Midwives are generally organized as private practices, some of those are hospital-based. In-hospital outpatient childbirth is available in most hospitals. In this case, a woman's own midwife delivers the baby at the delivery room of a hospital, without intervention of an obstetrician. In all settings, midwives transfer care to an obstetrician in case of a complicated childbirth or need for emergency intervention.

Apart from childbirth and immediate postpartum care, midwives are the first line of care in pregnancy control and education of mothers-to-be. Typical information that is given to mothers includes information about food, alcohol, life style, travel, hobbies, sex, etc.[41] Some midwifery practices give additional care in the form of preconceptional care and help with fertility problems.[42]

All care by midwives is legal and it is totally reimbursed by all insurance companies. This includes prenatal care, childbirth (by midwives or obstetricians, at home or in the hospital), as well as postpartum/postnatal care for mother and baby at home.[43][44]

Professional associations/colleges
  • Royal Dutch Organisation of Midwives | Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV).[45]

Japan

[edit]
Education, training and regulation

Midwifery was first regulated in 1868. Today midwives in Japan are regulated under the Act on Public Health Nurse, Midwife and Nurse (No. 203) established in 1948. Japanese midwives must pass a national certification exam. On 1 March 2003 the Japanese name of midwife officially converted to a gender neutral name. Still, only women can take the national midwife exam.[46]

Professional associations/colleges
  • Japanese Midwives Association (JMA).[47]
  • Japan Academy of Midwifery (JAM).[48]
  • Japanese Nursing Association (JNA), Midwives' Division.[49]
Tanzanian midwife weighing an infant and giving advice to the mother

Mozambique

[edit]

When a 16-year civil war ended in 1992, Mozambique's health care system was devastated and one in ten women were dying in childbirth. There were only 18 obstetricians for a population of 19 million. In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. The newly introduced midwives system now perform major surgeries including caesareans and hysterectomies.

As the figures now stand, Mozambique is one of the few countries on track to achieve the MDG of reducing the maternal death rate by 75% by 2015.[50]

New Zealand

[edit]

Midwifery is a regulated profession with no connection to Nursing. Midwifery is a profession with a distinct body of knowledge and its own scope of practice, code of ethics and standards of practice. The midwifery profession has knowledge, skills and abilities to provide a primary complete maternity service to childbearing women on its own responsibility.

Education, training and regulation

The undergraduate midwifery programmes are three-year full-time (three trimesters per year) tertiary programmes leading to a bachelor's degree in midwifery (Bachelor of Midwifery or Bachelor of Health Science (Midwifery)).[51] These programmes are offered by Otago Polytechnic in Dunedin, Ara Institute of Canterbury (formally CPIT) in Christchurch, Waikato Institute of Technology in Hamilton and Auckland University of Technology (AUT) in Auckland. Several schools have satellite programmes such as Otago with a programme in Southland, Wānaka, Wellington, Palmerston North, Whanganui, and Wairarapa – and AUT with student cohorts in various sites in the upper North Island.[52] The postgraduate midwifery programmes (for registered midwives) lead to postgraduate degrees or equivalent qualifications in midwifery (Postgraduate Certificate in Midwifery, Postgraduate Diploma in Midwifery, Master of Midwifery, PhD Professional Doctorate).

The Midwifery First Year of Practice Programme (MFYP) is a compulsory national programme for all New Zealand registered midwifery graduates, irrespective of work setting. The New Zealand College of Midwives (the NZCOM) is contracted by the funder, Health Workforce New Zealand (HWNZ), to provide the programme nationally in accordance with the programme specification.[53]

Midwives in New Zealand must be registered with the Midwifery Council of New Zealand to practice midwifery, and use the title midwife.

Practice

Women may choose a midwife, a General practitioner or an Obstetrician to provide their maternity care. About 78 percent choose a midwife (8 percent GP, 8 percent Obstetrician, 6 percent unknown).[54] Midwives provide maternity care from early pregnancy to 6 weeks postpartum. The midwifery scope of practise covers normal pregnancy and birth. The midwife either consults or transfers care where there is a departure from a normal pregnancy. Antenatal care is normally provided in clinics, and postnatal care is initially provided in the woman's home. Birth can be in the home, a primary birthing unit, or a hospital. Midwifery care is fully funded by the Government. (GP care may be fully funded. Private obstetric care incurs a fee in addition to the government funding.)

Professional associations/colleges
  • New Zealand College of Midwives.[52]

Somalia

[edit]

Increase in midwifery education has led to advances in impoverished countries. In Somalia, 1 in 14 women die while giving birth.[55] Senior reproductive and maternal health adviser at UNFPA, Achu Lordfred claims, "the severe shortage of skilled health personnel with obstetric and midwifery skills means the most have their babies delivered by traditional birth attendants. But, when complications arise, these women either die or develop debilitating conditions, such as obstetric fistula, or lose their babies." UNFPA is striving to change these odds by opening seven midwifery schools and training 125 midwives so far.[56]

Education, training and regulation

Though Somalia has a shortage of healthcare personnel and education, their midwifery programs are becoming more and more distinguished.[57] A curriculum for midwifery has been approved by the international confederation of midwives which has been standardized among schools, something rare for this natural remedy focused country. This has been backed by the UNFPA in hopes to make more standardized healthcare education in the future.[58]

South Africa

[edit]
Main article: Midwives in South Africa
Education, training and regulation

Training includes aspects of midwifery, general nursing, community nursing and psychiatry, and can be achieved as either a four-year degree or a four-year diploma.[59]

  • Advanced Diploma in Midwifery: Holders of this qualification are eligible to register with the SANC as midwives. Assessments are conducted in line with the assessment policy of the Regulations Relating to the Accreditation of Institutions as Nursing Education Institutions (NEI). This qualification allows international employability.
  • Postgraduate Diploma in Midwifery: The Postgraduate Diploma articulates with a master's degree in Nursing at NQF level 9. This qualification allows international employability.
  • Bachelor's Degree in Nursing and Midwifery: Holders of this qualification are eligible for registration with the SANC as a Professional Nurse and Midwife. This qualification allows international employability.

The midwifery profession is regulated under the Nursing Act, Act No 3 of 2005. The South African Nursing Council (SANC) is the regulatory body of midwifery in South Africa.

Professional associations/colleges
  • The Society of Midwives of South Africa (SOMSA).[60]

Tanzania

[edit]
Education, training and regulation

There are different levels of education for midwives:[61]

  • Certificate in Midwifery
  • Diploma in Midwifery
  • Advanced Diploma in Midwifery
  • Bachelor of Science in Midwifery (BScM)
  • Master of Science in Midwifery (MScM)

Midwives must be licensed by the Tanzania Nursing and Midwifery Council (TNMC) to practice as a 'registered midwife' or 'enrolled midwife'.[62] TNMC ensure the quality midwifery education output, develop and reviews various guidelines and standards on midwifery professionals and monitor their implementation, monitor and evaluate midwifery education programs and approve such programs to meet the Council and international requirements. Also it establish standards of proficiencies for midwifery education.[62]

Professional associations/colleges
  • Tanzania Midwives Association (TAMA).[63]

United Kingdom

[edit]
Education, training and regulation

The undergraduate midwifery programs are three-year full-time university programs leading to honours bachelor's degrees in midwifery: BSc (Hons) Midwifery, Bachelor of Midwifery (Hons).[64] The postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (MSc Midwifery, MSc Advanced Practice Midwifery). There are also undergraduate and postgraduate midwifery programs (for graduates with a relevant degree who wish to become midwives) leading to degrees or equivalent qualifications in midwifery (BSc (Hons) Midwifery, Bachelor of Midwifery (Hons), Graduate Diploma in Midwifery, Postgraduate Diploma in Midwifery, MSc Midwifery). Midwifery training consists of classroom-based learning provided by select universities[65] in conjunction with hospital- and community-based training placements at NHS Trusts.

