A midwife is a

health professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...

who cares for mothers and

newborn An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

s around

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glo ...

, a specialization known as

midwifery Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), in addition to the sexual and reproductive health of women throughout their lives. In many cou ...

. 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 recognized as skilled healthcare providers. Midwives are trained to recognize variations from the normal progress of

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the labour ...

and understand how to deal with deviations from normal. They may intervene in high risk situations such as

breech birth A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term (37–40 weeks pregnant) have a breech baby. Due to their higher than average rate of possible complications for th ...

twin birth Twins are two offspring produced by the same pregnancy.MedicineNet > Definition of TwinLast Editorial Review: 19 June 2000 Twins can be either ''monozygotic'' ('identical'), meaning that they develop from one zygote, which splits and forms two ...

s, and births where the baby is in a posterior position, using non-invasive techniques. For complications related to pregnancy and birth that are beyond the midwife's

scope of practice Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for ...

, including surgical and instrumental deliveries, they refer their patients to physicians or surgeons. 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 utilize obstetricians primarily over midwives. Many

developing countries A developing country is a sovereign state with a lesser developed Industrial sector, industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is al ...

are investing money and training for midwives, sometimes by upskilling those people already practicing as traditional birth attendants. Some

primary care Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist car ...

services are currently lacking, due to a shortage of funding for these resources.

Definition and etymology

According to the definition of the International Confederation of Midwives, which has also been adopted by the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

and the International Federation of Gynecology and Obstetrics: The word derives from Old English '' mid'', "with", and '' wif'', "woman", and thus originally meant "with-woman", that is, the person who is ''with'' the ''woman'' (mother) at childbirth. The word refers to midwives regardless of gender.

Scope of practice

The midwife is recognized as a responsible and accountable professional who works in partnership with women to give necessary support during pregnancy, labor, and the

postpartum period The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal peri ...

. They also provide care for the newborn and the infant; this care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance, and the carrying out of emergency measures. The midwife has an important task in health counselling and education, not only for the woman, 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.

Education, training, regulation and practice

Australia

Education, training and regulation The undergraduate

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)). 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 who wish to become midwives) leading to a bachelor's degree or equivalent qualification in midwifery (Bachelor of Midwifery, Graduate Diploma in Midwifery). 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).

Canada

Midwifery was reintroduced as a regulated profession in most of

Canada Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tota ...

's ten provinces in the 1990s. Prior to this legalization, some midwives had practiced in a legal "grey area" in some provinces.Midwifery in Saskatchewan
Midwives Association of Saskatchewan In 1981, a midwife in British Columbia was charged with practicing without a medical license.Midwifery in Canada
Law Now After several decades of intensive political

lobbying In politics, lobbying, persuasion or interest representation is the act of lawfully attempting to influence the actions, policies, or decisions of government officials, most often legislators or members of regulatory agencies. Lobbying, whic ...

by midwives and consumers, fully integrated, regulated and publicly funded

is now part of the health system in the provinces of

British Columbia British Columbia (commonly abbreviated as BC) is the westernmost Provinces and territories of Canada, province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include ...

(regulated since 1995),

Alberta Alberta ( ) is one of the thirteen provinces and territories of Canada. It is part of Western Canada and is one of the three prairie provinces. Alberta is bordered by British Columbia to the west, Saskatchewan to the east, the Northwest Ter ...

(regulated since 2000, fully funded since 2009)

Saskatchewan Saskatchewan ( ; ) is a province in western Canada, bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, to the northeast by Nunavut, and on the south by the U.S. states of Montana and North ...

(regulated since 1999),

Manitoba , image_map = Manitoba in Canada 2.svg , map_alt = Map showing Manitoba's location in the centre of Southern Canada , Label_map = yes , coordinates = , capital = Win ...

(regulated since 1997),

Ontario Ontario ( ; ) is one of the thirteen provinces and territories of Canada.Ontario is located in the geographic eastern half of Canada, but it has historically and politically been considered to be part of Central Canada. Located in Central C ...

