Midwifery
Encyclopedia
Midwifery is a health care
profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding.
A practitioner of midwifery is known as a midwife, a term used in reference to both women and men, although the majority of midwives are female. In addition to providing care to women during pregnancy and birth, many midwives also provide primary care
to women, well-woman care related to reproductive health, annual gynecological exams, family planning
, and menopausal care.
In the term midwife, the morpheme
-wife is pronounced as expected (waɪf), but midwifery is normally pronounced mɪdˈwɪf(ə)ri .
Midwives are specialists in low-risk pregnancy, childbirth
, and postpartum, although they are trained to recognize and deal with deviations from the normal. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery
. The two professions can be complementary, but may be at odds in some countries, where obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.
Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many parts of the world, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain more difficult deliveries, including breech birth
s, twin births and births where the baby is in a posterior position, using non-invasive techniques.
Compared with obstetricians, midwives offer lower maternity care cost, and midwife-led births are associated with lower intervention rates, reduced mortality and morbidity related to interventions, and fewer recovery complications, though this is largely due to the fact that they work with women who have low-risk pregnancies compare to obstetricians, not because there are lower risks to midwife deliveries.
(a definition that has also been adopted by the World Health Organization
and the International Federation of Gynecology and Obstetrics
):
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare, and to gain the knowledge to counteract the lack of pain relievers and antiseptics.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
and Old English, mid = "with", wīf = "woman"). In French the term for midwife is sage-femme which literally means "wise" woman. In Danish it is jordmoder or "earth-mother."
In ancient Egypt
, midwifery was a recognized female occupation, as attested by the Ebers papyrus
which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology
, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus
, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.
Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire
, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians. However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the 2nd century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times
. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.
Midwives were known by many different titles in antiquity, ranging from iatrinē (Gr. nurse), maia (Gr., midwife), obstetrix (Lat., obstetrician), and medica (Lat., doctor
). It appears as though midwifery was treated differently in the Eastern end of the Mediterranean basin
as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of gynaecologist (iatros gynaikeios, translated as women's doctor), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors. One example of such a midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.
However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.
The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they may also have helped with other medical problems relating to women when needed. Often, the midwife would call for the assistance of a physician when a more difficult birth was anticipated. In many cases the midwife brought along two or three assistants. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her. The midwife sat facing the mother, encouraging and supporting her through the birth, perhaps offering instruction on breathing and pushing, sometimes massaging her vaginal opening, and supporting her perineum during the delivery of the baby. The assistants may have helped by pushing downwards on the top of the mother's abdomen.
Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord
, and cleansed the baby. The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil
in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities
and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.
A 2nd-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the vagina, as encouraged by Soranus.
The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives. They may have been highly trained or only possessed a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine
or the newer methods of professional parturition. Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.
During the Christian era in Europe, midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law
.
In Medieval times, childbirth was considered so deadly that the Christian Church
told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth child
ren." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.
s and midwives arose, as medical men began to assert that their modern scientific techniques were better for mothers and infants than the folk medicine
practiced by midwives. As doctors and medical associations pushed for a legal monopoly on obstetrical care, midwifery became outlawed or heavily regulated throughout the United States and Canada. Despite accusations that midwives were "incompetent and ignorant", some argued that poorly trained surgeons were far more of a danger to pregnant women.
German social scientists
Gunnar Heinsohn
and Otto Steiger theorize that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion. According to Heinsohn and Steiger's theory, the state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague
which had swept over the continent in waves, starting in 1348.
in 1925 by Mary Breckinridge
for use in the Frontier Nursing Service
(FNS). Breckinridge chose the nurse-midwifery model used in England
and Scotland
because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky
. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the service and reported a substantially lower maternal and infant mortality
rate than for the rest of the country. The report concluded that if this type of care was available to other women in the U.S., thousands of lives would be saved, and suggested nurse-midwife training should be made available in the U.S. Breckinridge founded the Frontier Nursing University in 1939, the first nurse-midwifery education program in the U.S.
The Frontier School is still educating nurse-midwives and has added distance learning to its methodology. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier Nursing University faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1500 nurse-midwives.