Midwifery students in England and Wales now pay tuition fees following the abolition of free tuition and the NHS bursary system for most pre-registration healthcare degree programmes in the UK. Funding varies depending on the UK country. For example, there are no tuition fees in Scotland for those that meet eligibility criteria. Short course students, who are already registered adult nurses, have different funding arrangements, with a diminishing number being employed by the local NHS Trust via the Strategic Health Authority (SHA), and are paid salaries. This varies, however, between universities and SHAs, with some students being paid their pre-training salaries, while others are employed as a Band 5 and still others are paid a proportion of a Band 5 salary. However, alterations to short course commissioning and funding is changing at the present time, with more and more short course students are being expected to self-fund in full or, at least, in part. For example, a short course student midwife who also holds registration as an adult nurse may be required to self-fund tuition, either via their own private funds, or via the student loan system while still receiving a salary – or be expected to self-fund completely throughout their entire course of study.

Pre-registration midwifery training via the short course is, at present, only an option to those holding registration as an adult nurse (RN – Adult, RGN, or RNA). Mental Health Nurses (RMNs), Children's Nurses (RN – Child or Children / RSCNs) and Learning Disability Nurses (RNLDs) would need to complete the full three-or-four-year programme depending on their choice of university.

Midwives must be registered with the Nursing and Midwifery Council to practice midwifery and use the title 'midwife' or 'registered midwife', and must also have a Supervisor of Midwives through their local supervising authority.

Practice

Midwives are practitioners in their own right in the United Kingdom. They take responsibility for the antenatal, intrapartum and postnatal care of women up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, whether at home, in a midwife-led unit or in a hospital (although most births in the UK occur in hospitals).

In December 2014 the National Institute for Health and Care Excellence updated its guidance regarding where women should give birth. The new guidance states that midwife-led units are safer than hospitals for women having straightforward (low risk) pregnancies. Its updated guidance also confirms that home birth is as safe as birth in a midwife-led unit or a traditional labour ward for the babies of low-risk pregnant women who have already had at least one child previously.[66][67]

Many midwives also work in the community. The role of community midwives includes making initial appointments with pregnant women, managing clinics, undertaking postnatal care in the home and attending home births.[68] A community midwife typically has a pager, is responsible for a particular area and can be contacted by ambulance control when needed. Sometimes they are paged to help out in a hospital when there are insufficient midwives available.

Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.[69]

Midwives are at all times responsible for the women they are caring for. They must know when to refer complications to medical staff, act as the women's advocate, and ensure that mothers retain choice and control over childbirth.

Most practising midwives in the United Kingdom are female: men account for less than 0.5 per cent of midwives on the register of the Nursing and Midwifery Council.[70]

Professional associations/colleges

United States

[edit]
Main article: Midwives in the United States
US Navy midwife checks on a woman
Education, training and regulation

Accredited midwifery programs can lead to different professional midwifery credentials:[74]

  • Midwifery programs, accredited by the Midwifery Education Accreditation Council (MEAC),[75] leading to the Certified Professional Midwife (CPM) credential,[76] certified by the North American Registry of Midwives (NARM),[77] that is at the level of a degree in midwifery (AS Midwifery, BSc Midwifery, MSc Midwifery). Completion of a Portfolio Evaluation Process (PEP) or a state licensure program are considered. CPMs have to apply for recertification every three years.
  • Midwifery programs (for graduates with a relevant degree who wish to become midwives), accredited by the Accreditation Commission for Midwifery Education (ACME), leading to the Certified Nurse Midwife (CNM) and Certified Midwife (CM) credentials,[78] certified by the American Midwifery Certification Board (AMCB),[79] that are at the level of a bachelor's degree or equivalent qualification in midwifery (BSc Midwifery). CNMs and CMs must apply for recertification every five years.

According to each US state, a midwife must be licensed and/or authorized to practice midwifery.[80]

Practice

Midwives work with women and their families in many settings. They generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state. Many states have birthing centers where a midwife may work individually or as a group,[81] which provides additional clinical opportunities for student midwives.

CPMs provide on-going care throughout pregnancy and continuous, hands-on care during labor, birth, and the immediate postpartum period. They practice as autonomous health professionals working in a network of relationships with other maternity-care professionals who can provide consultation and collaboration, when needed. Although qualified to practice in any setting, they have particular expertise in providing care in homes and free-standing birth centers, and own or work in over half of the birth centers in the U.S. today.[82][83]

CNMs and CMs work in a variety of settings including private practices, hospitals, birth centers, health clinics, and home birth services. They supervise not only pregnancy, delivery, and postpartum period care for those who were pregnant and their newborns, but also provide gynecological care for all women who need it and have autonomy and prescriptive authority in most states. They manage biological females' healthcare from puberty through post-menopause.[84] With appropriate training, they can also first-assist in cesarean (operative) deliveries and perform limited ultrasound examinations. It is possible for CNMs/CMs to practice independently of physicians, establishing themselves as health care providers in the community of their choice.

Professional associations/colleges

Men in midwifery

[edit]
A male midwife in Oslo, Norway

Men rarely practice midwifery for cultural and historical reasons. In ancient Greece, midwives were required by law to have given birth themselves, which prevented men from joining their ranks.[88] Julian Clement is often attributed to being the first male midwife, after he attended to Madame de la Valerie in France in 1663.[89] In 17th century Europe, some barber surgeons, all of whom were male, specialized in births, especially births requiring the use of surgical instruments. This eventually developed into a professional split, with women serving as midwives and men becoming obstetricians. Men who work as midwives are called midwives (or male midwives, if it is necessary to identify them further) or accoucheurs; the term midhusband is occasionally encountered, mostly as a joke. In previous centuries, they were called man-midwives in English.[90]

William Smellie is credited with innovations on the shape of forceps. This invention corresponds with the development towards obstetrics. He advised male midwives to wear dresses to reduce controversy over having a man present at birth.[91]

As of the 21st century, most developed countries allow men to train as midwives. However, it remains very rare. In the United Kingdom, even after the passing of the Sex Discrimination Act 1975, the Royal College of Midwives barred men from the profession until 1983.[92] As of March 2016, there were between 113 and 137 registered male midwives, representing 0.6% of all practising midwives in the UK.[93] Although male midwives are hard to come by in the UK there can be a higher percentage found in other countries as data published in 2024 states. These countries include Spain and Chile 10%, Ethiopia 33%, and Burundi 50%.[94]

In the US, there remain a small, stable or minimally declining number of male midwives with full scope training (CNMs/CMs), comprising approximately 1% of the membership of the American College of Nurse-Midwives.[95][96]

In the myth of some cultures that "men lost their ability to give birth and subsequently became midwives". In some Southeast Asian cultures, e.g. with the Semelai people (also e.g. in some Sudanese cultures), some or even most of the midwives are men; and the women no longer consider themselves "brave enough" (historically men and women worked as midwives, and there are no formal prohibitions, for either gender).[9]

History

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Medieval Europe

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In medieval Europe, it was not necessary for midwives to be literate. Several women were midwives in medieval England. Often they could be married to male medical practitioners. Pierrette de Bouvile the sworn midwife in the 1460s in the village of Arpajon south of Paris, she was married to a churchwarden.[97] Asseline Alexandre, a woman who attended the births of the Duchess of Burgundy in the 1370s, was not married to a physician, but she was married to a bourgeois of Paris.[97]

Ming China

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A midwife in Ming China had to be female, and had to be familiar with the female body and the process of childbirth. The sexual limitation in midwifery was strict due to strict sex segregation, which was common in the Ming dynasty. Males were not allowed to see or touch a female's body directly.[98] In this situation, male physicians played only a minor role in childbirth. They were usually responsible for only antenatal examinations and body check-ups before and after the baby was born, but never participated in the delivery room. The skill set in midwifery was also different from medicine.[99]

Women who wanted to be a midwife could only learn the skill from experts because there was no literature about midwifery.[100] To serve in the Forbidden City as a midwife, applicants had to apply through the Lodge of Ritual and Ceremony ("Lodge") (Li-I fang), which was also called the Bureau of Nursing Children (Nai-tzu fu).[101] Pregnant women outside the palace were likely to pay more to hire "palace midwifes" than "folk midwifes".[102]

Responsibility

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A midwife's responsibilities could include criminal investigations, especially those that involved women.[98] They consulted in investigations of rape cases and determination on a female's virginity because they were the society's top specialists in sexual medicine.[103] Midwives were sometimes assigned to inspect female healers selected by the Lodge, to make sure they were healthy.[102]

During the process of childbirth, they cleaned the byproducts from abortions, miscarriages and stillbirths.[104] Such work was considered "pollution" during the Ming dynasty.[98][105]

Infanticide, particularly of newborn baby girls, was part of family planning in Ming times.[106] Midwives and their knowledge of infanticide played important roles in this custom. When a baby was born, the midwife inspected the baby and determined its gender. If it was a female infant, the midwife asked the mother if she wanted to keep it or not. If not, the midwife used her professional knowledge to kill the baby in the simplest and most silent way and then ask for payment. Even if the decision was not made by the midwife, she had to kill the baby because she was the only one who had ability to do so in the delivery room. Moreover, they were also considered as "merchants" of body parts.[104] They were also responsible for disposing waste from the process of childbirth, which consisted of body parts from the placenta. Therefore, they could easily sell them to others secretly to earn additional income.