(regulated since 1991),

Quebec Quebec ( ; )According to the Government of Canada, Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is ...

(regulated since 1999), and

Nova Scotia Nova Scotia ( ; ; ) is one of the thirteen provinces and territories of Canada. It is one of the three Maritime provinces and one of the four Atlantic provinces. Nova Scotia is Latin for "New Scotland". Most of the population are native En ...

(regulated since 2006), and in the

Northwest Territories The Northwest Territories (abbreviated ''NT'' or ''NWT''; french: Territoires du Nord-Ouest, formerly ''North-Western Territory'' and ''North-West Territories'' and namely shortened as ''Northwest Territory'') is a federal territory of Canada. ...

(regulated since 2003) and

Nunavut Nunavut ( , ; iu, ᓄᓇᕗᑦ , ; ) is the largest and northernmost territory of Canada. It was separated officially from the Northwest Territories on April 1, 1999, via the '' Nunavut Act'' and the '' Nunavut Land Claims Agreement Act'' ...

(regulated since 2008). In 2010, Midwifery legislation was proclaimed in

New Brunswick New Brunswick (french: Nouveau-Brunswick, , locally ) is one of the thirteen Provinces and territories of Canada, provinces and territories of Canada. It is one of the three Maritime Canada, Maritime provinces and one of the four Atlantic Canad ...

and

Newfoundland and Labrador Newfoundland and Labrador (; french: Terre-Neuve-et-Labrador; frequently abbreviated as NL) is the easternmost province of Canada, in the country's Atlantic region. The province comprises the island of Newfoundland and the continental region ...

. Only

Prince Edward Island Prince Edward Island (PEI; ) is one of the thirteen provinces and territories of Canada. It is the smallest province in terms of land area and population, but the most densely populated. The island has several nicknames: "Garden of the Gulf", ...

and

Yukon Yukon (; ; formerly called Yukon Territory and also referred to as the Yukon) is the smallest and westernmost of Canada's three territories. It also is the second-least populated province or territory in Canada, with a population of 43,964 as ...

have no legislation in place for the practice of midwifery. Education, training and regulation The undergraduate

programs are four-year full-time university programs leading to bachelor's degrees in midwifery (B.H.Sc. in Midwifery, Bachelor of Midwifery). In British Columbia, the program is offered at the

University of British Columbia The University of British Columbia (UBC) is a public university, public research university with campuses near Vancouver and in Kelowna, British Columbia. Established in 1908, it is British Columbia's oldest university. The university ranks a ...

Mount Royal University Mount Royal University (MRU) is a public university in Calgary, Alberta, Canada. History Mount Royal University was founded by Alberta provincial charter by the Arthur Sifton government on December 16, 1910 and officially opened on September 8 ...

in Calgary, Alberta offers a Bachelor of Midwifery program. In Ontario, the Midwifery Education Program (MEP) is offered by

McMaster University McMaster University (McMaster or Mac) is a public research university in Hamilton, Ontario, Canada. The main McMaster campus is on of land near the residential neighbourhoods of Ainslie Wood and Westdale, adjacent to the Royal Botanical ...

and

Toronto Metropolitan University Toronto Metropolitan University (TMU or Toronto Met) is a public research university located in Toronto, Ontario, Canada. The university's core campus is situated within the Garden District, although it also operates facilities elsewhere in To ...

and previously by

Laurentian University Laurentian University (french: Université Laurentienne), officially the Laurentian University of Sudbury, is a mid-sized Bilingualism in Canada, bilingual public university in Greater Sudbury, Ontario, Canada, incorporated on March 28, 1960. Lau ...

. In Manitoba, the program is offered by the

University of Manitoba The University of Manitoba (U of M, UManitoba, or UM) is a Canadian public research university in the province of Manitoba.University College of the North. In

, the program is offered at the Université du Québec à Trois-Rivières. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. There is also a programme for aboriginal midwives in Ontario. There are also three "bridging programs" for internationally educated midwives. The International Midwifery Pre-registration Program (IMPP) is a nine-month program offered by

in Ontario. The Internationally Educated Midwives Bridging Program (IEMBP) runs between 8 and 10 months at the

. 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

, 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. The legal recognition of midwifery has brought midwives into the mainstream of

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health ...

