Midwifery

Community birth attendants before professional registers

A 2024 review of traditional birth attendants describes them as people generally considered to sit outside the formal healthcare system who provide support, advice and care to women during pregnancy and childbirth. Its authors state that the history and impact of such attendants differ across geography and culture. The Royal College of Midwives (RCM) likewise notes that midwifery was practiced in England long before 1902, often by women with experience of childbirth, by nurses with practical experience, or by people without formal education.

In the United States, an analytical essay on the history of Black women's health describes Black midwives, later known as granny midwives, as playing a significant role in childbirth and maternal care outside formal medical systems, passing practices down between generations. The essay argues that they preserved knowledge and offered trusted networks of care during segregation. This is an interpretive essay about Black women's health history, not a dated history of midwifery as a whole.

Professionalization in Britain

An RCM article describes the Midwives Act of 1902 in England and Wales as the first formal recognition and development of professional midwifery. It led to the Central Midwives Board, which regulated practice and formalized education, and after the Act took effect in 1905 only certified women could use the title midwife. The article reports that parts of the medical profession feared competition and debated whether midwives should attend only natural births. It suggests the Act mainly aimed to protect the public. This page treats the Act as history only.

Integration efforts and international definitions

The 2024 review of traditional birth attendants reports that past attempts to integrate such attendants into formal maternal care have largely been considered ineffective. It cites a World Health Organization (WHO) effort under the Safe Motherhood Initiative in which attendants were seen as obstacles because they would not conform to guidelines set for them. The International Confederation of Midwives (ICM) adopted its international definition of the midwife in 2005 and revised it in 2024. The sources reviewed do not give a dated history of nurse-midwifery in North America.

Midwife and midwifery

The ICM defines a midwife as a person who has completed a midwifery education program that follows the ICM Essential Competencies and Global Standards for Midwifery Education as recognized in that country. The person must also hold the qualifications needed to be registered or licensed and to use the title, and must demonstrate competence within the scope of practice. The ICM definition therefore ties the title to education and registration, and the exact requirements are set within each country.

Credentials named by professional bodies

The American College of Nurse-Midwives (ACNM) distinguishes three credentials in the United States. A certified nurse-midwife (CNM) holds a registered nurse license and graduate-level midwifery education. A certified midwife (CM) completes the same midwifery education and certification without a nursing license requirement. A certified professional midwife (CPM) is certified by the North American Registry of Midwives (NARM), is trained mainly for out-of-hospital birth, and does not need an academic degree for certification.

In the United Kingdom, the Nursing and Midwifery Council (NMC) is the regulator that keeps a register covering both nurses and midwives, so a UK registered midwife is a person on that register. The sources reviewed do not define the terms direct-entry midwife or community midwife, and those terms vary between countries and employers. Requirements differ by country and region.

Place within Machipedia

Midwifery is a regulated healthcare profession, and Machipedia lists it under Complementary because it is often used alongside conventional maternity care. It is a member of the Birth Support family page, which should be read for the wider group of birth-related practices. Doula, Natural Childbirth, Water Birth, Childbirth Preparation and Prenatal Massage have their own pages. The ICM scope names antenatal education and parenthood preparation, and the sources reviewed do not describe the other topics as part of midwifery.

Scope of practice

The ICM describes midwives as responsible, accountable professionals who work with women to provide support, care and advice during pregnancy, labor and the postnatal period. Its scope includes conducting births on the midwife's own responsibility, caring for the newborn, preventive care, promoting normal birth, detecting complications in mother and child, arranging access to medical or other appropriate help, and carrying out emergency measures. It also includes health counseling and education, including antenatal education and parenthood preparation.

Settings and models of care

The ICM states that midwives may practice in any setting, including the home, community, hospital, clinic or health unit. ACNM reports that in 2022 certified nurse-midwives and certified midwives attended 10.9 percent of all US births, with 94 percent of their births in hospitals, 3 percent in freestanding birth centers and 3 percent at home. ACNM states that most certified professional midwives attend births in homes or birth centers and do not attend births in hospitals.

Research often describes midwife-led continuity of care, a model in which a known midwife or small group of midwives cares for a woman through pregnancy, birth and the postnatal period. In the Cochrane review of this model, women were far more likely to be attended at birth by a known midwife (risk ratio 7.04). The English Birthplace study compared four planned settings: home, freestanding midwifery units, midwifery units alongside hospital obstetric units, and obstetric units.

Uses described by professional bodies

Professional bodies describe midwifery as care for people who are pregnant, giving birth or postpartum, and for their newborns. The ICM scope lists prevention, promotion of normal birth, recognition of complications, access to medical help and emergency measures. Midwives work with women and, in ICM wording, with gender-diverse people, families and communities, through counseling and education. These are descriptions of the profession and not findings about outcomes.