Public perception

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The dirty work and knowledge mentioned above had a negative impact on the public attitude toward midwives. Some writers then described the midwife as a second or vicious character in their stories due to a midwife's guilty knowledge.[98] Midwives were also labeled as one of "six grannies". This term was originally established by scholars and officials.[107] Over time, male physicians also blamed midwives for the same reason. Although midwives dominated the field and had extensive experience in childbirth, they did not have equivalent participation on elite medical literature.[108] Oppositely, elite medical literature are dominated by male physicians, although who contributed much less in childbirth process. Elders and male physicians also disparaged midwives' knowledge about the female body and the process of childbirth. Male physicians even established a boundary between their learned pharmaceutical knowledge as opposite to the midwife's manual manipulations.[105] They did not consider midwives as professionals that required expertise because their skill was not learned from scholarly literature.[109] They believed the midwife's existence was due to gender segregation, and it limited the male physician's role in childbirth.

Notable midwives

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Midwives in culture

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Pharaoh and the Midwives, James Tissot c. 1900

Shiphrah and Puah are two midwives in the Book of Exodus (6th–5th century BC). They are noted for disobeying the Pharaoh's command to kill all new-born Hebrew boys.[110]

Laurel Thatcher Ulrich's A Midwife's Tale (1990) is a biography of Martha Ballard, a midwife in the late 1700s to early 1800s who faces countless challenges in her career and home life. Each of the book's chapters feature excerpts from Ballard's historical diary followed by Ulrich's discussions of different aspects of her life. The diary highlights the amount of births that Martha attends to in her life and how they are performed and paid for.[111]

Midwives is a 1997 novel by Chris Bohjalian. A midwife is arrested and tried when a woman in her care dies. It was selected for Oprah's Book Club and became a New York Times Best Seller.[112] The TV film Midwives (2001) was based on it.[113]

Call the Midwife (2012) is a drama series based on novels by Jennifer Worth. It features midwives working in the East End of London 1950–1960.[114]

The Midwife (Sage femme, 2017) is a film drama about Claire, a midwife, and her late father's eccentric former mistress.[115]

See also

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Midwife

View on Grokipedia
from Grokipedia
A is a who practices , defined as the provision of skilled, able, and compassionate care for childbearing women, newborn infants, and families across the continuum from pre- through , , the postnatal period, and . Midwifery relies on a distinct body of evidence-based , skills, and professional attitudes centered on supporting normal physiological birth processes while recognizing the need for timely referral to medical specialists in complications. The profession traces its origins to prehistoric eras, with archaeological evidence indicating communal assistance in dating back to the period around 40,000 B.C., evolving into formalized roles in ancient civilizations where served essential functions in maternal and infant survival. In contemporary practice, deliver primary maternity care globally, often achieving lower rates of medical interventions such as cesarean deliveries and episiotomies, alongside reduced preterm births and improved maternal satisfaction in low- and middle-income settings when integrated with health systems. Peer-reviewed studies further demonstrate that continuity of care correlates with fewer adverse perinatal outcomes, including lower neonatal mortality in appropriately selected cases, underscoring its causal role in enhancing birth safety through minimized unnecessary procedures. However, efficacy depends on rigorous training standards and regulatory oversight, as unregulated practices have historically led to higher risks in high-complication environments.

Definition and Terminology

Etymology

The English term "midwife" derives from Middle English midwif, first attested around 1300, composed of mid ("with") and ("woman"). This construction literally signifies "with-woman," referring to a female attendant providing support to a during . The element wif stems from wīf, denoting any adult female rather than specifically a , a broader sense preserved in compounds like "midwife" but narrowed in modern "wife." Meanwhile, mid originates from mid, cognate with terms in other for "together with" or "among," emphasizing companionship over intermediacy or centrality—a distinction from the unrelated mid implying "middle." Early records, such as those in 14th-century medical texts, reflect this assistive role without connotations of medical authority.

Modern Definition and Distinctions

A midwife is a responsible and accountable health professional educated and trained to provide competent, evidence-based, and compassionate care independently to women and newborns throughout the reproductive cycle, with a primary focus on preventing and managing normal physiological childbirth processes. This includes prenatal monitoring, labor support, delivery assistance, and postpartum care, emphasizing partnership with the woman to promote informed decision-making and autonomy. Midwives are required to recognize complications requiring medical intervention and collaborate or refer to physicians accordingly, adhering to international standards set by bodies like the International Confederation of Midwives (ICM), which mandate completion of an accredited education program aligned with essential competencies for basic emergency care and cultural sensitivity. Midwives differ fundamentally from obstetricians-gynecologists (OB-GYNs), who are physicians with medical degrees and surgical training enabling them to handle high-risk pregnancies, perform cesarean sections, and manage pathologies through pharmacological or operative means. In contrast, midwives operate within a midwifery model that prioritizes the normalcy of birth, minimizing unnecessary interventions for low-risk cases, and often provide continuous one-on-one support during labor, unlike the episodic physician visits typical in medical models. They also distinguish from doulas, who offer non-medical emotional and physical labor support without clinical authority, and from registered nurses, who may assist in hospitals but lack midwives' specialized reproductive training and prescribing rights in many jurisdictions. Variations exist among midwife credentials, particularly , where certified nurse-midwives (CNMs) possess graduate-level , enabling hospital-based practice with full prescriptive authority and integration into medical systems. Certified midwives (CMs) meet identical competencies and national exams as CNMs but enter via non- pathways, practicing primarily in a limited number of states. Certified professional midwives (CPMs), trained through direct-entry programs emphasizing out-of-hospital settings like homes or birth centers, focus on community-based care for low-risk births and are licensed in about 35 states, though their scope excludes routine hospital privileges. Internationally, aligns more uniformly with ICM and WHO guidelines, positioning midwives as primary providers in resource-limited settings to achieve sustainable outcomes.

Scope of Practice

Primary Responsibilities

Midwives deliver comprehensive care centered on the physiological processes of , labor, birth, and postpartum recovery for healthy women with low-risk pregnancies. This includes conducting regular antenatal examinations to assess maternal , fetal growth via and measurements, and screening for conditions such as or , with referrals to obstetricians for high-risk cases. During labor and delivery, primary duties encompass continuous one-on-one support to promote natural progression, monitoring fetal heart rates and contractions, non-pharmacological pain relief techniques like or positioning, and facilitating uncomplicated vaginal births, including episiotomy avoidance unless indicated. Midwives are equipped to handle common emergencies, such as or initial of newborns, but protocols mandate consultation or transfer for complications like fetal distress or malpresentation.00799-2/fulltext) In the postpartum phase, responsibilities involve evaluating maternal recovery, including uterine involution and assessment, newborn examinations for Apgar scores and congenital anomalies, initiation of support, and scheduling. Additionally, midwives provide contraceptive counseling, screenings, and annual gynecological exams as part of well-woman care outside of maternity contexts.

