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)). 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).
Midwives in Australia must be registered with the Australian Health Practitioner Regulation Agency to practice midwifery, and use the title midwife or registered midwife.
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.
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Australian College of Midwives (ACM).
Canada
Midwifery was reintroduced as a regulated profession in most of Canada's ten provinces in the 1990s. Prior to this legalization, some midwives had practiced in a legal "grey area" in some provinces. In 1981, a midwife in British Columbia was charged with practicing without a medical license.
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). In 2023, Midwifery is regulated in New Brunswick, Newfoundland and Labrador, Prince Edward Island and Yukon.
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).
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. In Quebec, 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. 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.
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.
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).
British Columbia
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.
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 University of British Columbia (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.
European Union
The qualification of midwife in the European Union is regulated by Directive 2005/36/EC.
France
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.
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 (CNOSF).
Collège National des Sages-Femmes de France (CNSF).
Société Française de Maïeutique (SFMa).
Ireland
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). 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
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). 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. 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. 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).
Japan
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.
Professional associations/colleges
Japanese Midwives Association (JMA).
Japan Academy of Midwifery (JAM).
Japanese Nursing Association (JNA), Midwives' Division.
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 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.
New Zealand
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)).
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. 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.
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, 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.
Education, training and regulation
Though Somalia has a shortage of healthcare personnel and education, their midwifery programs are becoming more and more distinguished. 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.
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.
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).
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 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'. 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 midwifery 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).