In the United States, nurse-midwives
are variably licensed depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensing, many nurse-midwives have a master's degree in nursing, public health
, or midwifery. Nurse-midwives practice in hospital
s, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty
through menopause
. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies
can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.
, apprenticeship, a private midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. As of November 2010, there are approximately 1800 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 27 states as of 2011.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed traditional midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife (CPM) credential was available).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York
, New Jersey
, and Rhode Island
). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs.
The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). The CPM certification process validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives Alliance of North America {Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
. In many states, midwives form birthing center
s where a group of midwives may work individually or together and provide additional clinical opportunities to student midwives. Midwives 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.
, and 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 or in a hospital (although most births in the UK occur in a hospital). There are two routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to a degree in midwifery (diploma courses in midwifery have been discontinued) and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available 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. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies depending on which country within the UK the student is located and whether they are taking a degree or diploma course. Midwifery degrees are paid for by the National Health Service (NHS). Some students may also be eligible for NHS bursaries.
All practising midwives must be registered with the Nursing and Midwifery Council
and also must 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.
Midwives are at all times responsible for the woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth
experience.
program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities in conjunction with hospital and community based training placements at NHS Trusts.
Midwives may train to be community Health Visitor
s (as may Nurses).
s, postnatal care in the home, and attending home birth
s. A community midwife would typically have a pager and be responsible for a particular area, contacted by ambulance control when needed. Sometimes they are paged to help out in the hospital when there are insufficient midwives available.
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.
Midwives in Canada come from a variety of backgrounds including: Aboriginal, post nursing certification, direct-entry and "lay" or traditional midwifery. However, after a process of assessment by the provincial regulatory bodies, registrants are all simply known as 'midwives', 'registered midwives' or by the French-language equivalent, 'sage femme', regardless of their route of training. 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 a limited schedule of medications. Founding principles of the Canadian model of midwifery include informed choice, choice of birth place, 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. As fully integrated health care providers, Canada's midwifery homebirth outcomes have been excellent.
Five provinces offer a four year university baccalaureate
degree in 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 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. A Bridging program for internationally educated midwives is in place in Ontario at Ryerson University
. A federally funded Multi-jurisdictional Midwifery Bridging Program is offered in Western Canada
. Regulated provinces and territories admit internationally educated midwives to their regulatory body if they can demonstrate competency through a Prior Learning and Experience Assessment (PLEA) process.
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 midwifery regulated provinces.
In BC Midwives are primary care providers for women in all stages of pregnancy, from prenatal phase to six weeks postpartum. 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. Midwives also care for newborns.
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.
Current Supply:
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. There are three routes to registration in BC:
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.
Professional Association/College:
College of Midwives of BC.
Midwives Association of BC.
in 1990. The Nurses Amendment Act restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions. Nearly all midwives gaining registration now are direct entry midwives who have not undertaken any nursing training. Registration requires a degree in midwifery. This is a three year full time programme of 45 weeks per year.
Women must choose one of 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 normal. 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.)
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.
Education in midwifery is direct entry, i.e. no previous education as a nurse is needed. A 4-year education program can be followed at four colleges, in Groningen, Amsterdam, Rotterdam and Maastricht.
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.
, midwifery was first regulated in 1868. Today, midwives must pass a national certification exam. Up until March 1, 2003 only women could be midwives.
, 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.
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding.
A practitioner of midwifery is known as a midwife, a term used in reference to both women and men, although the majority of midwives are female. In addition to providing care to women during pregnancy and birth, many midwives also provide primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
to women, well-woman care related to reproductive health, annual gynecological exams, family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
, and menopausal care.
In the term midwife, the morpheme
Morpheme
In linguistics, a morpheme is the smallest semantically meaningful unit in a language. The field of study dedicated to morphemes is called morphology. A morpheme is not identical to a word, and the principal difference between the two is that a morpheme may or may not stand alone, whereas a word,...
-wife is pronounced as expected (waɪf), but midwifery is normally pronounced mɪdˈwɪf(ə)ri .
Midwives are specialists in low-risk pregnancy, childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
, and postpartum, although they are trained to recognize and deal with deviations from the normal. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. The two professions can be complementary, but may be at odds in some countries, where obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.
Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many parts of the world, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain more difficult deliveries, including breech birth
Breech birth
A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation....
s, twin births and births where the baby is in a posterior position, using non-invasive techniques.
Compared with obstetricians, midwives offer lower maternity care cost, and midwife-led births are associated with lower intervention rates, reduced mortality and morbidity related to interventions, and fewer recovery complications, though this is largely due to the fact that they work with women who have low-risk pregnancies compare to obstetricians, not because there are lower risks to midwife deliveries.
Definition
According to the International Confederation of MidwivesInternational Confederation of Midwives
The International Confederation of Midwives supports, represents and works to strengthen professional associations of midwives on a global basis...
(a definition that has also been adopted by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
and the International Federation of Gynecology and Obstetrics
International Federation of Gynecology and Obstetrics
The International Federation of Gynaecology and Obstetrics, usually just FIGO as the acronym of its French name Fédération Internationale de Gynécologie et d'Obstétrique, is a worldwide NGO organisation representing obstetricians and gynaecologists in over one hundred territories...
):
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labor and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare, and to gain the knowledge to counteract the lack of pain relievers and antiseptics.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
Etymology
The term midwife is derived from , literally "with-woman", i.e. "the woman with, the woman assisting" (in Middle EnglishMiddle English
Middle English is the stage in the history of the English language during the High and Late Middle Ages, or roughly during the four centuries between the late 11th and the late 15th century....
and Old English, mid = "with", wīf = "woman"). In French the term for midwife is sage-femme which literally means "wise" woman. In Danish it is jordmoder or "earth-mother."
Early historical perspective
Midwives are mentioned in the Old Testament: Exodus, Chapter 1. The Bible describes how the children of Israel (Hebrews) were enslaved in Egypt and they multiplied greatly. The Egyptians became fearful of the potential power of so many Hebrews. Pharaoh, therefore, commanded the Hebrew midwives (named Shiphrah and Puah) to kill all male babies delivered to the Hebrew women. The midwives, however, "feared God" and disobeyed Pharaoh by allowing the male babies to live. When Pharaoh asked the midwives why they had disobeyed his orders, the midwives told him the Hebrew women had easier labors than Egyptian women and delivered their babies before the midwife arrived. "And God dealt well with the midwives" (Exodus, Chap. 1, verse 20).In ancient Egypt
Ancient Egypt
Ancient Egypt was an ancient civilization of Northeastern Africa, concentrated along the lower reaches of the Nile River in what is now the modern country of Egypt. Egyptian civilization coalesced around 3150 BC with the political unification of Upper and Lower Egypt under the first pharaoh...
, midwifery was a recognized female occupation, as attested by the Ebers papyrus
Ebers papyrus
The Ebers Papyrus, also known as Papyrus Ebers, is an Egyptian medical papyrus dating to circa 1550 BC. Among the oldest and most important medical papyri of ancient Egypt, it was purchased at Luxor, in the winter of 1873–74 by Georg Ebers...
which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology
Obstetrics and gynaecology
Obstetrics and gynaecology are the two surgical–medical specialties dealing with the female reproductive organs in their pregnant and non-pregnant state, respectively, and as such are often combined to form a single medical specialty and postgraduate training programme...
, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus
Westcar Papyrus
The Westcar Papyrus is an ancient Egyptian text containing five stories about miracles performed by priests and magicians. Each of these tales are being told at the royal court of the King Cheops by his sons...
, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.
Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire
Roman Empire
The Roman Empire was the post-Republican period of the ancient Roman civilization, characterised by an autocratic form of government and large territorial holdings in Europe and around the Mediterranean....
, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians. However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the 2nd century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times
Ancient history
Ancient history is the study of the written past from the beginning of recorded human history to the Early Middle Ages. The span of recorded history is roughly 5,000 years, with Cuneiform script, the oldest discovered form of coherent writing, from the protoliterate period around the 30th century BC...
. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.