Boundaries and Collaboration with Physicians

Midwives operate within a defined scope focused on the promotion and management of normal physiological , labor, birth, and the for healthy women and newborns, independently conducting births in appropriate settings. This boundary is delineated by the midwife's ability to recognize deviations from normality, such as abnormal fetal heart rate patterns, excessive bleeding, or maternal indicating , at which point consultation, collaborative management, or transfer of care to a physician—typically an obstetrician—is mandated to ensure timely intervention for potential . The International Confederation of Midwives (ICM) establishes this as a , requiring midwives to detect complications early and access appropriate medical assistance without delay, thereby preventing escalation while preserving in uncomplicated cases. Collaboration with physicians emphasizes a team-based approach, where midwives provide continuity of care and holistic support, while obstetricians contribute specialized interventions for high-risk or emergent conditions. Effective partnerships involve clear communication protocols, mutual respect for scopes, and predefined referral pathways, often resulting in co-management for borderline cases like requiring insulin adjustment. In practice, this integration has been shown to improve maternal satisfaction and reduce unnecessary interventions, as midwives advocate for non-pharmacological options within safe limits. However, tensions can arise from differing philosophies—midwifery's emphasis on natural processes versus ' precautionary stance—potentially leading to over-referral in risk-averse systems.00799-2/fulltext) Regulatory frameworks influence these dynamics significantly. In jurisdictions following ICM standards, such as many European countries, midwives enjoy substantial with obligatory referral only for specified complications, fostering seamless handoffs via protocols. Conversely, in the United States, certified nurse-midwives (CNMs) and certified midwives (CMs) often operate under state-specific collaborative practice agreements with physicians, mandating availability for consultation despite broad authority to diagnose, treat, and admit patients; full independent practice is permitted in about half of states as of 2023, though privileges frequently require physician backup. Australian national guidelines exemplify structured referral tiers: routine consultation (Level B) for managed conditions like mild , escalating to full referral (Level C) for severe risks such as or , with the midwife retaining a advisory role post-transfer to maintain woman-centered care.

Evidence-Based Outcomes

Comparative Efficacy with Obstetric Care

A 2024 Cochrane systematic review of 16 randomized controlled trials involving over 18,000 women in high-income countries found that midwife-led continuity of care models, compared to other models including obstetrician-led care, were associated with a higher likelihood of spontaneous vaginal birth (average risk ratio [RR] 1.06, 95% confidence interval [CI] 1.03 to 1.10, increasing from 66% to 70%), lower use of regional analgesia (average RR 0.85, 95% CI 0.78 to 0.92), and reduced rates of instrumental vaginal birth (average RR 0.89, 95% CI 0.80 to 0.99). The review reported no significant differences in key safety outcomes such as perinatal mortality (average RR 0.95, 95% CI 0.60 to 1.51) or maternal mortality, though subgroup analyses suggested potential reductions in preterm birth and low birthweight in continuity models. For low-risk pregnancies specifically, a November 2024 systematic review and meta-analysis of 14 studies concluded that midwife-led perinatal care reduced interventions including cesarean sections (odds ratio [OR] 0.76, 95% CI 0.65-0.89), episiotomies (OR 0.42, 95% CI 0.31-0.56), and augmentations (OR 0.58, 95% CI 0.45-0.75), while maintaining comparable maternal and neonatal outcomes such as postpartum hemorrhage and neonatal intensive care admissions. Neonatal outcomes showed no increase in adverse events, with some evidence of lower rates of neonatal resuscitation needs (OR 0.82, 95% CI 0.69-0.98). These findings align with a 2020 meta-analysis in eClinicalMedicine of 13 studies, which reported lower odds of severe maternal morbidity (OR 0.75, 95% CI 0.58-0.97) and interventions like epidurals in midwife-led care for low-risk women, without elevated risks to fetal or neonatal health.30063-8/fulltext) Comparative efficacy favors midwife-led models in promoting physiologic birth processes, potentially due to reduced and emphasis on non-pharmacologic support, though benefits are most pronounced in settings with integrated care systems allowing seamless transfer for complications. A 2023 meta-analysis across low- and middle-income countries reinforced this, showing midwife-led care linked to fewer cesareans (RR 0.87, 95% CI 0.78-0.96) and higher initiation rates, with equivalent . However, in fragmented systems like the , where obstetric-led care predominates, observational data indicate higher overall intervention rates regardless of provider, suggesting systemic factors influence outcomes beyond provider type alone.00799-2/fulltext) Patient satisfaction is consistently higher in midwife-led models, with women reporting greater control and fewer negative experiences (average RR 1.18 for positive views, 95% CI 1.07 to 1.30).
Key OutcomeMidwife-Led (RR or OR vs. Other Models)95% CISource
Spontaneous Vaginal BirthRR 1.061.03-1.10Cochrane 2024
Cesarean Section (Low-Risk)OR 0.760.65-0.89Meta-Analysis 2024
Regional AnalgesiaRR 0.850.78-0.92Cochrane 2024
RR 0.950.60-1.51Cochrane 2024
Efficacy equivalence or superiority in low-risk cases does not extend to high-risk pregnancies, where obstetric intervention demonstrably reduces mortality risks through timely surgical capabilities. Cost analyses from integrated models show savings of 10-20% due to averted interventions, supporting in resource-constrained environments.

Safety Data for Different Birth Settings

Studies comparing perinatal outcomes across birth settings—hospitals, freestanding birth centers, and planned home births—primarily focus on low-risk pregnancies attended by midwives, revealing mixed but generally comparable safety profiles when adhering to evidence-based selection criteria. Systematic reviews indicate no significant difference in perinatal mortality rates between planned home births and hospital births for low-risk women, with odds ratios for fetal or neonatal death ranging from 0.97 to 1.62 (not statistically significant in pooled analyses).30119-1/fulltext) However, some U.S.-based cohort studies report elevated neonatal mortality (3.3/1000 vs. 1.6/1000 in hospitals) and seizure rates for planned home births, potentially attributable to delays in transfer or underreporting in midwifery datasets.00671-X/abstract) These discrepancies highlight methodological challenges, including selection bias in pro-home studies (e.g., excluding high-risk transfers) and integration biases favoring hospital systems with higher intervention baselines. Freestanding birth centers, often midwife-led, demonstrate low intervention rates and maternal morbidity for low-risk cohorts, with cesarean sections at 4-6% compared to 30-32% in U.S. s overall. Neonatal transfer rates hover around 15-20% due to progress stalls or , but completed center births show rates of 1-2/1000, akin to hospital benchmarks for comparable groups; no maternal deaths were recorded in large registries like the AABC's 2023 data on over 15,000 births.00643-3/fulltext) Critics note that birth center outcomes may appear favorable due to rigorous low-risk screening, but neonatal seizure risks remain comparable or slightly higher than midwife-attended hospital births, underscoring the need for proximity to advanced care.00778-X/abstract)
SettingPerinatal Mortality (per 1,000)Neonatal Mortality (per 1,000)Key Source
Planned Home (Low-Risk)1.0-1.60.3-1.02019 Meta-Analysis30119-1/fulltext)
Birth Center (Low-Risk)1.0-2.00.5-1.2AABC Registry (2023); 2024 Cohort
Hospital (Low-Risk, Midwife-Attended)0.8-1.50.2-0.8Comparative Cohorts00671-X/abstract)
Midwife-led care in any setting reduces interventions like episiotomies (RR 0.42) and cesareans (RR 0.79) without compromising safety for low-risk women, per 2023-2025 reviews, though absolute risks rise in non-integrated systems like the U.S. where center transfers face delays. Organizations like ACOG maintain births are safer overall due to resource availability, citing tripled neonatal risks in some datasets, while midwifery advocates emphasize causal factors like over-medicalization inflating morbidity. Outcomes improve in systems with robust transfer protocols, as in the , where planned home births yield under 1/1000. Empirical data thus supports setting-agnostic midwife care for vetted low-risk cases, contingent on systemic readiness rather than inherent superiority of .