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 A professional association (also called a professional body, professional organization, or professional society) usually seeks to further a particular profession, the interests of individuals and organisations engaged in that profession, and th ...

have legislation and standards in place to provide protection, particularly for choice of birth

place Place may refer to: Geography * Place (United States Census Bureau), defined as any concentration of population ** Census-designated place, a populated area lacking its own municipal government * "Place", a type of street or road name ** Ofte ...

, 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

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 Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

. 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).

British Columbia

On 16 March 1995, the BC government announced the approval of regulations that govern

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. 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. 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 reported 247 General, 2 Temporary, 46 Non-practicing Registrant midwives. There were 2 midwives per 100,000 people in BC in 2006. 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. The

(UBC) has a four-year Bachelor of Midwifery program. 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 and the Midwives Association of BC.

France

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

programs are five-year full-time university programs (four years in midwifery schools after a first year of medical studies common with Medicine,

Odontology Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions o ...

and Pharmacy) leading to an accredited master's degree in midwifery (Diplôme d'Etat de Sage-Femme). Midwives in France must be registered with the Ordre des sages-femmes to practice midwifery and use the title ''sage-femme''. Professional associations/colleges: * L'Ordre des Sages-Femmes, Conseil National. * Collège National des Sages-Femmes de France (CNSF). * Société Française de Maïeutique (SFMa).

Ireland

Education, training and regulation The undergraduate

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). 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''.

Japan

Education, training and regulation

Midwifery Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), in addition to the sexual and reproductive health of women throughout their lives. In many cou ...

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. Professional associations/colleges * Japanese Midwives Association (JMA). * Japan Academy of Midwifery (JAM). * Japanese Nursing Association (JNA), Midwives' Division. The National Archives UK - CO 1069-157-11 cropped

The National Archives UK - CO 1069-157-11 cropped

Mozambique

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

obstetrician Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surg ...

s 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 Cesareans 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.

Netherlands

Education, training and regulation The undergraduate

programs are four-year full-time university programs leading to a bachelor's degree in midwifery (HBO-bachelor Verloskunde). There are four colleges for midwifery in the

Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...

: in

Amsterdam Amsterdam ( , , , lit. ''The Dam on the River Amstel'') is the Capital of the Netherlands, capital and Municipalities of the Netherlands, most populous city of the Netherlands, with The Hague being the seat of government. It has a population ...

Groningen Groningen (; gos, Grunn or ) is the capital city and main municipality of Groningen province in the Netherlands. The ''capital of the north'', Groningen is the largest place as well as the economic and cultural centre of the northern part of t ...

Rotterdam Rotterdam ( , , , lit. ''The Dam on the River Rotte'') is the second largest city and municipality in the Netherlands. It is in the province of South Holland, part of the North Sea mouth of the Rhine–Meuse–Scheldt delta, via the ''"N ...

and

Maastricht Maastricht ( , , ; li, Mestreech ; french: Maestricht ; es, Mastrique ) is a city and a municipality in the southeastern Netherlands. It is the capital and largest city of the province of Limburg. Maastricht is located on both sides of the ...

. 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 2005–2008, 29% of babies were delivered at home. This figure fell to 23% delivered at home between 2007-2010 according to Midwifery in the Netherlands, a 2012 pamphlet by The Royal Dutch Organization for Midwives. 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. Some midwifery practices give additional care in the form of preconceptional care and help with fertility problems. 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. Professional associations/colleges * Royal Dutch Organisation of Midwives , Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV).