Midwives were known by many different titles in antiquity, ranging from iatrinē (Gr. nurse), maia (Gr., midwife), obstetrix (Lat., obstetrician), and medica (Lat., doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
). It appears as though midwifery was treated differently in the Eastern end of the Mediterranean basin
Mediterranean Basin
In biogeography, the Mediterranean Basin refers to the lands around the Mediterranean Sea that have a Mediterranean climate, with mild, rainy winters and hot, dry summers, which supports characteristic Mediterranean forests, woodlands, and scrub vegetation...
as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of gynaecologist (iatros gynaikeios, translated as women's doctor), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors. One example of such a midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.
However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.
The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they may also have helped with other medical problems relating to women when needed. Often, the midwife would call for the assistance of a physician when a more difficult birth was anticipated. In many cases the midwife brought along two or three assistants. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her. The midwife sat facing the mother, encouraging and supporting her through the birth, perhaps offering instruction on breathing and pushing, sometimes massaging her vaginal opening, and supporting her perineum during the delivery of the baby. The assistants may have helped by pushing downwards on the top of the mother's abdomen.
Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord
Umbilical cord
In placental mammals, the umbilical cord is the connecting cord from the developing embryo or fetus to the placenta...
, and cleansed the baby. The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil
Olive oil
Olive oil is an oil obtained from the olive , a traditional tree crop of the Mediterranean Basin. It is commonly used in cooking, cosmetics, pharmaceuticals, and soaps and as a fuel for traditional oil lamps...
in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.
A 2nd-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the vagina, as encouraged by Soranus.
The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives. They may have been highly trained or only possessed a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine
Folk medicine
-Description:Refers to healing practices and ideas of body physiology and health preservation known to a limited segment of the population in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience.All cultures and societies...
or the newer methods of professional parturition. Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.
During the Christian era in Europe, midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law
Canon law
Canon law is the body of laws & regulations made or adopted by ecclesiastical authority, for the government of the Christian organization and its members. It is the internal ecclesiastical law governing the Catholic Church , the Eastern and Oriental Orthodox churches, and the Anglican Communion of...
.
In Medieval times, childbirth was considered so deadly that the Christian Church
Christian Church
The Christian Church is the assembly or association of followers of Jesus Christ. The Greek term ἐκκλησία that in its appearances in the New Testament is usually translated as "church" basically means "assembly"...
told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth child
Child
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
ren." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.
Later historical perspective
In the early 20th century, a conflict between surgeonSurgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
s and midwives arose, as medical men began to assert that their modern scientific techniques were better for mothers and infants than the folk medicine
Folk medicine
-Description:Refers to healing practices and ideas of body physiology and health preservation known to a limited segment of the population in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience.All cultures and societies...
practiced by midwives. As doctors and medical associations pushed for a legal monopoly on obstetrical care, midwifery became outlawed or heavily regulated throughout the United States and Canada. Despite accusations that midwives were "incompetent and ignorant", some argued that poorly trained surgeons were far more of a danger to pregnant women.
German social scientists
Social sciences
Social science is the field of study concerned with society. "Social science" is commonly used as an umbrella term to refer to a plurality of fields outside of the natural sciences usually exclusive of the administrative or managerial sciences...
Gunnar Heinsohn
Gunnar Heinsohn
Gunnar Heinsohn is a German sociologist and economist. He was born in Gdynia, Poland, under German occupation used as Kriegsmarine-Arsenal and named Gotenhafen, on November 21, 1943 to Roswitha Heinsohn, née Maurer and the late Kapitänleutnant Heinrich Heinsohn, last serving on U-438...
and Otto Steiger theorize that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion. According to Heinsohn and Steiger's theory, the state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague
Bubonic plague
Plague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...
which had swept over the continent in waves, starting in 1348.
United States
There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.Nurse-midwives
Nurse-midwives were introduced in the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
in 1925 by Mary Breckinridge
Mary Breckinridge
Mary Breckinridge was an American nurse-midwife and the founder of the Frontier Nursing Service. She also was known as Mary Carson Breckinridge.She started family care centers in the Appalachian mountains...
for use in the Frontier Nursing Service
Frontier Nursing Service
The Frontier Nursing Service provides healthcare services to rural, underserved populations and educates nurse-midwives.The Service maintains six rural healthcare clinics in eastern Kentucky, the Mary Breckinridge Hospital, the Mary Breckinridge Home Health Agency, the Frontier School of Midwifery...
