INTRODUCTION:

Midwifery plays a vital role in advancing maternal and newborn health through evidence-based, compassionate, and culturally sensitive care. Midwives are skilled professionals who provide care before, during, and after childbirth, often serving as the primary care providers for women and newborns. Their approach emphasizes person-centered care, minimal medical intervention, and the promotion of natural physiological processes.

Midwifery-led models of care have been shown to significantly reduce maternal and neonatal mortality and improve clinical outcomes, while also enhancing women’s satisfaction and overall experience. These models promote continuity of care, respectful partnerships, and community engagement, making them effective across diverse settings—from hospitals to humanitarian crises. Successful implementation depends on supportive policies, strong governance, education, workforce investment, and interprofessional collaboration. As countries strive toward Universal Health Coverage and the Sustainable Development Goals, investing in midwifery is not only cost-effective but also essential to ensuring equitable, high-quality maternal and newborn health services worldwide. This article summarizes the habdbook of ‘’Transitioning to midwifery model of care’’ by WHO as a simplified version for better understanding for the healthcare workers.

Who Are Midwives and What Do They Do?

Midwives are highly trained healthcare professionals who plan, deliver, manage, and evaluate care services for women and newborns before, during, and after pregnancy and childbirth. They play a pivotal role in ensuring safe deliveries, reducing maternal and neonatal mortality, and minimizing health risks by adhering to the principles and standards of modern evidence-based midwifery¹. Midwives work autonomously or collaboratively within interdisciplinary healthcare teams, providing not only clinical care but also engaging in research, education, and training across both clinical and community settings¹.

Their scope of practice spans the full continuum of care—from pre-pregnancy, antenatal, intrapartum, and postnatal periods—and, depending on the context, may extend beyond this timeframe². Midwifery care is rooted in a philosophy that promotes person-centered care, fosters a strong woman–midwife partnership, and supports the physiological, psychological, social, and cultural processes of childbirth. It emphasizes the use of clinical interventions only when medically necessary³.

When midwives are educated and regulated to international standards, integrated into functional health systems, and supported by enabling work environments, they can deliver up to 90% of the essential sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) services worldwide^2,4. Their contribution is especially impactful in interdisciplinary models of care, improving health outcomes and advancing global health equity.

Scope of Midwifery Practice:

Midwives provide a wide range of essential health services that extend far beyond childbirth. Their responsibilities include health education and promotion for women, their partners, and families; continuous assessment and monitoring of maternal and newborn well-being; and early screening for health risks and harmful behaviors. Midwives work in partnership with women to plan individualized care, support the natural processes of pregnancy, childbirth, and postpartum recovery, and deliver essential newborn care, including selected specialized interventions.

Trained to international standards, midwives are authorized to prescribe, administer, and dispense medications and health products, as well as to order and interpret diagnostic and laboratory investigations. Their scope of work also includes family planning and contraceptive counseling, immunization, early childhood development, and nutritional guidance, including breastfeeding promotion. In addition, midwives conduct gynecological and obstetric ultrasound scans, manage and screen for sexually transmitted infections (STIs) and HIV, offer pelvic floor rehabilitation, and provide comprehensive sexuality education. Midwives also play a critical role in preventing, identifying, and supporting survivors of gender-based violence, highlighting their contribution to holistic, respectful, and gender-sensitive care across the life span.^2-7

Midwifery Models of Care:

Midwifery models of care are service delivery approaches in which licensed, educated, and regulated midwives serve as the primary providers for women and newborns throughout the perinatal period. These models are grounded in the midwifery philosophy, which emphasizes:

· Personalized, respectful, and culturally sensitive care.

· Support for optimal physiological, emotional, and social processes.

· Use of clinical interventions only when medically indicated.

· Continuity and autonomy in midwifery practice.^4,6

In these models, midwives operate within supportive health systems that facilitate collaboration, consultation, and referral with other health professionals. These care models are adaptable to various contexts—including hospitals, communities, homes, and humanitarian settings—and can be implemented within public and private sectors.^4,5,7

Why Choose Midwifery Models of Care?