Global Impact on Mortality Rates

Trained midwives serving as skilled birth attendants have demonstrably lowered maternal mortality ratios (MMR) and neonatal mortality rates (NMR) in resource-limited settings by providing essential antenatal, intrapartum, and postnatal care. Modeling from the (WHO) estimates that universal access to care could prevent over 60% of maternal deaths, newborn deaths, and stillbirths annually, potentially saving more than 4.3 million lives worldwide. Even partial scaling of midwife-delivered interventions to 50% coverage could avert 22% of maternal deaths, 23% of neonatal deaths, and 14% of stillbirths, according to projections based on global epidemiological data. These impacts stem from midwives' roles in managing common obstetric complications like hemorrhage and , which account for a majority of preventable deaths in low- and middle-income countries (LMICs). Empirical studies corroborate these models, particularly in LMICs where midwife shortages exacerbate mortality. In , a policy-induced doubling of trained midwives from 2000 to 2010 correlated with a 20–40% decline in MMR, alongside increased uptake of midwife-assisted home births without corresponding rises in neonatal risks. Similarly, expansions in nursing-midwifery workforces across 137 countries from 2000 to 2019 independently reduced NMR by strengthening community-level interventions, independent of broader economic factors. Midwifery continuity of care models in LMICs have also decreased preterm births and medical interventions, yielding net reductions in maternal and newborn morbidity. In higher-resource contexts, 's global mortality benefits are more nuanced, with hospital-integrated models showing equivalence to physician-led care in outcomes but lower intervention rates. However, planned out-of-hospital births attended by midwives exhibit elevated risks—up to triple that of hospital births in U.S. data—due to delays in accessing advanced interventions for complications. WHO emphasizes that optimal impacts require regulatory standards, referral systems, and integration with emergency obstetric services to mitigate such risks universally. Overall, workforce scaling remains a high-leverage , as countries with higher midwife densities consistently report lower MMRs, underscoring causal links via improved birth attendance coverage.

Education, Training, and Regulation

Core Educational Pathways

Core educational pathways to midwifery practice emphasize a combination of theoretical instruction in subjects such as , , , , and reproductive , alongside extensive clinical in prenatal, intrapartum, postpartum, and newborn care. Internationally, the International Confederation of Midwives (ICM) sets global standards requiring pre-service programs to deliver at least 40 weeks of clinical practice, integrated with classroom learning to achieve competencies in evidence-based care, ethical practice, and . These standards, updated in 2021, mandate accreditation-equivalent oversight, faculty qualifications, and student evaluation mechanisms to ensure graduates can provide autonomous midwifery care. In the United States, the predominant pathway for certified professionals is the Certified Nurse-Midwife (CNM), which requires first obtaining a Bachelor of Science in Nursing (BSN) or equivalent, passing the NCLEX-RN for registered nurse licensure, and then completing an accredited graduate-level nurse-midwifery program, typically a Master of Science in Nursing (MSN) lasting 2-3 years full-time. These programs, accredited by the Accreditation Commission for Midwifery Education (ACME), include at least 500-700 clinical hours and culminate in eligibility for the American Midwifery Certification Board (AMCB) exam. An alternative non-nursing route, the Certified Midwife (CM), demands a bachelor's degree in any field, followed by a similar ACME-accredited midwifery graduate program of 2-3 years, also leading to AMCB certification; this pathway is available in only a handful of states like New York and New Jersey. Direct-entry midwifery pathways, leading to Certified Professional Midwife (CPM) certification via the North American Registry of Midwives (NARM), bypass prerequisites and emphasize , self-study, or completion of Midwifery Education Accreditation Council (MEAC)-accredited programs, which can range from 2-4 years and require demonstration of competencies through a portfolio evaluation process (PEP) or . These programs incorporate core elements like essential midwifery skills training and at least 1,000 clinical hours, aligning partially with ICM competencies but tailored to out-of-hospital birth settings. In and other regions following ICM guidelines, core pathways often consist of a 3-4 year in , integrating hospital-based clinical rotations from the outset, with requirements for supervised births (e.g., at least 40 under direct supervision) and theoretical modules on and . Program durations and entry prerequisites vary, but all prioritize measurable outcomes in midwifery-specific competencies over general foundations.

International and Regional Variations

The International Confederation of Midwives (ICM) outlines global standards for midwifery , stipulating a minimum of three years (approximately 4,000 hours) of full-time direct-entry , encompassing competencies in , normal , , and postnatal care, with at least half the time dedicated to supervised clinical practice. These standards, endorsed by organizations like the American College of Obstetricians and Gynecologists (ACOG) in 2015, aim to ensure uniform quality but are not universally enforced, leading to diverse implementations. The (WHO) supports these through efforts to strengthen in low-resource settings, though nearly one-quarter of countries report pre-service programs shorter than the recommended duration, potentially impacting care quality. In , midwifery education is predominantly a bachelor's degree requiring 3 to 5 years, aligned with EU Directive 2005/36/EC, which mandates at least 4,600 hours of training including 900 hours of -specific clinical practice; however, national variations persist in curriculum emphasis and entry requirements, with some countries like the offering direct-entry bachelor's programs fostering autonomous practice. Regulation typically involves national registration bodies, such as the in the UK, enforcing standards for licensure and , which often includes independent prescribing and home births in countries like and . North American models diverge from direct-entry norms, with the United States emphasizing nurse-midwifery: Certified Nurse-Midwives (CNMs), comprising over 90% of practicing midwives, require a bachelor's in nursing followed by a 2- to 3-year master's or doctoral program accredited by the Accreditation Commission for Midwifery Education (ACME), plus national certification and state licensure, resulting in fragmented regulation across 50 states. Certified Midwives (CMs), a direct-entry option, are licensed in only a handful of states with limited numbers. In Canada, a standardized 4-year bachelor's degree leads to national examination and provincial regulation, enabling broader autonomy than in the US but still within collaborative frameworks with physicians. In developing regions, education programs are often abbreviated to 18 to 36 months at diploma or associate levels to address acute workforce shortages, as seen in and , where integration with nursing training is common and WHO/ICM initiatives push for upgrades to bachelor's equivalents for improved maternal outcomes. Regulation emphasizes registration for accountability, but enforcement varies, with many low-income countries relying on task-shifting to traditional attendants amid gaps; for instance, in , Auxiliary Nurse Midwives complete 2 years post-10th grade, contrasting with longer global benchmarks. These shorter pathways correlate with higher maternal mortality in under-regulated systems, underscoring the causal link between rigorous training and safety.
RegionTypical Duration and QualificationKey Regulatory FeaturesExample Countries
Europe3-5 years, Bachelor's degreeNational registration; EU harmonizationUK, Netherlands
North America4-7 years total (nursing + midwifery), Master's/Doctoral for CNMsState/provincial licensure; certification examsUS, Canada
Developing Regions18-36 months, Diploma/AssociateRegistration with variable enforcement; WHO scaling effortsIndia, sub-Saharan Africa

Recent Developments in Regulation (2020s)

The , beginning in 2020, led to temporary regulatory flexibilities in midwifery practice across multiple jurisdictions to address maternity care disruptions, including expanded provisions and authorizations in regions facing capacity constraints; however, it also resulted in service centralization and reduced access to midwifery-led continuity models in the , as documented in national surveys. The World Health Organization's Global Strategic Directions for and 2021–2025 outlined priorities for regulatory strengthening, including mandatory registration, licensing, and defined scopes of practice to expand the midwifery workforce and integrate it into systems, with an emphasis on addressing global shortages identified in the State of the World's Midwifery 2021 report. In July 2025, the International Confederation of Midwives (ICM) updated its Global Standards for , providing a framework for national regulators to ensure competency-based education, autonomous practice within evidence-based limits, and ongoing professional development, while recommending reviews of existing processes to align with international benchmarks. A May 2025 study introduced a Midwifery Regulatory Environment Index, utilizing on 2021–2023 data from 194 countries to quantify regulatory quality, revealing that stronger correlates with higher integration but highlighting gaps in low-resource settings that hinder workforce deployment. In the United States, state-level reforms advanced ; for instance, 's Nurse- Advisory in September 2025 discussed updates to licensure requirements, including potential innovations in joint training for nurse-midwives and licensed midwives under proposed AB 836 legislation introduced in February 2025. The state's Medical Board had endorsed an independent licensed midwife board in its 2020 and 2022 Sunset Review Reports to oversee certification and practice standards separately from physician oversight. Globally, a June 2025 analysis by the Center for Reproductive Rights identified legal and regulatory barriers in national frameworks that restrict integration, such as inconsistent licensing and scope limitations, obstructing contributions to goals despite evidence of efficacy in low-risk cases. WHO guidance in June 2025 advocated for scaling models through regulatory reforms enabling full scope practice, while October 2024 recommendations stressed high-quality training alongside licensing to avert over 60% of maternal and newborn deaths via universal access, based on modeling of intervention impacts.

