Australia ;Education, training and regulation The undergraduate midwifery programs are three-year full-time university programs leading to a bachelor's degree in midwifery (Bachelor of Midwifery) with additional one-year full-time programs leading to an honours bachelor's degree in midwifery (Bachelor of Midwifery (Honours)). 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. ;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'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). ;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 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
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. 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.
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). 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. Pre-registration midwifery training via the short course is, at present, only an option to those holding registration as an adult nurse (RN – Adult, RGN, or RNA). Mental Health Nurses (RMNs), Children's Nurses (RN – Child or Children / RSCNs) and Learning Disability Nurses (RNLDs) would need to complete the full three-or-four-year programme depending on their choice of university. Midwives must be registered with the
Nursing and Midwifery Council to practice midwifery and use the title 'midwife' or 'registered midwife', and must also have a Supervisor of Midwives through their local supervising authority. ;Practice Midwives are practitioners in their own right in the United Kingdom. They take responsibility for the
antenatal,
intrapartum and
postnatal care of women up until 28 days after the birth, or as required thereafter. Midwives are the lead
health care professional attending the majority of births, whether at home, in a midwife-led unit or in a hospital (although most births in the UK occur in hospitals). In December 2014 the
National Institute for Health and Care Excellence updated its guidance regarding where women should give birth. The new guidance states that midwife-led units are safer than hospitals for women having straightforward (low risk) pregnancies. Its updated guidance also confirms that home birth is as safe as birth in a midwife-led unit or a traditional labour ward for the babies of low-risk pregnant women who have already had at least one child previously. 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. 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. Midwives are at all times responsible for the women they are caring for. They must know when to refer complications to medical staff, act as the women's advocate, and ensure that mothers retain choice and control over childbirth. Most practising midwives in the United Kingdom are female: men account for less than 0.5 per cent of midwives on the register of the
Nursing and Midwifery Council. ;Professional associations/colleges • Royal College of Midwives (RCM). • Independent Midwives UK (IMUK). •
Association of Radical Midwives (ARM).
United States ;Education, training and regulation Accredited midwifery 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==