A midwife is a professional in midwifery. In addition to providing care to women during pregnancy and birth, midwives may also provide primary care related to reproductive health, including annual gynecological exams, family planning, and menopausal care. Many developing countries are investing money and training for midwives and other community health workers so that they can provide well-woman primary care services that are currently lacking.
Midwives are specialists in childbirth, postpartum, and well-woman health care. They are educated and trained to recognize the variations of normal progress of labor and deal with deviations from normal to discern and intervene in high risk situations, such as breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques. When a pregnant woman requires care beyond the midwife's scope of practice, they refer women to obstetricians or perinatologists who are specialists in complications related to pregnancy and birth, including surgical and instrumental deliveries. 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.
- Definition and etymology 1
- Scope of practice 2
- Male midwives 3
Education, training, regulation and licensure 4
British Columbia 4.1.1
- Current supply 220.127.116.11
- British Columbia 4.1.1
- France 4.2
- Guatemala (Maya community) 4.3
- Hong Kong 4.4
- History and development of maternal and child health services 4.5.1
- Karbis of Goria Ghuli 4.5.2
- Ireland 4.6
- Japan 4.7
- Mozambique 4.8
- Netherlands 4.9
- New Zealand 4.10
- Pakistan (province of Balochistan) 4.11
United Kingdom 4.12
- Midwifery training 4.12.1
- Community midwives 4.12.2
United States 4.13
- Certified professional midwives 4.13.1
- Certified midwives 4.13.2
- Certified nurse midwives 4.13.3
- Licensed midwife 4.13.4
- Canada 4.1
- See also 5
- References 6
- External links 7
Definition and etymology
According to the definition of the International Federation of Gynecology and Obstetrics:
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 and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
The word derives from Old English mid, "with" and wif, "woman", and thus originally meant "with-woman", that is, the woman who is with the mother at childbirth. In spite of its origins, the word is used to refer to both male and female midwives.
Scope of practice
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to 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 women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics or health units.
Men rarely practice midwifery for cultural and historical reasons. In the United States and the United Kingdom, fewer than 1% of nurse-midwives are men. In some Southeast Asian cultures, some or even most of the traditional midwives are men.
In ancient Greece, midwives were required by law to have given birth themselves, which prevented men from joining their ranks. 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. In previous centuries, they were called man-midwives in English.
Education, training, regulation and licensure
Midwifery was reintroduced as a regulated profession in most of Canada's ten provinces in the 1990s. 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, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, and Nova Scotia, and in the Northwest Territories and Nunavut. Midwifery legislation has recently been proclaimed in New Brunswick where the government is in the process of integrating midwifery services there. Only Prince Edward Island, Yukon and Newfoundland and Labrador do not have legislation in place for the practice of midwifery.
The midwifery education program is a four-year full-time university program leading to a bachelor's degree in midwifery (Bachelor of Health Sciences (B.H.Sc.) in Midwifery or Bachelor of Midwifery (BMW)). 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 a consortium of McMaster University, Ryerson University and Laurentian University. In Manitoba the program is offered by 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 are Bridging programs for internationally educated midwives in Ontario at Ryerson University and in British Columbia at the University of British Columbia. A federally funded pilot project called the Multi-jurisdictional Midwifery Bridging Program has been offered in Western Canada.
After a process of assessment by the provincial regulatory bodies, registrants are known as 'midwives', 'registered midwives' or by the French-language equivalent, 'sage femme'. 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 will 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 woman as the primary decision maker. Midwives typically have hospital privileges and support women's right to choose where she will have 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 with regulated midwifery.
The BC government announced on March 16, 1995 the approval of regulations governing midwifery and establishing 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 received Cabinet approval on April 13, 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. To see the approximate proportion of women whose primary birth attendant was a midwife in British Columbia see, "What Mothers Say: The Canadian Maternity Experiences Survey. Public Health Agency of Canada. Ottawa, 2009, p. 115.
In BC midwives deliver natural births in hospitals or homes and if a complication arises in a pregnancy, labour, birth or postpartum, a midwife will consult 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 August, 2011, the College of Midwives of BC reported 182 General, 3 Temporary, 1 Conditional, 32 Non-practicing Registrant midwives.