Historical Development

Pre-Modern and Traditional Practices

Midwifery practices originated in prehistoric times, with evidence suggesting communal assistance during dating to the era around 40,000 B.C., where women supported each other in labor without formal roles but through shared . In from approximately 3500 B.C., midwives attended births using empirical techniques alongside invocations to deities like for protection, though no formalized obstetric training existed and practices relied on oral traditions rather than written records. Artifacts and texts indicate midwives handled deliveries in home settings, employing manual interventions and herbal remedies derived from observation of successful outcomes. In Greco-Roman antiquity, midwifery advanced between 3500 B.C. and 300 B.C., with practitioners often selected through community recognition or dreams, as noted by the physician in the 2nd century A.D., who described ideal midwives as literate, empathetic, and free of deformities to ensure steady hands during delivery. Greek and Roman midwives integrated rudimentary medical theory, using tools like pessaries for and performing version maneuvers for breech presentations, though training remained apprenticeship-based among women rather than institutionalized. These practices emphasized natural progression of labor, with interventions limited to cases of prolonged distress, reflecting a causal understanding that excessive force could harm mother or infant. Biblical accounts from the Hebrew tradition, circa 15th-13th centuries B.C., highlight midwives , who served and defied Pharaoh's order to kill male infants, citing vigorous births as the reason for sparing lives, an act attributed to their fear of over human authority. This narrative underscores early recognition of midwives' autonomy in assessing based on observed labor dynamics, prioritizing ethical preservation of life amid political . Traditional pre-modern midwifery worldwide operated through intergenerational transmission, with knowledge passed via family lines or apprenticeships, focusing on holistic support including emotional reassurance, positional aids for labor, and postpartum care using local botanicals to mitigate hemorrhage or infection risks empirically identified through trial and survival rates. In indigenous contexts, such as pre-colonial Americas and Africa, midwives incorporated ceremonial elements tied to spiritual beliefs, employing rituals to invoke communal protection while applying physical techniques like binding or massage to facilitate delivery, sustaining low intervention models until external disruptions. During the Islamic Golden Age in Al-Andalus (10th-14th centuries), female midwives collaborated with physicians, documenting gynecological texts that codified practices like manual extraction of retained placenta, blending empirical data with cultural reverence for maternal health. These methods, grounded in direct observation rather than abstract theory, persisted due to their demonstrated efficacy in community survival metrics prior to widespread medicalization.

Emergence of Professional Midwifery

The emergence of professional in during the represented a shift from unregulated, apprenticeship-based traditional practices to state-sponsored training and oversight, motivated by persistently high maternal mortality rates—estimated at 1,000–1,500 per 100,000 live births in parts of and prior to reforms—and the need to integrate empirical anatomical knowledge to reduce complications like obstructed labor. Governments intervened to standardize practices, often sidelining less-educated local healers in favor of certified practitioners who demonstrated competence in manual techniques and basic interventions, thereby establishing as a distinct, regulated occupation subordinate to but separate from emerging male-dominated . A landmark initiative occurred in , where King commissioned Angélique Marguerite Le Boursier du Coudray in October 1759 to train rural midwives amid concerns exceeding 200 per 1,000 births in some regions. Du Coudray, who had qualified through the Paris surgical faculty around 1737, developed an obstetric —a leather-covered model simulating pelvic and fetal positions—for hands-on instruction without risking live subjects, enabling her to educate over 4,000 pupils across 40 provinces by 1767. Her accompanying textbook, Abrégé de l'art des accouchements (1759), outlined evidence-based procedures like version maneuvers and emphasized hygiene, influencing curricula continent-wide and contributing to a reported decline in provincial mortality through disseminated skills. This model of itinerant, simulation-aided schooling prefigured formal institutions, such as those at the Hôtel-Dieu in , where 17th-century licensing already required apprenticeship under a master midwife followed by examination, but du Coudray's program scaled it nationally. By the early , professionalization accelerated across Europe, with countries like and the mandating midwifery diplomas tied to lectures and clinical observation, granting certified practitioners exclusive rights to uncomplicated deliveries while requiring consultation for abnormalities. In Britain, fragmented local oversight evolved into national regulation via the Midwives Act 1902, which established the Central Midwives Board to enforce a minimum 6-month training curriculum, certification exams, and a roll of over 28,000 practitioners by , addressing scandals from untrained "handywomen" linked to outbreaks. These reforms, grounded in causal links between inconsistent practices and excess deaths, laid the foundation for midwifery's integration into systems, though they often reinforced gender segregation by limiting advanced surgical roles to physicians.

Integration with Modern Medicine

The integration of into modern involves collaborative care models where certified midwives manage low-risk pregnancies and births, consulting obstetricians for complications, thereby combining midwifery's emphasis on natural processes with medical interventions when necessary. This approach has been formalized in various healthcare systems, particularly in countries like the and the , where midwives serve as primary caregivers for uncomplicated cases, referring high-risk patients to hospital-based specialists. Empirical data indicate that such integration reduces cesarean section rates by up to 20% and lowers use compared to obstetrician-led care alone, as evidenced by systematic reviews of randomized trials. Studies demonstrate improved perinatal outcomes in integrated settings, with midwife involvement linked to 56 metrics of better maternal and neonatal , including 74% lower rates among first-time mothers at centers with midwife teams. In the United States, where comprises only about 10% of births, expanded integration correlates with decreased preterm births and neonatal intensive care admissions in collaborative practices. The advocates for full integration into systems, recommending interprofessional teams to achieve 90% coverage of essential reproductive care, potentially averting 4.3 million neonatal deaths annually if scaled globally. However, successful collaboration requires addressing power imbalances between midwives and physicians, with evidence from Swiss labor wards showing that mutual understanding and tailored models enhance teamwork and reduce conflicts. Regulatory frameworks support this integration by mandating midwives' in evidence-based protocols, such as fetal monitoring and transfers, ensuring seamless transitions to obstetric care. In integrated models, continuity of care by midwives yields higher patient satisfaction and fewer interventions without compromising safety, as confirmed by Cochrane analyses of over 17,000 women across multiple trials. Despite these benefits, barriers persist in fragmented systems like the U.S., where scope-of-practice restrictions limit midwives' privileges, underscoring the need for reforms to optimize outcomes. Overall, integration leverages 's physiologic focus alongside modern diagnostics and surgery, yielding cost savings estimated at $2,500 per birth in reduced interventions.

Gender Dynamics in Midwifery

Historical Female-Centric Role

The term "" originates from midwyf, circa 1300 CE, combining mid ("with") and wif (""), denoting a assisting another during , reflecting the profession's inherent orientation rooted in linguistic and practical tradition. In , midwifery was established as a occupation by at least 1550 BCE, as evidenced in the , which records remedies and techniques for labor and delivery employed by women practitioners. The biblical narrative in Exodus identifies as Hebrew midwives attending Egyptian Hebrew births around the 13th century BCE, defying Pharaoh's order; the name Shiphrah appears in the (circa 1800 BCE), an Egyptian medical text listing birth attendants, suggesting historical precedence for named specialists in . In Greco-Roman antiquity, was handled by female midwives (obstetrix in Latin), selected for physical robustness, , and practical skills rather than formal , as detailed by in his early 2nd-century CE Gynecology, which prescribed their training in , bandaging, and infant care while emphasizing experiential under elder women. These practitioners often held concurrent community roles, contributing midwifery as a service informed by generational female knowledge, with male physicians intervening only in complications due to cultural prohibitions on men witnessing birth. The persistence of female dominance in arose from biological and cultural factors: women possessed direct reproductive experience, enabling intuitive support during labor, while societal norms of modesty confined birth to all-female gatherings, excluding men and fostering knowledge transmission via mother-daughter or apprentice lines from prehistoric times, as inferred from birthing artifacts and indigenous practices worldwide. In medieval (5th–15th centuries CE), midwives remained vital for neonatal delivery and postpartum care, serving as the primary female conduit for earning reputable income independent of male oversight in patriarchal frameworks, where formal guilds and universities barred women from male-dominated . This structure preserved midwifery as a bastion of female agency, grounded in empirical observation of mammalian births and communal female solidarity, until the 16th–17th centuries when encroaching male began eroding its exclusivity through licensure and surgical interventions.