(FNS). Breckinridge chose the nurse-midwifery model used in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
and Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky
Kentucky
The Commonwealth of Kentucky is a state located in the East Central United States of America. As classified by the United States Census Bureau, Kentucky is a Southern state, more specifically in the East South Central region. Kentucky is one of four U.S. states constituted as a commonwealth...
. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the service and reported a substantially lower maternal and infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
rate than for the rest of the country. The report concluded that if this type of care was available to other women in the U.S., thousands of lives would be saved, and suggested nurse-midwife training should be made available in the U.S. Breckinridge founded the Frontier Nursing University in 1939, the first nurse-midwifery education program in the U.S.
The Frontier School is still educating nurse-midwives and has added distance learning to its methodology. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier Nursing University faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1500 nurse-midwives.
In the United States, nurse-midwives
Nurse midwife
In the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
are variably licensed depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensing, many nurse-midwives have a master's degree in nursing, public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
, or midwifery. Nurse-midwives practice in hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...
through menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.
Direct-entry midwives
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not require prior education as a nurse. Direct-entry midwives learn midwifery through self-studyAutodidacticism
Autodidacticism is self-education or self-directed learning. In a sense, autodidacticism is "learning on your own" or "by yourself", and an autodidact is a person who teaches him or herself something. The term has its roots in the Ancient Greek words αὐτός and διδακτικός...
, apprenticeship, a private midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. As of November 2010, there are approximately 1800 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 27 states as of 2011.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed traditional midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife (CPM) credential was available).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
, New Jersey
New Jersey
New Jersey is a state in the Northeastern and Middle Atlantic regions of the United States. , its population was 8,791,894. It is bordered on the north and east by the state of New York, on the southeast and south by the Atlantic Ocean, on the west by Pennsylvania and on the southwest by Delaware...
, and Rhode Island
Rhode Island
The state of Rhode Island and Providence Plantations, more commonly referred to as Rhode Island , is a state in the New England region of the United States. It is the smallest U.S. state by area...
). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs.
The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). The CPM certification process validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives Alliance of North America {Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
Practice
Midwives work with women and their families in many different settings. While the vast majority of nurse-midwives work in hospitals, some nurse-midwives and virtually all direct-entry midwives work within the community or homeHome birth
A home birth in developed countries is an attended or an unattended childbirth in a non-clinical setting, typically using natural childbirth methods, that takes place in a residence rather than in a hospital or a birth centre, and usually attended by a midwife or lay attendant with expertise in...
. In many states, midwives form birthing center
Birthing center
A birthing center or centre is a healthcare facility, staffed by nurse-midwives, midwives and/or obstetricians, for mothers in labor, who may be assisted by doulas and coaches. By attending the laboring mother, the doulas can assist the midwives and make the birth easier. The midwives monitor the...
s where a group of midwives may work individually or together and provide additional clinical opportunities to student midwives. Midwives generally support and encourage natural childbirth
Natural childbirth
Natural Childbirth is a philosophy of childbirth that is based on the notion that women who are adequately prepared are innately able to give birth without routine medical interventions. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained...
in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state.
United Kingdom
Midwives are practitioners in their own right in the United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, and take responsibility for the antenatal, intrapartum and postnatal
Postnatal
Postnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...
care of women, up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional
Health profession
The health care industry, or medical industry, is the sector of the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, palliative, or, at times, unnecessary care...
attending the majority of births, whether at home or in a hospital (although most births in the UK occur in a hospital). There are two routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to a degree in midwifery (diploma courses in midwifery have been discontinued) and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available to adult branch nurses, and any child, mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
, or learning disability
Learning disability
Learning disability is a classification including several disorders in which a person has difficulty learning in a typical manner, usually caused by an unknown factor or factors...
branch nurse must complete the full three-year course to qualify as a midwife. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies depending on which country within the UK the student is located and whether they are taking a degree or diploma course. Midwifery degrees are paid for by the National Health Service (NHS). Some students may also be eligible for NHS bursaries.