New Zealand

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)). These programmes are offered by

Otago Polytechnic Otago Polytechnic was a public New Zealand tertiary education institute, centred in Dunedin with additional campuses in Cromwell and Auckland. Otago Polytechnic provided career-focused education and training, offering a range of New Zealand accr ...

in Dunedin, Ara Institute of Canterbury (formally CPIT) in Christchurch,

Waikato Institute of Technology The Waikato Institute of Technology, also known as Wintec, is an institute of technology based in New Zealand's Waikato region. Wintec offers over 130 degrees, diplomas and certificates. Wintec specialises in applied tertiary training for nurses ...

in Hamilton and

Auckland University of Technology Auckland University of Technology (AUT) ( mi, Te Wānanga Aronui o Tāmaki Makau Rau) is a university in New Zealand, formed on 1 January 2000 when a former technical college (originally established in 1895) was granted university status. AUT ...

(AUT) in Auckland. Several schools have satellite programmes such as Otago with a programme in Southland, Wanaka, Wellington, Palmerston North, Wanganui, and Wairarapa - and AUT with student cohorts in various sites in the upper North Island. 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 New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 List of islands of New Zealand, smaller islands. It is the ...

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. 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). 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.

Somalia

Increase in midwifery education has led to advances in impoverished countries. In

Somalia Somalia, , Osmanya script: 𐒈𐒝𐒑𐒛𐒐𐒘𐒕𐒖; ar, الصومال, aṣ-Ṣūmāl officially the Federal Republic of SomaliaThe ''Federal Republic of Somalia'' is the country's name per Article 1 of thProvisional Constitut ...

, 1 in 14 women die while giving birth. 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.

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.http://www.sanc.co.za 5 June 2017. *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 South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring count ...

. Professional associations/colleges * The Society of Midwives of South Africa (SOMSA).

Tanzania

Education, training and regulation There are different levels of education for midwives: * Certificate in Midwifery * Diploma in Midwifery * Advanced Diploma in Midwifery * Bachelor of Science in Midfwifery (BScM) * Master of Science in Midwifery (MScM) Midwives must be licensed by the

Tanzania Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands ...

Nursing and Midwifery Council (TNMC) in order to practice as a 'registered midwife' or 'enrolled midwife'. 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. Professional associations/colleges * Tanzania Midwives Association (TAMA).

United Kingdom

Education, training and regulation The undergraduate

programs are three-year full-time university programs leading to honours bachelor's degrees in midwifery: BSc (Hons) Midwifery, Bachelor of Midwifery (Hons). 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 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. It is important to note that 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 The Nursing and Midwifery Council (NMC) is the regulator for nursing and midwifery professions in the UK. The NMC maintains a register of all nurses, midwives and specialist community public health nurses and nursing associates eligible to pr ...

in order 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 The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

. They take responsibility for the

antenatal Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...

, intrapartum and

postnatal The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...

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 The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care in England that publishes guidelines in four areas: * the use of health technologies withi ...

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. Many midwives also work in the community. The role of community midwives includes making initial appointments with pregnant women, managing

clinic A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care nee ...

s, undertaking postnatal care in the home and attending

home birth A home birth is a birth that takes place in a residence rather than in a hospital or a birthing center. They may be attended by a midwife, or lay attendant with experience in managing home births. Home birth was, until the advent of modern med ...

s. 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 The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

, 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. 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

. 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

. Professional associations/colleges * Royal College of Midwives (RCM). * Independent Midwives UK (IMUK). * Association of Radical Midwives (ARM).

United States

Education, training and regulation Accredited

programs can lead to different professional midwifery credentials: * Midwifery programs, accredited by the Midwifery Education Accreditation Council (MEAC), leading to the Certified Professional Midwife (CPM) credential, certified by the North American Registry of Midwives (NARM), 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, certified by the American Midwifery Certification Board (AMCB), 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. 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, 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. 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. 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 * Midwives Alliance of North America (MANA). * National Association of Certified Professional Midwives (NACPM). * American College of Nurse-Midwives (ACNM).