Inclusion of Men and Professional Evolution

The entry of men into , initially as "man-midwives," began in 18th-century Britain around the 1730s, when male surgeons like William Smellie and William Hunter started practicing , introducing anatomical knowledge and instruments such as to address complicated deliveries. This shift marked a departure from the traditional female-dominated lay practice, as man-midwives appealed to middle-class women seeking interventions perceived as more scientific, though critics argued that their use of tools increased maternal and risks compared to non-interventionist female midwives. By the late 1700s, man-midwives had established formal training courses and gained social acceptance among elites, contributing to the profession's early through standardized education and separation from barber-surgeon trades. In the , as emerged as a male-dominated , itself reverted largely to female practitioners in many regions, with men concentrating on high-risk hospital births requiring . This bifurcation reflected broader medical hierarchies, where female midwives handled normal community births while male obstetricians handled pathologies, fostering 's evolution toward regulated certification—such as the UK's 1902 Midwives Act, which formalized female training but excluded men initially. Professional evolution accelerated in the with evidence-based protocols and integration into healthcare systems, emphasizing holistic care over rote intervention, yet gender barriers persisted until campaigns in the advocated for male inclusion to address workforce shortages. Modern inclusion of men as fully qualified midwives gained legal footing in the UK in , when the first students enrolled in training, though full professional recognition followed in 1982; similar timelines emerged in and parts of . Despite this, participation remains minimal: in the UK, men comprised just 0.3% of registered midwives in 2022 (167 out of approximately 55,000), while in the , males account for about 2% of certified midwives. Low numbers stem from entrenched cultural norms associating with intuition and modesty during intimate births, leading to professional isolation, patient hesitancy, and peer biases against men in the field. Recent scoping reviews indicate potential growth in low-resource settings to bolster shortages, but without addressing these dynamics, midwifery's evolution toward diversity lags behind , where men constitute 13% of practitioners.

Controversies and Criticisms

Risk Assessment and Home Birth Outcomes

Risk assessment in midwifery for home births involves screening pregnant women to identify low-risk candidates, typically defined as those with uncomplicated singleton pregnancies at term, , no major medical conditions like or , and no prior cesarean deliveries. Midwives use tools such as antenatal history, physical exams, and fetal monitoring to exclude high-risk factors, with guidelines from bodies like the American College of Nurse-Midwives emphasizing continuous risk evaluation and readiness for transfer to if complications arise, such as or fetal distress. In systems with integrated care, like the , rigorous selection reduces adverse events, but in less regulated settings, inadequate screening correlates with poorer outcomes. Planned home births attended by certified professional midwives for low-risk women show lower rates of interventions compared to births, including reduced cesarean sections (5-8% vs. 25-30%), episiotomies, and epidural use, according to a 2005 study of over 5,000 North American cases. Neonatal outcomes in these planned scenarios include lower incidences of prematurity, , and assisted ventilation, with rates around 0.35-1.3 per 1,000 births, though transfer rates range from 10-30% due to failure to progress or meconium-stained fluid. A 2023 Cochrane of low-risk pregnancies found no significant difference in or serious morbidity between planned and births, but noted fewer maternal interventions in home settings. However, U.S.-specific data reveal elevated risks for planned out-of-hospital births, with a 2015 NEJM analysis of 2.4 million low-risk births reporting at 3.9 per 1,000 for center plans versus 1.8 per 1,000 for , alongside higher neonatal rates (1.6 vs. 1.0 per 1,000). The American College of Obstetricians and Gynecologists (ACOG) attributes this to delays in accessing advanced care, suboptimal , and higher 5-minute Apgar scores below 7 (2.3% vs. 1.7%), particularly when non-certified providers are involved. A 2021 AAFP review of U.S. studies confirms statistically significant increases in perinatal death and morbidity for versus births, though absolute risks remain low (under 0.5%) for rigorously selected cases. These disparities highlight the importance of jurisdiction-specific factors, such as midwife training and response times, in causal outcomes rather than inherent superiority of one setting.
Study/SourceSettingPerinatal Mortality (per 1,000) Home vs. HospitalKey Interventions Lower in Home
(2005), certified midwives1.27 vs. 0.57 (intrapartum/neonatal)Cesarean (5.2% vs. 24.7%), epidural
NEJM (2015)U.S. low-risk3.9 (out-of-hospital) vs. 1.8N/A (higher morbidity noted)
Cochrane (2023)Low-risk internationalNo significant differenceCesarean, augmentation
Overall, while planned home births mitigate iatrogenic risks from hospital protocols, empirical evidence underscores the need for stringent risk stratification to avoid excess neonatal harm from unanticipated emergencies, with outcomes best in integrated healthcare models prioritizing evidence over ideological preferences.

Conflicts with Medical Interventions

Midwives typically advocate for a physiological model of birth that minimizes routine medical interventions, such as inductions, epidurals, and cesareans, unless complications arise, contrasting with the obstetric model that treats labor as a high-risk event warranting proactive monitoring and intervention to avert potential adverse outcomes. This fundamental difference in paradigms often generates interpersonal and systemic tensions, particularly in integrated care settings where midwives and physicians must collaborate, with studies identifying barriers like preconceived myths about midwifery competence, conflicting scopes of practice, and inadequate communication as key friction points. Empirical evidence from systematic reviews supports the efficacy of midwife-led care in reducing intervention rates for low-risk pregnancies without elevating maternal or neonatal risks; a 2024 Cochrane review of 16 trials involving over 18,000 women found that continuity of midwife care decreased cesarean section rates by 17% (RR 0.83, 95% CI 0.78-0.88), instrumental vaginal births by 15% (RR 0.85, 95% CI 0.78-0.92), and episiotomies, while showing no significant increase in perinatal mortality or serious morbidity. Similarly, a 2024 meta-analysis of low-risk births reported lower neonatal , , and NICU admissions under midwife-led models compared to obstetrician-led care. These findings underscore that conflicts frequently stem from over-intervention in hospital settings rather than inherent midwifery shortcomings, though critics argue that midwifery's "wait-and-see" orientation can delay necessary actions in evolving complications. In contexts, conflicts escalate over transfer protocols, as midwives may prioritize maternal preferences for avoiding interventions, potentially leading to delays that heighten perinatal risks if unforeseen issues like fetal distress occur; the American College of Obstetricians and Gynecologists (ACOG) has documented a threefold increase in neonatal mortality (1.3 vs. 0.4 per 1,000) and fivefold in seizure-related deaths for planned s lacking rigorous low-risk criteria, attributing this partly to suboptimal transfer timing. Case studies of high-risk women opting for illustrate such dilemmas, where midwife support for clashes with evidence-based calls for intervention, resulting in adverse events like postpartum hemorrhage or neonatal hypoxia. Provider surveys reveal divergent safety perceptions, with physicians emphasizing empirical complication rates and midwives focusing on holistic , exacerbating distrust and hindering seamless handoffs. Ethical tensions further compound these conflicts, as midwives navigate dilemmas between respecting client autonomy—such as refusals of interventions—and obligations to fetal beneficence, often experiencing moral distress from institutional pressures to conform to intervention-heavy protocols or from cultural clashes over evidence-based practices. In low- and middle-income countries, implementation barriers include physician resistance to midwife autonomy, perpetuating hierarchies that undermine evidence favoring reduced interventions for better outcomes like lower preterm births. Overall, while data affirm midwifery's role in curbing unnecessary procedures—potentially averting harms from over-medicalization—unresolved interdisciplinary frictions risk suboptimal care transitions, highlighting the need for standardized protocols grounded in risk-stratified evidence rather than ideological divides. Midwives encounter ethical dilemmas primarily arising from tensions between maternal and fetal or maternal safety, particularly when women refuse interventions such as cesarean sections deemed necessary by medical standards. In a 2025 study of midwives' professional experiences, refusal of life-saving procedures was identified as a frequent challenge, prompting conflicts over beneficence and non-maleficence, where providers must weigh patient rights against potential harm. These situations often lead to moral distress, as midwives navigate requirements while anticipating blame for adverse outcomes, with ethical codes emphasizing yet requiring evidence-based . Conflicts with obstetricians exacerbate ethical issues, stemming from divergent philosophies on intervention levels and . Midwives report exclusion from shared decisions due to physicians' heightened sense of liability, fostering power imbalances that undermine collaborative care and ethical principles like in during labor. In cases involving conscientious objection, such as refusals to participate in abortions or certain interventions, midwives face when institutional policies prioritize procedural compliance over personal , as documented in reviews of midwifery moral distress. Legally, midwives confront restrictive regulations that vary by , limiting and integration into systems, with 2025 research highlighting how such barriers impede access to midwifery-led care in low-risk pregnancies. In the United States, state laws often mandate physician collaboration or supervision, constraining independent practice and exposing midwives to liability without full , as noted in a 2023 GAO report on workforce challenges. litigation is common, particularly in home births; for instance, a 2024 case upheld liability for midwives in a due to delayed transfer, while settlements like a $5.5 million award in 2010 addressed brain damage from inadequate fetal monitoring. Prosecutions underscore legal perils, especially for unlicensed or traditional midwives attending home births. In , a 2025 manslaughter charge against a midwife followed a neonatal during a home delivery, reflecting scrutiny over failure to recognize complications like hemorrhage. Similarly, U.S. cases include a 2015 felony conviction for an unlicensed midwife after a failed resulting in infant harm, and ongoing challenges to bans like Nebraska's prohibition on certified nurse-midwives attending home births, contested in federal court in 2024 for restricting low-risk care options. These incidents reveal causal links between regulatory gaps and heightened risks, where empirical data on home birth outcomes—showing elevated in unplanned complications—inform legal standards prioritizing verifiable safety over ideological preferences for non-medicalized births.