All practising midwives must be registered with the Nursing and Midwifery Council
Nursing and Midwifery Council
Established in 2002, the Nursing and Midwifery Council is a statutory body set up by the Parliament of the United Kingdom through the . The NMC is the UK regulator for nursing and midwifery professions with a stated aim to safeguard the health and wellbeing of the public...
and also must have a Supervisor of Midwives through their local supervising authority. Most midwives work within the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
, 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 woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
experience.
Midwifery training
Midwifery training is considered one of the most challenging and competitive courses amongst other healthcare subjects. Most midwives undergo a 32 month vocational trainingVocational education
Vocational education or vocational education and training is an education that prepares trainees for jobs that are based on manual or practical activities, traditionally non-academic, and totally related to a specific trade, occupation, or vocation...
program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities in conjunction with hospital and community based training placements at NHS Trusts.
Midwives may train to be community Health Visitor
Health visitor
Health visitors are UK community health nurses who have undertaken further training to work as part of a primary health care team. As their name suggests, their role is to promote mental, physical and social well-being in the community by giving advice and support to families in all age groups...
s (as may Nurses).
Community midwives
Many midwives also work in the community. The role of community midwives include the initial appointments with pregnant women, managing clinicClinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
s, postnatal care in the home, and attending home birth
Home birth
A home birth in developed countries is an attended or an unattended childbirth in a non-clinical setting, typically using natural childbirth methods, that takes place in a residence rather than in a hospital or a birth centre, and usually attended by a midwife or lay attendant with expertise in...
s. A community midwife would typically have a pager and be responsible for a particular area, contacted by ambulance control when needed. Sometimes they are paged to help out in the hospital when there are insufficient midwives available.
Canada
Midwifery was reintroduced as a regulated profession in CanadaCanada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
in the 1990s. After several decades of intensive political lobbying
Lobbying
Lobbying is the act of attempting to influence decisions made by officials in the government, most often legislators or members of regulatory agencies. Lobbying is done by various people or groups, from private-sector individuals or corporations, fellow legislators or government officials, or...
by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
, Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
, Saskatchewan
Saskatchewan
Saskatchewan is a prairie province in Canada, which has an area of . Saskatchewan is bordered on the west by Alberta, on the north by the Northwest Territories, on the east by Manitoba, and on the south by the U.S. states of Montana and North Dakota....
, Manitoba
Manitoba
Manitoba is a Canadian prairie province with an area of . The province has over 110,000 lakes and has a largely continental climate because of its flat topography. Agriculture, mostly concentrated in the fertile southern and western parts of the province, is vital to the province's economy; other...
, Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
, Quebec
Quebec
Quebec or is a province in east-central Canada. It is the only Canadian province with a predominantly French-speaking population and the only one whose sole official language is French at the provincial level....
, and Nova Scotia
Nova Scotia
Nova Scotia is one of Canada's three Maritime provinces and is the most populous province in Atlantic Canada. The name of the province is Latin for "New Scotland," but "Nova Scotia" is the recognized, English-language name of the province. The provincial capital is Halifax. Nova Scotia is the...
, and in the Northwest Territories
Northwest Territories
The Northwest Territories is a federal territory of Canada.Located in northern Canada, the territory borders Canada's two other territories, Yukon to the west and Nunavut to the east, and three provinces: British Columbia to the southwest, and Alberta and Saskatchewan to the south...
and Nunavut
Nunavut
Nunavut is the largest and newest federal 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, though the actual boundaries had been established in 1993...
. Midwifery legislation has recently been proclaimed in New Brunswick
New Brunswick
New Brunswick is one of Canada's three Maritime provinces and is the only province in the federation that is constitutionally bilingual . The provincial capital is Fredericton and Saint John is the most populous city. Greater Moncton is the largest Census Metropolitan Area...
where the government is in the process of integrating midwifery services there. Only Prince Edward Island
Prince Edward Island
Prince Edward Island is a Canadian province consisting of an island of the same name, as well as other islands. The maritime province is the smallest in the nation in both land area and population...
, Yukon
Yukon
Yukon is the westernmost and smallest of Canada's three federal territories. It was named after the Yukon River. The word Yukon means "Great River" in Gwich’in....
and Newfoundland and Labrador
Newfoundland and Labrador
Newfoundland and Labrador is the easternmost province of Canada. Situated in the country's Atlantic region, it incorporates the island of Newfoundland and mainland Labrador with a combined area of . As of April 2011, the province's estimated population is 508,400...
do not have legislation in place for the practice of midwifery.