There were 2 midwives per 100,000 people in BC in 2006.
A midwife must be registered with the College of Midwives of BC in order 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.
Midwives education in BC: The University of British Columbia (UBC) has a four-year Bachelors 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.
- College of Midwives of BC
- Midwives Association of BC
In France, midwives (sage-femmes "wise women" or maïeuticien/maïeuticienne) are independent practitioners, specialists in birth and women's medicine. They gain qualification after a five-year study : the first year is spend at medical school with would-be physicians and dentists, the four last at midwifery school. Since 2010, the Midwife State Diploma is accredited as a master's degree.
Guatemala (Maya community)
Most of the documented evidence has been from San Pedro la Laguna, a Tz'utujil Maya community. The midwives of San Pedro have many roles in the society, and are respected highly for them. The shamans of San Pedro are rapidly declining which has caused an increase in the number of midwives, to care for the people. They call the midwife, "iyom". The Maya believe that being pregnant is to be "yawa", meaning ill. The midwife is an obstetrical and religious specialist all at once. She provides prenatal care, massage, attends delivery, and takes care "takes charge of" mother and child after birth. Midwives in this society are similar to shamans, in that her calling is divine. She is the connection between the spiritual and real world, and to protect her 'patients' she performs rituals to keep them safe. The load of work for these midwives is huge. There are not many, and they serve most women in the village. (This case study was done in 1975, and the community has changed since. A recent book documents cultural change and continuity in San Pedro and in local midwifery practices as related to the life and work of a renowned local iyom.)
In Hong Kong the Midwives Registration Ordinance requires midwives to be registered with the Midwives Council.
History and development of maternal and child health services
Maternal and child health services in India were started with the help of voluntary organizations. Modern maternal and child health work was begun in India by foreign missionaries with an effort to train dais. The time line are as follows:
- 1885 – An association for medical aid by the women of India was established by the Countess of Dufferin.
- 1918 – Lady Reading Health School was started in Delhi, offering health visitors course, which was another stepping stone in MCH Services
- 1921 – Lady Chelmsford League was formed in India for developing maternity and child welfare services.
1931 – The Indian Red Cross society established MCH Bureau in association with the Lady Chelmsford League & Victories memorial Scholarship Fund and co-ordinated the MCH work throughout the country.
- Madras was the first state then to set up a separate section for maternal and child welfare in the public health department under the charge of an Assistant Director of Public Health. It was again Madras state which first attempted to replace by the better qualified personnel such as midwives and nurse midwives.
- 1938 – Indian Research Fund Association was established which formed a committee that undertook the investigation into the incidence and cause of Maternal and infant morbidity and mortality. Sir A. Mudaliar was the key person of the committee.
Investigation thus carried out in certain cities of the country revealed that
- Institutional midwifery services were limited
- Maternal and child welfare centre were poorly equipped and staffed
- Untrained dais mostly handled deliveries
This situation continued for some more time. In 1946, the fifth health survey and development committee (Bhore committee) stated in its report that India was facing the problem of high maternal and infant death. It recommended empathetically that the measures for the reduction of sickness and mortality of mothers and children should have the highest priority in the health development programme of India. It was also mentioned that these deaths were preventable with the help of organized health services.
- 1951 – BCG vaccination programme was launched
- 1952 – Primary Health centre set up
- 1953 – A nationwide family planning programme was initiated
- 1965 – Direct BCG vaccination without prior tuberculosis test on a house-to-house basis initiated
- 1970 – All India Hospital (Post partum) Family Planning Programme was started
- 1976 – The National Programme for Prevention of Blindness was formulated.
- 1977 – Multipurpose health worker scheme was launched
- 1978 – EPI was launched
- 1983 – National Health Policy – MCH and family welfare services were integrated during this policy
- 1985 – The Universal Immunization Programme was launched. A separate department of women and child development was set up under the newly created Ministry of Human Resource Development.