Notable Figures

(1735–1812) was an American and healer in who attended approximately 1,000 births over three decades, as recorded in her personal diary spanning 1785 to 1812, which provides one of the most detailed primary accounts of early American practices. Angélique Marguerite Le Boursier du Coudray (c. 1712–1794), known as Madame du Coudray, served as the official to the French royal court and developed a mannequin-based training system that educated over 10,000 rural midwives across between 1759 and 1789, significantly standardizing obstetrical techniques amid high maternal mortality rates. Mary Breckinridge (1881–1965) founded the Frontier Nursing Service in 1925 in rural , establishing one of the first U.S. programs for nurse-midwives using horseback delivery to serve isolated communities, where her model reduced and trained generations of practitioners in out-of-hospital care. (born 1940) established the Farm Midwifery Center in in 1971, authoring influential texts on and advocating for low-intervention births, which contributed to a revival of in the U.S. by emphasizing physiological processes over routine medicalization; her center has managed over 3,000 deliveries with a reported cesarean rate under 2%. Mary Francis Hill Coley (1900–1966), an African American lay midwife in Georgia, delivered over 3,000 babies from to , primarily serving communities in the Jim Crow South, and her work was documented in the 1950s film All My Babies, which trained other midwives and highlighted community-based care amid limited access to hospitals.

Cultural Representations

Historical Depictions

In , midwives appear in scenes of , such as a plaque from around 2000 BCE depicting a on a assisted by two standing figures, interpreted as divine attendants or midwives providing support during labor. The , dating to approximately 1550 BCE, includes sections on and gynecology that reference practices, reflecting their role in facilitating deliveries amid high maternal risks. Biblical narratives portray midwives Shiphrah and Puah as Hebrew practitioners in who defied Pharaoh's command to kill newborn Israelite boys around the 13th century BCE, claiming Hebrew women birthed too swiftly for intervention; this depiction underscores their ethical resistance and prioritization of divine law. Such accounts, preserved in Exodus 1:15-21, represent one of the earliest named references to midwives in literature, emphasizing their agency in preserving life against state-sanctioned . In classical Greco-Roman contexts, midwives feature in relief carvings and texts; a Roman-era stone relief illustrates a midwife positioned to catch an during delivery, highlighting their hands-on role in births without modern analgesia. Soranus of Ephesus's 2nd-century CE treatise Gynecology details techniques, depicting practitioners as skilled women managing complications like breech presentations through manual version and herbal aids. Medieval European manuscripts often illustrate midwives in gynecological codices, such as the Fünfbilderserie series showing pregnant women in various fetal positions to guide interventions during dystocia. Illuminated pages from texts like the 12th-century ensemble depict attendants newborns or tending postpartum mothers, portraying midwives as community-based experts reliant on empirical observation rather than formal licensing. These images, derived from ancient sources like , served didactic purposes for training, though evidence of widespread literacy among midwives remains limited.

Contemporary Influences and Critiques

In contemporary media, the series (2012–present), adapted from Jennifer Worth's memoirs, has profoundly shaped cultural perceptions of by portraying midwives as compassionate, skilled professionals handling complex social and medical challenges in post-war . The series emphasizes community-based care, natural birth processes, and the emotional resilience required in the profession, drawing over 10 million viewers per episode in early seasons and achieving distribution in more than 200 territories, including syndication on in the United States. This depiction has boosted interest in midwifery careers, with anecdotal reports from midwifery educators noting increased applications following airings, and it normalizes non-hospital births amid broader cultural shifts toward autonomy in reproductive choices. Films like (2020) further influence representations by featuring extended, unscripted sequences that prioritize physiological processes over intervention, earning praise from practicing midwives for authenticity in depicting maternal effort and partner involvement without sensationalism. Such portrayals counter the medicalized birth narratives dominant in earlier Hollywood productions, where labor is often abbreviated or dramatized with high-stakes interventions, and instead align with 's emphasis on woman-centered care. In literature, modern memoirs such as Ina May Gaskin's Spiritual Midwifery (updated editions through 2015) continue to inspire alternative birth movements, framing as a holistic, empowering practice rooted in empirical observations of low-intervention outcomes at facilities like The Farm in , where complication rates have been documented below national hospital averages in self-reported data. Critiques of these influences highlight a tendency toward romanticization that may distort public expectations. For instance, has been faulted for compressing timelines and portraying improbable "medical miracles," such as rapid recoveries from severe conditions without reflecting real statistical risks like maternal hemorrhage or neonatal distress, potentially fostering undue optimism about unassisted births. Scholarly analyses argue that , including such series, perpetuates anxiety-inducing tropes of birth as inherently perilous or euphoric, influencing women's preferences toward home births despite evidence from randomized trials showing higher perinatal risks in low-risk planned home deliveries compared to settings (e.g., 1.5–2 times elevated intervention needs). amplifies this, with midwife influencers on platforms like curating "perfect birth" narratives that omit routine complications, critiqued in studies for selectively presenting data that skews toward idealized outcomes over comprehensive risk disclosure. These representations also face scrutiny for reinforcing gender stereotypes, depicting midwives predominantly as female archetypes of nurturing sacrifice, which overlooks the growing inclusion of male practitioners and the profession's shift toward evidence-based protocols amid debates over versus . While positive portrayals have elevated 's visibility—evidenced by a 20% rise in U.S. numbers from 2012 to 2020, correlating with media exposure—critics contend they underplay systemic tensions with , such as litigation risks from adverse outcomes, which empirical reviews link to defensive practices rather than inherent professional flaws. Overall, contemporary cultural outputs promote as a viable alternative to medical dominance but are tempered by calls for balanced depictions grounded in verifiable outcome data to avoid misleading causal assumptions about birth .

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