Midwives in Canada come from a variety of backgrounds including: Aboriginal, post nursing certification, direct-entry and "lay" or traditional midwifery. However, after a process of assessment by the provincial regulatory bodies, registrants are all simply known as 'midwives', 'registered midwives' or by the French-language equivalent, 'sage femme', regardless of their route of training. 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 a limited schedule of medications. Founding principles of the Canadian model of midwifery include informed choice, choice of birth place, 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. As fully integrated health care providers, Canada's midwifery homebirth outcomes have been excellent.
Five provinces offer a four year university baccalaureate
Bachelor's degree
A bachelor's degree is usually an academic degree awarded for an undergraduate course or major that generally lasts for three or four years, but can range anywhere from two to six years depending on the region of the world...
degree in midwifery. In British Columbia, the program is offered at the University of British Columbia
University of British Columbia
The University of British Columbia is a public research university. UBC’s two main campuses are situated in Vancouver and in Kelowna in the Okanagan Valley...
. 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
McMaster University
McMaster University is a public research university whose main campus is located in Hamilton, Ontario, Canada. The main campus is located on of land in the residential neighbourhood of Westdale, adjacent to Hamilton's Royal Botanical Gardens...
, Ryerson University
Ryerson University
Ryerson University is a public research university located in downtown Toronto, Ontario, Canada. Its urban campus is adjacent to Yonge-Dundas Square located at the busiest intersection in Downtown Toronto. The majority of its buildings are in the blocks northeast of the square in Toronto's Garden...
and Laurentian University
Laurentian University
Laurentian University , was incorporated on March 28, 1960, is a mid-sized bilingual university in Greater Sudbury, Ontario, Canada....
. In Manitoba the program is offered by University College of the North
University College of the North
University College of the North is a post-secondary institution located in Northern Manitoba, Canada.UCN has a student body of approximately 2,700 annually, and a staff of approximately 400...
. In Quebec
Quebec
Quebec or is a province in east-central Canada. It is the only Canadian province with a predominantly French-speaking population and the only one whose sole official language is French at the provincial level....
, the program is offered at the Université du Québec à Trois-Rivières
Université du Québec à Trois-Rivières
The Université du Québec à Trois-Rivières , established in 1969 is a campus of the Université du Québec, located in Trois-Rivières, Quebec. The university has 12,500 students in 8 different campuses, including the main one in Trois-Rivières. About 1000 of them come from overseas, from 60...
. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. A Bridging program for internationally educated midwives is in place in Ontario at Ryerson University
Ryerson University
Ryerson University is a public research university located in downtown Toronto, Ontario, Canada. Its urban campus is adjacent to Yonge-Dundas Square located at the busiest intersection in Downtown Toronto. The majority of its buildings are in the blocks northeast of the square in Toronto's Garden...
. A federally funded Multi-jurisdictional Midwifery Bridging Program is offered in Western Canada
Western Canada
Western Canada, also referred to as the Western provinces and commonly as the West, is a region of Canada that includes the four provinces west of the province of Ontario.- Provinces :...
. Regulated provinces and territories admit internationally educated midwives to their regulatory body if they can demonstrate competency through a Prior Learning and Experience Assessment (PLEA) process.
The legal recognition of midwifery has brought midwives into the mainstream of health care
Health care in Canada
Health care in Canada is delivered through a publicly-funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards...
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
Professional body
A professional association is usually a nonprofit organization seeking to further a particular profession, the interests of individuals engaged in that profession, and the public interest.The roles of these professional associations have been variously defined: "A group of people in a...
have legislation and standards in place to provide protection, particularly for choice of birth place
Home birth
A home birth in developed countries is an attended or an unattended childbirth in a non-clinical setting, typically using natural childbirth methods, that takes place in a residence rather than in a hospital or a birth centre, and usually attended by a midwife or lay attendant with expertise in...
, 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
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
. 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 midwifery regulated provinces.
British Columbia
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 phase to six weeks postpartum. 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. Midwives also care for newborns.
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.