A 2014 Lancet series paper built a framework for quality maternal and newborn care and reported that more than 50 outcomes could be improved by care within the scope of midwifery. The outcomes it lists include lower maternal and newborn mortality and morbidity, fewer unnecessary interventions and better psychosocial results. The authors found these associations when care was provided by midwives who were educated, trained, licensed and regulated.

Wider health services in the United States

ACNM reports that, beyond births, 55.1 percent of certified nurse-midwives and certified midwives identify reproductive care and 38.5 percent identify primary care as responsibilities in their full-time positions. Examples it gives include annual exams, prescriptions, nutrition counseling and parenting education. ACNM states that certified professional midwives provide gynecologic, sexual and reproductive care and well-person care. These are the bodies' own descriptions, and scope varies by jurisdiction.

Midwife-led continuity of care

A 2016 Cochrane systematic review compared midwife-led continuity models with other models of care in 15 randomized trials involving 17,674 women, searched to January 2016. The authors graded evidence for all primary outcomes as high quality. Women in midwife-led continuity models were less likely to have regional analgesia (risk ratio 0.85), instrumental vaginal birth (0.90) and preterm birth before 37 weeks (0.76), and more likely to have a spontaneous vaginal birth (1.05). There were no differences in cesarean birth or intact perineum.

The same review reported fewer fetal losses and neonatal deaths overall (risk ratio 0.84, 95 percent confidence interval 0.71 to 0.99), a longer mean labor (0.50 hours) and mostly higher maternal satisfaction, which was reported narratively. The authors concluded that adverse outcomes were at least comparable and called for further research on the preterm birth and fetal loss findings. The results apply to this care model, not to every setting in which midwives work.

The Lancet Series on Midwifery and WHO commentary

The 2014 Lancet Series on Midwifery opened with a paper that mapped the scope of midwifery and synthesized systematic reviews into a quality framework. It reported that midwifery was associated with more efficient use of resources and improved outcomes when delivered by educated, trained, licensed and regulated midwives. This record is a PubMed abstract. A 2018 WHO article states that evidence around midwife-led continuity is promising but that it remains unclear which model gives the strongest results on key birth outcomes.

Place of birth for low-risk pregnancies

The Birthplace in England cohort study followed 64,538 women with low-risk singleton pregnancies who gave birth in 2008 to 2010. Overall incidence of a composite of perinatal death and intrapartum-related neonatal illness was 4.3 per 1,000 births, with no significant difference between non-obstetric settings and obstetric units. For first-time mothers, the odds were higher for planned home birth (adjusted odds ratio 1.75, 95 percent confidence interval 1.07 to 2.86). For women with previous births there were no significant differences, and interventions were lower in all non-obstetric settings.

Birthplace was observational, so women who chose different settings may differ in ways the analysis could not fully adjust for, and it describes England in 2008 to 2010. It should not be transferred automatically to other health systems or to higher-risk pregnancies.

Risk selection, consultation and transfer

ACOG believes that hospitals and accredited birth centers are the safest settings for birth while holding that each woman has the right to a medically informed decision. Its Committee Opinion 697 on planned home birth, reaffirmed in 2026, lists factors for favorable outcomes: appropriate candidate selection, a qualified attendant working in an integrated and regulated system, ready access to consultation, and timely transport to a hospital. It treats fetal malpresentation, multiple gestation and prior cesarean delivery as absolute contraindications to planned home birth.

In Birthplace, transfers from non-obstetric settings were more frequent for first-time mothers (36 to 45 percent) than for women with previous births (9 to 13 percent). The ICM scope includes arranging access to medical or other appropriate help when complications are detected, which describes the referral role of midwives in general terms.

Training, registers and regulation

Education and registration are set by professional bodies and regulators in each country. In the United States, ACNM states that certified nurse-midwife and certified midwife education is at the graduate level and accredited by the Accreditation Commission for Midwifery Education. NARM states that the CPM credential is accredited by the National Commission for Certifying Agencies and that state licensure and scope are set separately by each state. The NMC keeps the UK register for nurses and midwives. Credentials are not interchangeable, and a reader can check a register directly.

Care boundaries

This page is educational information and not medical advice. Pregnancy and birth can involve complications that need medical or surgical care, and the sources reviewed describe midwife-led care as working alongside medical teams, with referral and emergency measures within its scope. Sudden severe symptoms in pregnancy or after birth are a reason to contact emergency services or a maternity unit without delay. The sources reviewed do not provide harm data for every midwifery setting or credential.