- 1987 – A worldwide “Safe Motherhood Campaign” was launched by World Bank
- 1990 – Control of Acute respiratory infection (ARI) programme initiated as a pilot Project in 14 districts
- Child Survival and Safe Motherhood programme (CSSM) was launched on 20 August
- SMI (Safe Motherhood Initiative) programme was started
- The infant milk substitute, feeding bottles and infant food (regulation of production, supply and distribution) act 1992 came into force
- 1995 – ICDS renamed as Integrated Mother and Child Development Services (IMCD)
1996 – Pulse Polio Immunization (PPI), the largest single-day public health event, took place on 9 and 20 January 1996. The second phase of PPI was conducted on 7 December 1996 and 8 January 1997
- Family Planning Programme made target free from 1 April 1996
- Prenatal Diagnostic Technique (Regulation and Prevention of Misuse) act 1994 came into force from January 1996
Karbis of Goria Ghuli
The village of Goria Ghuli is an example of a rural and traditional village. It has no electricity or access to a telephone. The primary health facility is in Sonapur, which is about 7 km from the village. This health facility has 3 doctors, 2 lady health visitors, 6 auxiliary nurse midwives, 3 microscopists, and 2 pharmacists. The Karbis believe that good health “is the outcome of a pious life and illness is the punishment meted out by spirits”
The Karbis have specialists or healers who are not alike; midwives or ethnogynacologists are one of these specialists. The village has two categories of midwives. The first is known as the ‘traditional’ midwife, who is also an herbalist. The second is the ‘nurse’ midwife; these are the ‘government’ midwives. Traditional midwives are favored in the village. They receive some informal training that is used to help with before, during, and after pregnancy care. This information is transferred from generation to generation. In the village there are 3 ethnogynacologists, which can be approached for assistance at the time of delivery. She, and usually another elderly woman in the village, help during and after the delivery. If for any reason there are complications, the village midwife will forward the ‘patient’ to the ‘nurse’. If she is unable to help then they are forwarded to the Primary Health Center. These midwives do not take on the traditional role of a midwife that we may see in the United States, for example. Rather, a huge role of the midwife is as an herbalist for the village.
Midwives in the Republic of Ireland are trained either as nurses, obtaining a higher diploma in midwifery after 18 months of study, or as midwives on "direct entry" to a course of study and practice that lasts four years, with an internship in the final year. The first male midwife was registered in 2009.
Japanese midwives must pass a national certification exam. Up until March 1, 2003 only women could be midwives.
To understand the Japanese model see, Midwifery in Japan by the Japanese Nursing Association.
- Japan Academy of Midwifery
- Japanese Midwives Association
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. These midwives 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 United Nations Millennium Development Goal (MDG) of reducing the maternal death rate by 75 percent by 2015.
Midwives are called vroedvrouw (knowledge woman), vroedmeester (knowledge master, male), or verloskundige (deliverance experts) in Dutch. 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
The validation of midwifery education, through one of the following categories:
- Graduation of a midwifery education program accredited by the Midwifery Education Accreditation Council (MEAC).
- NARM's Portfolio Evaluation Process (PEP) pathway.
- Midwifery licensure of a state approved by NARM.
- Midwifery international education.
- AMCB-certification CNM or CM.
- The NARM Written Examination
- Jim Campbell; et al. (2011). Fauveau, Vincent, ed. The State of the World's Midwifery 2011 – Delivering Health, Saving Lives (PDF). [New York]: United Nations Population Fund (UNFPA). p. 10.
- Epstein, Abby (January 9, 2008). "The Business of Being Born (film)". The New York Times. Retrieved 2009-10-30.
- "International Definition of the Midwife". International Confederation of Midwives. Retrieved 2015.
- "midwife". The Oxford English Dictionary. Retrieved 2015.
- "Midwife: Word History". The American Heritage Dictionary of the English Language, Fifth Edition. Houghton Mifflin Harcourt Publishing Company. 2015.
- Pilkenton, Deanna; Schorn, Mavis N (February 2008). "Midwifery: A career for men in nursing". Men In Nursing.
- Gianno, Rosemary (2004). Women are not brave enough' Semelai male midwives in the context of Southeast Asian cultures"'". Bijdragen tot de Taal-, Land- en Volkenkunde 160 (1): 31–71.
- Schroff, F. (1997). The New Midwifery. Toronto: Women's Press.
- "midwiferybridging.ca". midwiferybridging.ca. Retrieved 2012-12-10.
- "cmbc.bc.ca". cmbc.bc.ca. 1998-01-01. Retrieved 2012-12-10.