Midwifery-led care models have proven to be transformative in improving maternal and newborn health outcomes across the globe. According to the World Health Organization (WHO), more than 60% of maternal and neonatal deaths and stillbirths could be prevented through the effective implementation of midwife-led interventions. The potential impact is staggering: if universal access to midwifery services were achieved by 2035, it could save approximately 4.3 million lives annually.

Even incremental progress makes a significant difference. For example, a 10% increase in midwifery coverage every five years could lead to 1.3 million additional lives saved each year.

Midwifery care is not just about survival—it also enhances the quality of care and maternal experience. Women receiving care from midwives consistently report:

· Greater satisfaction with their childbirth experience

· Lower use of unnecessary medical interventions

· Higher rates of spontaneous vaginal births

· More timely initiation of breastfeeding

From a health systems perspective, midwifery care is cost-effective. Compared to physician-led models, midwives:

· Require shorter and less expensive training.

· Are associated with lower rates of complications, long-term health issues, and costly procedures such as cesarean sections and inductions.

Overall, midwifery-led models provide a clinically effective, economically sound, and sustainable approach to achieving universal health coverage and improving maternal and newborn outcomes.

Key Pillars of Midwifery Models of Care:

1. Political Commitment and Funding:

· Governments must show sustained political will to prioritize midwifery.

· This includes investment in education, workforce expansion, and infrastructure to ensure midwives are well-trained and accessible.

2. Strong Governance:

· Effective implementation requires clear policies, regulations, and accountability mechanisms.

· Leadership at all levels (national, regional, local) must support midwifery within broader health system strategies.

3. Partnership Building:

· Midwifery services thrive when there is inclusive collaboration.

· This includes multi-sectoral partnerships among health professionals, communities, NGOs, and policymakers to ensure culturally respectful and community-based care.

4. Sustainability Planning:

· Long-term strategies are necessary for the institutionalization and scalability of midwifery models.

· This involves integration into national health plans, ongoing evaluation, and adaptability to meet population needs over time.^1&4

Transition Areas for Effective Implementation:

1. Community Engagement:

Meaningful involvement of women, families, and community leaders in the design, implementation, budgeting, and evaluation of midwifery services fosters cultural relevance, community trust, and social accountability.^1,3

2. Service Delivery Innovations:

Integrating midwifery-led continuity of care models into both community-based and facility-based services allows for personalized, responsive, and context-specific care. These innovations bridge gaps between home and hospital care while improving outcomes and satisfaction.^4,6

3. Interprofessional Collaboration:

A successful midwifery model depends on mutual respect, clear communication, and role clarity among midwives, obstetricians, nurses, pediatricians, and other health workers. Joint trainings, interdisciplinary meetings, and functional referral systems enhance teamwork and ensure seamless, coordinated care.^3,4

4. Midwifery Leadership and Research:

Midwives must be equipped and encouraged to take on leadership roles at policy, academic, and clinical levels. Promoting midwife-led research, investing in capacity building, and supporting strong professional associations can drive innovation, visibility, and influence in health policy decision-making.^1,5,7

5. Supportive Policy and Regulatory Environment:

Enabling policies should formally recognize midwives as independent professionals, allowing them to work within their full scope of practice. Regulations must establish standards for education, licensure, ethical conduct, and continuing professional development, in alignment with international guidelines. Strong regulatory frameworks help ensure quality, safety, and accountability, thereby fostering trust among communities and within the broader health system.

