Midwife


A midwife is a health professional who cares for mothers and newborns around childbirth, a specialisation known as midwifery.
The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; concentrating on being experts in what is normal and identifying conditions that need further evaluation. In most countries, midwives are recognised as skilled healthcare providers. Midwives are trained to recognise variations from the normal progress of labour and understand how to deal with deviations from normal. They may intervene in high risk situations such as breech births, twin births, using non-invasive techniques. For complications related to pregnancy and birth that are beyond the midwife's scope of practice, including surgical and instrumental deliveries, they refer their patients to physicians or surgeons. In many parts of the world, these professions work in tandem to provide care to childbearing women. In others, only the midwife is available to provide care, and in yet other countries, many women elect to use obstetricians primarily over midwives.
Many developing countries are investing money and training for midwives, sometimes by retraining those people already practicing as traditional birth attendants. Some primary care services are currently lacking, due to a shortage of funding for these resources.

Definition and etymology

According to the definition of the International Confederation of Midwives, which has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics:
The word derives from Middle English mid, "with", and wif, "woman", and thus originally meant "with-woman", that is, a woman who is with another woman and assists her in giving birth. The term "male midwife" is common parlance when referring to males who work as midwives.
In English, the noun midwife is gendered, and in most countries, the corresponding noun and practice is historically used for women, while in English, the verb midwifery is also applied to men.
The older Semelai word for midwife, mudem, "itself provides insight into the ritual role a midwife is expected to play. Mudem also meant, and continues to mean, 'circumcisor'."

Scope of practice

The midwife has a certification and can either be a certified nurse midwife or a certified professional midwife and is recognized as a responsible and accountable professional who works in partnership with women to give necessary support preconception, during pregnancy, labor, and the postpartum period. When using a midwife preconception all the way through postpartum they give the best chance of increasing the mother and the infants health. They also provide care for the newborn and the infant up to a month after birth; this care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, perventing disease, the accessing of medical care and proscribing medicinces when needed or other appropriate assistance, and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not to be easily mistaken as a doula who also helps with education but mainly focuses on supporting the women both physically, with certain positions that make delievery more comfortable, or emotionally helping them remain calm and collected. Midwife's don't only educate the woman giving birth, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to the pregnant's health, sexual or reproductive health, and child care.
A midwife may practice in any setting, including the home, community, hospitals, clinics, or health units. Specific midwifery guides are made to help instruct midwives, which include material relating to prenatal and postnatal care. Midwifery guides are also written to be accessible to everyone, not just midwives.

Education, training, regulation and practice

Australia

;Education, training and regulation
The undergraduate midwifery programs are three-year full-time university programs leading to a bachelor's degree in midwifery with additional one-year full-time programs leading to an honours bachelor's degree in midwifery. The postgraduate midwifery programs lead to master's degrees in midwifery. There are also postgraduate midwifery programs leading to a bachelor's degree or equivalent qualification in midwifery.
Midwives in Australia must be registered with the Australian Health Practitioner Regulation Agency to practice midwifery, and use the title midwife or registered midwife.
;Practice
Midwives work in a number of settings including hospitals, birthing centres, community centres and women's homes. They may be employed by health services or organisations, or self-employed as privately practising midwives. All midwives are expected to work within a defined scope of practice and conform to ongoing regulatory requirements that ensure they are safe and autonomous practitioners.
;Professional associations/colleges
Midwifery was reintroduced as a regulated profession in most of Canada's ten provinces in the 1990s. Prior to this legalization, some midwives had practiced in a legal "grey area" in some provinces. In 1981, a midwife in British Columbia was charged with practicing without a medical license.
After several decades of intensive political lobbying by midwives and consumers, fully integrated, regulated and publicly funded midwifery is now part of the health system in the provinces of British Columbia, Alberta Saskatchewan, Manitoba, Ontario, Quebec, and Nova Scotia, and in the Northwest Territories and Nunavut. In 2023, Midwifery is regulated in New Brunswick, Newfoundland and Labrador, Prince Edward Island and Yukon.
;Education, training and regulation
The undergraduate midwifery programs are four-year full-time university programs leading to bachelor's degrees in midwifery.
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 is offered by McMaster University and Toronto Metropolitan University and previously by Laurentian University. In Manitoba, the program is offered by the University of Manitoba and previously at the University College of the North. In Quebec, the program is offered at the Université du Québec à Trois-Rivières. In northern Quebec and Nunavut, Inuit women are being educated to be midwives in their own communities. There is also a programme for aboriginal midwives in Ontario. In Ontario, the Midwifey Act exempts Indigenous people from obtaining a four-year midwifery degree or registering with the College of Midwives of Ontario if they practice as midwife in their own community.
There are also three "bridging programs" for internationally educated midwives. The International Midwifery Pre-registration Program is a nine-month program offered by Toronto Metropolitan University in Ontario. The Internationally Educated Midwives Bridging Program runs between 8 and 10 months at the University of British Columbia. At the Université du Québec à Trois-Rivières, French-speaking internationally trained midwives may earn the Certificat personnalisé en pratique sage-femme.
Midwives in Canada must be registered, after assessment by the provincial regulatory bodies, to practice midwifery, and use the title midwife, registered midwife or, the French-language equivalent, sage-femme.
;Practice
From the original 'alternative' style of midwifery in the 1960s and 1970s, midwifery practice is offered in a variety of ways within regulated provinces: midwives offer continuity of care within small group practices, choice of birthplace, and a focus on the woman as the primary decision-maker in her maternity care. When women or their newborns experience complications, midwives work in consultation with an appropriate specialist. Registered midwives have access to appropriate diagnostics like blood tests and ultrasounds and can prescribe some medications. Founding principles of the Canadian model of midwifery include informed choice, choice of birthplace, continuity of care from a small group of midwives and respect for the mother as the primary decision maker. Midwives typically have hospital privileges, and support the woman's right to choose where she has her baby.
The legal recognition of midwifery has brought midwives into the mainstream of health care with universal funding for services, hospital privileges, rights to prescribe medications commonly needed during pregnancy, birth and postpartum, and rights to order blood work and ultrasounds for their own clients and full consultation access to physicians. To protect the tenets of midwifery and support midwives to provide woman-centered care, the regulatory bodies and professional associations have legislation and standards in place to provide protection, particularly for choice of birth place, informed choice and continuity of care. All regulated midwives have malpractice insurance. Any unregulated person who provides care with 'restricted acts' in regulated provinces or territories is practicing midwifery without a license and is subject to investigation and prosecution.
Prior to legislative changes, very few Canadian women had access to midwifery care, in part because it was not funded by the health care system. Legalizing midwifery has made midwifery services available to a wide and diverse population of women and in many communities, the number of available midwives does not meet the growing demand for services. Midwifery services are free to women living in provinces and territories with regulated midwifery.
;Professional associations/colleges
  • Canadian Association of Midwives.