Men in midwifery

Men rarely practice midwifery for cultural and historical reasons. In

ancient Greece Ancient Greece ( el, Ἑλλάς, Hellás) was a northeastern Mediterranean civilization, existing from the Greek Dark Ages of the 12th–9th centuries BC to the end of classical antiquity ( AD 600), that comprised a loose collection of cult ...

, midwives were required by law to have given birth themselves, which prevented men from joining their ranks. In 17th century Europe, some

barber surgeons The barber surgeon, one of the most common European medical practitioners of the Middle Ages, was generally charged with caring for soldiers during and after battle. In this era, surgery was seldom conducted by physicians, but instead by barbers ...

, 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'' (based on a misunderstanding of the etymology of ''midwife'') is occasionally encountered, mostly as a joke. In previous centuries, they were called ''man-midwives'' in English. 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. 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 Sex Discrimination Act 1975 (c. 65) was an Act of the Parliament of the United Kingdom which protected men and women from discrimination on the grounds of sex or marital status. The Act concerned employment, training, education, harassme ...

, the Royal College of Midwives barred men from the profession until 1983. As of March 2016, there were between 113 and 137 registered male midwives, representing 0.6% of all practising midwives in the UK. 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. In some Southeast Asian cultures, some or even most of the traditional midwives are men.

History

Medieval Europe

In Medieval Europe, it wasn't 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. 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.

Ming China

A midwife in

Ming China The Ming dynasty (), officially the Great Ming, was an imperial dynasty of China, ruling from 1368 to 1644 following the collapse of the Mongol-led Yuan dynasty. The Ming dynasty was the last orthodox dynasty of China ruled by the Han peop ...

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.Ropp, Paul S."Chinese Women in the Imperial Past: New Perspectives (review)." ''China Review International'', vol. 9 no. 1, 2002, pp. 43. 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. Women who wanted to be a midwife could only learn the skill from experts because there was no literature about midwifery. To serve in the

Forbidden City The Forbidden City () is a palace complex in Dongcheng District, Beijing, China, at the center of the Imperial City of Beijing. It is surrounded by numerous opulent imperial gardens and temples including the Zhongshan Park, the sacrific ...

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''). Pregnant women outside the palace were likely to pay more to hire "palace midwifes" than "folk midwifes".

Responsibility

A midwife's responsibilities could include criminal investigations, especially those that involved women. 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. Midwives were sometimes assigned to inspect female healers selected by the Lodge, to make sure they were healthy.Cass, Victoria B. “Female Healers in the Ming and the Lodge of Ritual and Ceremony.” ''Journal of the American Oriental Society'', vol. 106, no. 1, 1986, pp. 239. During the process of childbirth, they cleaned the byproducts from

abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical ...

s and

stillbirth Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The ter ...

s.Furth, Charlotte. “Ming Women as Healing Experts”. ''A Flourishing Yin: Gender in China's Medical History, 960-1665''. pp. 281. Such work was considered "pollution" during the Ming dynasty.Judge, Joan. "Chinese Women’s History: Global Circuits, Local meanings." ''Journal of Women's History'', vol. 25 no. 4, 2013, pp. 233.

Infanticide Infanticide (or infant homicide) is the intentional killing of infants or offspring. Infanticide was a widespread practice throughout human history that was mainly used to dispose of unwanted children, its main purpose is the prevention of resou ...

, particularly of newborn baby girls, was part of

family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...

in Ming times. 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. They were also responsible for disposing waste from the process of childbirth, which consisted of body parts from the

placenta The placenta is a temporary embryonic and later fetal organ (anatomy), organ that begins embryonic development, developing from the blastocyst shortly after implantation (embryology), implantation. It plays critical roles in facilitating nutrien ...

. Therefore, they could easily sell them to others secretly to earn additional income.

Public perception

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. Midwives were also labeled as one of "six grannies". This term was originally established by scholars and officials. 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. 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 A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and ...

knowledge as opposite to the midwife's manual manipulations. They did not consider midwives as professionals that required expertise because their skill was not learned from scholarly literature. They believed the midwife's existence was due to gender segregation, and it limited the male physician's role in childbirth.