6. Education and Continuous Professional Development (CPD):

High-quality, competency-based midwifery education, coupled with regular in-service and refresher training, ensures that midwives are updated on best practices and emerging evidence. Training should be aligned with WHO and ICM global standards and incorporate components like emergency obstetric care, respectful care, and digital literacy.^5,6

7. Health Workforce Strategies:

Workforce reforms must address equitable distribution, retention strategies, gender-sensitive work environments, and safe staffing norms. Adequate remuneration, benefits, and career advancement pathways are essential to prevent burnout and ensure the long-term sustainability of the midwifery workforce. ^1,4

8. Supportive Health System Environment:

An enabling health system must ensure that midwives are supported by:

· Adequate transportation systems for timely referrals

· Effective communication tools for consultations and emergency coordination

· Safe and respectful work environments, especially in rural and fragile contexts.^1,3

Outcomes of Midwifery-Led Care Models:

Global evidence strongly supports the positive impact of midwifery-led continuity of care models on both clinical outcomes and patient experience. In models where a woman is supported by a known midwife throughout pregnancy, labor, and postpartum, 97% of women reported familiarity with their attending midwife, which significantly enhances trust, communication, and care continuity.

Key Outcomes:

Maternal Satisfaction:

Increased emotional support and personalized care lead to higher levels of satisfaction and improved antenatal and postnatal service utilization.

Clinical Improvements:

· Vaginal births: Increased frequency

· Emergency cesarean sections: ↓ 51%

· Vacuum-assisted deliveries: ↓ 57%

· Episiotomy rates: ↓ 73%

· Labor inductions: ↓ 47%

Newborn Outcomes:

· Preterm births: ↓ 61%

· Low 5-minute Apgar scores: ↓ 59%

Moreover, midwives practicing in continuity of care models report greater professional satisfaction, autonomy, and lower burnout, reinforcing the sustainability and resilience of these care models.

CONCLUSION:

Midwifery-led models of care are a transformative solution for advancing maternal and newborn health worldwide. These models offer a high-impact, cost-effective approach rooted in trust, continuity, and respect. By integrating midwives into national health systems, investing in their education and leadership, and ensuring supportive policy environments, countries can improve clinical outcomes and enhance the childbirth experience. Midwives are central to delivering essential reproductive health services, especially in underserved areas. Strengthening midwifery models is not only a public health imperative but a commitment to equity, dignity, and sustainability in healthcare. Their scale-up is critical for achieving global health targets.

REFERENCES:

1. World Health Organization. Global strategic directions for nursing and midwifery 2021–2025. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240033863

2. United Nations Population Fund, International Confederation of Midwives, World Health Organization. State of the World’s Midwifery 2021: Building a health workforce to meet the needs of women, newborns and adolescents everywhere. New York: UNFPA; 2021. Available from: https://www.unfpa.org/sowmy-2021

3. Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, et al. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet. 2014 Sep 20;384(9948):1129–45. doi:10.1016/S0140-6736(14)60789-3

4. Homer CSE, Friberg IK, Dias MAB, Ten Hoope-Bender P, Sandall J, Speciale AM, et al. The projected effect of scaling up midwifery. Lancet. 2014 Sep 20; 384(9948): 1146–57. doi:10.1016/S0140-6736(14)60790-X

5. World Health Organization. Defining competent maternal and newborn health professionals. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240063501

6. International Confederation of Midwives. Essential competencies for midwifery practice framework 2019 update. The Hague: ICM; 2019. Available from: https://www.internationalmidwives.org

7. World Health Organization. Midwifery educator core competencies. Geneva: WHO; 2023. Available from: https://www.who.int/publications/i/item/9789240067318

Received on 05.08.2025 Revised on 25.08.2025

Accepted on 09.09.2025 Published on 03.11.2025

Available online from November 15, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(4):214-217.

DOI: 10.52711/ijnmr.2025.40

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Concept note on Midwives and Midwifery Models of Care –

Transforming Maternal and Newborn Health

M Priya¹, S. K. Mohanasundari²

Why Choose Midwifery Models of Care?

Key Pillars of Midwifery Models of Care:

Concept note on Midwives and Midwifery Models of Care –

Transforming Maternal and Newborn Health

M Priya1, S. K. Mohanasundari2

Why Choose Midwifery Models of Care?

Key Pillars of Midwifery Models of Care:

M Priya¹, S. K. Mohanasundari²