- "College of Midwives of British Columbia". Cmbc.bc.ca. Retrieved 2012-12-10.
- Canadian Institute for Health Information document titled, Number of Health Personnel in Selected Professions by Registration Status, 2006. This data has the following proviso, “Due to the variation in regulatory requirements, interprofessional comparison should be interpreted with caution.”
- "bcmidwives.com". bcmidwives.com. Retrieved 2012-12-10.
- (French) ONISEP on midwives
- Paul, B. D.; Paul, L. (1975). "The maya midwife as sacred specialist: A guatemalan case". American Ethnologist 2 (4): 707–726.
- Rogoff, B. (2011). Developing destinies: A Mayan midwife and town. New York: Oxford University Press.
- Neelam Kumari, Shivani Sharma and Dr. Preeti Gupta (2010). Midwifery and Gynecological Nursing. (Jalandhar): S. Vikas & Company (Medical Publishers).
- Das, I. (2003). "Ethnomedical practices among the karbis of goria ghuli of sonapur, assam, with special reference to the female health problems" (PDF). Journal of Human Ecology 14 (2): 119–124.
- "Japanese Midwives Association" (in Japanese).
- "Midwifery in Japan" (PDF). Japanese Nursing Association. Retrieved 1 November 2012.
- "HOME". Square.umin.ac.jp. Retrieved 2012-12-10.
- "http". //www.midwife.or.jp. 2009-01-04. Retrieved 2012-12-10.
- Birth of a SurgeonPBS documentary
- "Fewer women give birth at home". CVZ,Central Bureau of Statistics.
- "Midwifery in the Netherlands" (PDF). (KNOV). Retrieved 2012.
- "Obstetric Practice in the City of Groningen" (in Dutch).
- "Preconceptional care" (in Dutch).
- "Midwifery in the Netherlands". The Royal Dutch Organisation of Midwives (KNOV):.
- "Having a baby in the Netherlands".
- "Care package". CVZ, College for Healthcare Insurances.
- "KNOV - Koninklijke Nederlandse Organisatie van Verloskundigen". Knov.nl. Retrieved 2012-12-10.
- "New Zealand College of Midwives".
- New Zealand Health Information Service: "Report on Maternity - Maternal and Newborn Information 2003."
- """Socialedge.org blog "SVT on Impact. from 7/10 interview and subsequent correspondence with Khalida Brohi, founder of Participatory Development Initiatives.
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- "Care of Healthy Women and Their Babies During Childbirth". National Collaborating Centre for Women's and Children's Health. National Institute for Health and Care Excellence. December 2014. Retrieved 21 December 2014.
- "Threat to Independent Midwifery". BBC News. 2007-03-10. Retrieved 2012-12-10.
- Royal College of Midwives official website
- The Nursing and Midwifery Council official website
- Midwifery Universities in the UK
- "Career Profile: Community Midwife - Royal College of Midwives". Rcm.org.uk. Retrieved 2012-12-10.
- "Birth Center Regulations | American Association of Birth Centers". Birthcenters.org. Retrieved 2012-12-10.
- "What is a CPM?", North American Registry of Midwives
- "CPM Certification Process", North American Registry of Midwives
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- "Direct-Entry Midwifery State-by-State Legal Status". Mana.org. Retrieved 2012-12-10.
CPMs have to apply for recertification every three years.
A certified midwife (CM) is certified by the American Midwifery Certification Board (AMCB). The CM route was created in 1997 to provide an alternative entry to midwifery. The CM program is at the post-baccalaureate level. Candidates can apply for admissions to a midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) with a bachelor’s degree and completion of relevant courses in the sciences. After completion of the education component, CM candidates earn a master’s degree and are eligible to take the national exam toward certification. All CMs must pass the same national certification exam administered by the AMCB. CMs also have to go through a recertification process every five years.
Certified nurse midwives
A certified nurse midwife (CNM) is a registered nurse who has advanced training in women's health care certified by the American Midwifery Certification Board (AMCB). CNMs focus on care of women and their families during pregnancy, delivery, and the postpartum period. They are licensed and practice in every state. CNMs provide physical and emotional support during normal birth, which can reduce the rate of complications and interventions. They practice in hospital, birth center, and home settings, with the majority associated with a hospital or birth centers. CNMs are taught to identify conditions which are beyond their scope of practice and consult with, or refer to, physician care as appropriate. They also provide well-woman care, including annual exams, birth control, infection checks, and pre-pregnancy counseling.