Current Supply:
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. There are three routes to registration in BC:
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.
Professional Association/College:
College of Midwives of BC.
Midwives Association of BC.
New Zealand
Midwifery regained its status as an autonomous profession in New ZealandNew Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
in 1990. The Nurses Amendment Act restored the professional and legal separation of midwifery from nursing, and established midwifery and nursing as separate and distinct professions. Nearly all midwives gaining registration now are direct entry midwives who have not undertaken any nursing training. Registration requires a degree in midwifery. This is a three year full time programme of 45 weeks per year.
Women must choose one of a midwife, a General Practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
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 normal. 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.)
Netherlands
Midwives are called vroedvrouw (female midwives), vroedmeester (male midwives), or verloskundige (general) in Dutch. Midwives are independent specialists in physiologic birth. In the Netherlands, home birth is still a common practice, although rates have declined during the past decades. In the period of 2005-2008, 29% of babies were delivered at home rather than in a hospital. 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 will 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.
Education in midwifery is direct entry, i.e. no previous education as a nurse is needed. A 4-year education program can be followed at four colleges, in Groningen, Amsterdam, Rotterdam and Maastricht.
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.
Japan
In JapanJapan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, midwifery was first regulated in 1868. Today, midwives must pass a national certification exam. Up until March 1, 2003 only women could be midwives.
Balochistan (Tribal Pakistan)
In BalochistanBalochistan
Balochistan or Baluchistan is a region which covers parts of Afghanistan, Iran and Pakistan. It can also refer to one of several modern and historical territories within that region:...
, 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.
Mozambique
When a 16-year-long 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.The Karbis of Goria Ghuli
The village of Goria Ghuli is an example of a rural and traditional village. The village has no electricity, and they have no 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 different 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 of villagers. This information is transferred from generation to generation. In the village there are 3 ethnogynacologist, which can be approached at any time 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’, and 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.The Maya of Guatemala
This study was specifically in San Pedro. 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, in order 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 shamen, in that her calling is divine. She is the connection between the spiritual and real world, and in order 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, this society has changed since)See also
- Afghanistan Midwifery ProjectAfghanistan Midwifery ProjectThe Afghanistan Midwifery Project is a non-profit organization that is dedicated to helping the women of Afghanistan through childbirth, and other women's health issues. Afghanistan currently rests near the bottom of the World Health Organization's list for infant mortality rates, child birth...
- Midwives Alliance of North America
- Childbirth and obstetrics in antiquityChildbirth and Obstetrics in AntiquityTraditionally obstetrics is defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium, although in Antiquity surgical intervention did not exist. Without the presence of surgical technology an alternative was necessary...
- Global Library of Women's Medicine
- International Confederation of MidwivesInternational Confederation of MidwivesThe International Confederation of Midwives supports, represents and works to strengthen professional associations of midwives on a global basis...
- Justine SiegemundJustine SiegemundJustine Siegemund, also Justine Siegemundin, was a renowned German midwife whose Court Midwife was the first female-authored German medical text.-Early life:...
- Natural childbirthNatural childbirthNatural Childbirth is a philosophy of childbirth that is based on the notion that women who are adequately prepared are innately able to give birth without routine medical interventions. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained...
- Nurse midwifeNurse midwifeIn the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
- ObstetricsObstetricsObstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
- Traditional birth attendantTraditional birth attendantA traditional birth attendant , also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider...
- Yvonne CrynsYvonne CrynsYvonne Cryns is an American midwife and political activist. From 1991 to 2001, she served as a traditional midwife in Illinois and Wisconsin...
Additional reading
- S. Solagbade Popoola, Ikunle Abiyamo: It is on Bent Knees that I gave Birth 2007 Research material, scientific and historical content based on traditional forms of African Midwifery from YorubaYoruba peopleThe Yoruba people are one of the largest ethnic groups in West Africa. The majority of the Yoruba speak the Yoruba language...
of West AfricaWest AfricaWest Africa or Western Africa is the westernmost region of the African continent. Geopolitically, the UN definition of Western Africa includes the following 16 countries and an area of approximately 5 million square km:-Flags of West Africa:...
detailed within the Ifa traditional philosophy. Asefin Media Publication