Notable midwives

* Marie-Rosalie Cadron-Jetté *

Yvonne Cryns Yvonne Cryns (born 1951) is an American midwife and political activist. From 1991 to 2001, she served as a traditional midwife in Illinois and Wisconsin. Cryns has a Certified Professional Midwife (CPM) designation. As a childbirth activist, sh ...

* Charlotte Führer *

Barbara Kwast Barbara E Kwast (1938) is an epidemiologist, midwife and educator. Her research on the cause of maternal deaths has, according to the UNFPA, contributed to reducing the maternal mortality rates in the world. Life Kwast studied to become a nur ...

Zeinebou Mint Taleb Moussa Zeinebou Mint Taleb Moussa ( ar, زينب منت طالب موسى) is a women's rights activist in Mauritania, focused on combating sexual violence through her work as founder of El Wafa, a survivors' center, and as president of the non-governme ...

* Elizabeth Nihell *

Justine Siegemund Justine Siegemund or Siegemundin (26 December 1636 – 10 November 1705) was a renowned midwife from Lower Silesia whose ''Court Midwife'' (1690) was the most read, but not the first, female-published German obstetrical manual. Early life She was ...

* Ronnie Lichtman * Ina May Gaskin *

Juana Miranda Juana Miranda Petrona (1842 - 1914) was an Ecuadorian obstetrician and the first female university professor in Ecuador. Early life and education Juana Miranda Petrona was the first of five children. Her parents were Sebastiana de la Pulla Corte ...

* Traize Ikhmaise

Midwives in culture

Shiphrah and Puah Shiphrah ( he, שִׁפְרָה ') and Puah ( he, פּוּעָה ') were two midwives who briefly prevented a genocide of children by the Egyptians, according to Exodus 1:15–21. According to the Exodus narrative, they were commanded by the Ki ...

are two midwives in the

Book of Genesis The Book of Genesis (from Greek ; Hebrew: בְּרֵאשִׁית ''Bəreʾšīt'', "In hebeginning") is the first book of the Hebrew Bible and the Christian Old Testament. Its Hebrew name is the same as its first word, ( "In the beginning" ...

(6th-5th century BC). They are noted for disobeying the Pharaoh's command to kill all new-born Hebrew boys. '' 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 Oprah's Book Club was a book discussion club segment of the American talk show ''The Oprah Winfrey Show'', highlighting books chosen by host Oprah Winfrey. Winfrey started the book club in 1996, selecting a new book, usually a novel, for viewers ...

and became a ''New York Times'' Best Seller. The TV film '' Midwives'' (2001) was based on it. ''

Call the Midwife ''Call the Midwife'' is a BBC period drama series about a group of nurse midwives working in the East End of London in the late 1950s and 1960s. The principal cast of the show has included Jessica Raine, Miranda Hart, Helen George, Bryony H ...

'' (2012) is a drama series based on novels by Jennifer Worth. It features midwives working in the

East End of London The East End of London, often referred to within the London area simply as the East End, is the historic core of wider East London, east of the Roman and medieval walls of the City of London and north of the River Thames. It does not have un ...

1950–1960. '' The Midwife'' (''Sage femme'', 2017) is a film drama about Claire, a midwife, and her late father's eccentric former mistress.

References

Notes

External links

International Confederation of Midwives (ICM)

Partnership Maternal Newborn and Child Health (PMNCH)

Becoming a Midwife

Graduate Diploma of Midwifery at the University of Notre Dame AustraliaNovels about midwives
{{Authority control Health care occupations

Definition and etymology

Scope of practice

Education, training, regulation and practice

Australia

Canada

British Columbia

France

Ireland

Japan

Mozambique

Netherlands

New Zealand

Somalia

South Africa

Tanzania

United Kingdom

United States

Men in midwifery

History

Medieval Europe

Ming China

Responsibility

Public perception

Notable midwives

Midwives in culture

See also

References

External links