Licensure for direct-entry midwives is available in 27 states as of 2011.
- International Confederation of Midwives (ICM)
- Partnership Maternal Newborn and Child Health (PMNCH)
A certified professional midwife (CPM) is an independent professional certified by the North American Registry of Midwives (NARM) and adheres to the Midwives Model of Care. The CPM is the only US credential that requires knowledge and experience for out-of-hospital settings. The CPM certification process validates entry-level knowledge, skills, and experience vital to responsible midwifery practice; encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college and university-based midwifery programs, and nurse-midwifery; consists of two steps:
Certified professional midwives
There are midwifery education programs leading to different qualifications:
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.
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. 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.
The midwifery education program is a three-year full-time university program leading to a bachelor's degree in midwifery (Bachelor of Science (BSc) (Hons) Midwifery or Bachelor of Midwifery (BMid) (Hons)). Some universities also offer a 18-month full-time program for qualified registered adult nurses leading to a bachelor's degree in midwifery or an equivalent qualification (Bachelor of Science (BSc) (Hons) Midwifery, Bachelor of Midwifery (BMid) (Hons), Graduate Diploma in Midwifery (Grad Dip Mid) or Postgraduate Diploma in Midwifery (PG Dip Mid)). Midwifery training consists of classroom-based learning provided by select universities in conjunction with hospital- and community-based training placements at NHS Trusts.
- The Royal College of Midwives
- The Nursing and Midwifery Council is the regulatory body for nurses, midwives and health visitors in the UK.
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.
All practising midwives in the UK must be registered with the Nursing and Midwifery Council, and each must also have a Supervisor of Midwives through their local supervising authority. 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.
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.
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 NMC.
Midwifery students do not pay tuition fees and are eligible for additional financial support while training. Funding varies depending on which country within the UK the student is located in: students are eligible for NHS bursaries in addition to a grant of 1,000 pounds a year, and neither has to be repaid. Shortened-course students, who are already registered adult nurses, have different funding arrangements, are employed by the local NHS Trust via the Strategic Health Authority (SHA), and are paid salaries. This varies 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.
There are two routes to qualify as a midwife. Most midwives qualify via a "direct entry" course, which refers to a three- or four-year course undertaken at a university that leads to a degree in midwifery and entitles them to apply for admission to the register. Alternatively, following completion of training as a nurse, a nurse may become a registered midwife by completing an eighteen-month post-registration course leading to a degree. However, this route is available only to adult branch nurses, and any child, mental health or learning disability branch nurse must complete the full three-year course to qualify as a midwife.
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 Balochistan, midwives are the third most powerful leaders in the community, and the most powerful among women. People say that they give life to a child as the majority of tribal areas have no doctors. Midwives also solve problems between women. If there is a conflict between a man and a woman, the man has more power, and he will go to the tribal chief instead.
Pakistan (province of Balochistan)
- The New Zealand College of Midwives, a professional organisation for midwives, representing nearly 90% of practising midwives. Membership is voluntary.
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 will either consult or transfer 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 will incur a fee in addition to the government funding.)
The midwifery education program is a four-year undergraduate degree equivalent program leading to a bachelor's degree in midwifery (Bachelor of Midwifery). There are also postgraduate programs leading to postgraduate qualifications and degrees (Postgraduate Certificate in Midwifery, Postgraduate Diploma in Midwifery, Master of Midwifery, PhD Professional Doctorate). These programs are offered by Otago Polytechnic in Dunedin, Christchurch Polytechnic Institute of Technology (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 Invercargill and AUT with student cohorts in various sites in the upper North Island.
Midwifery regained its status as an autonomous profession in New Zealand in 1990. 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.
- The Royal Dutch Organisation of Midwives is the primary midwifery organisation in the Netherlands.
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.
The midwifery education program is a four-year full-time entry university program 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.
 practices give additional care in the form of preconceptional care and help with fertility problems.midwifery Some