Posted: January 5th, 2021

How will the field of midwifery develop in the future?

Midwifery has a long history as a woman-centered model of maternity care. However, the profession has faced challenges to its legitimacy and autonomy over the years as medicalized birth became the norm in many Western nations (Lundgren & Ahlberg, 2020). Today, midwifery is resurging as a holistic, evidence-based approach valued by childbearing populations. This paper explores how the field may continue to progress and expand its impact in the years ahead by addressing women’s needs through specialized, community-based and culturally-sensitive care models supported by technology.
Woman-Centered Models of Care
A core principle guiding midwifery’s future development is strengthening woman-centered philosophies of care. This means prioritizing women’s autonomy, informed choice, consent and participation in decision-making about their own births (American College of Nurse-Midwives, 2022). Midwives promote informed choice through unbiased counseling on all options and respect for cultural or personal preferences. They view pregnancy and birth as normal life processes rather than medical conditions and aim to empower women as experts in their own experiences (Lundgren & Ahlberg, 2020).
Midwifery organizations are advocating for health systems and policies supporting this model. For example, the Midwives Alliance of North America’s “Core Competencies” document outlines philosophies of care centered on human dignity, social justice and informed consent as foundations for practice (Midwives Alliance of North America, 2022). As midwifery gains recognition, its woman-centered approach may shape wider norms around respectful maternity care.
Expanded Scope of Practice
Midwives’ autonomy and responsibilities are expanding in many regions. Certified nurse-midwives and certified midwives in some U.S. states can now attend home births and provide primary care for low low low-risk pregnant women, including well-woman exams and prescribing certain medications (American College of Nurse-Midwives, 2022). In Canada, midwives have full practice authority as primary maternity care providers (Canadian Association of Midwives, 2022).
As midwives demonstrate safety and satisfaction comparable to obstetric models, their scope is likely to continue widening to meet needs. For example, midwives in the United Kingdom are pursuing prescribing rights for more medications to treat common conditions and authorize more procedures like insertion of intrauterine devices (Royal College of Midwives, 2022). As health systems recognize midwifery’s cost-effectiveness, midwives may gain authority to manage more aspects of normal pregnancy, birth and postpartum care independently.
Integration of Sexual and Reproductive Health
A holistic model of women’s health encompasses sexual wellness and family planning alongside pregnancy and birth. Midwifery education and practice could increasingly incorporate these topics, especially for adolescents and marginalized groups facing barriers (Lundgren & Ahlberg, 2020). For example, midwives may counsel clients on sexuality during pregnancy, sexually transmitted infections, contraceptive options and menopause in addition to antenatal and intrapartum care.
This aligns with midwifery’s woman-centered philosophy and addresses social determinants of health. It also positions midwives as trusted sources of information to support clients’ sexual autonomy and reproductive choices over their lifetimes. As midwifery expands its focus on wellness beyond birth, it can play an even greater preventive role in communities.
Specialization Within the Profession
As midwifery care diversifies to meet varied needs, midwives may develop expertise in certain practice areas. For example, some may specialize in low-risk home and freestanding birth center births while others focus on high-risk pregnancies, lactation support or perinatal mental health in clinical settings (Midwifery Today, 2022).
This allows for personalized, specialized care. A midwife experienced in caring for women with medical complexities like diabetes or twins feels confident managing those situations, while another prefers low-intervention settings. Clients benefit from midwives’ experience in their particular needs rather than one-size-fits-all models of care. Specialization also enhances midwives’ career satisfaction by playing to their strengths and interests.
Community-Based Models of Care
Community midwifery programs demonstrate success in improving access, outcomes and satisfaction for culturally-diverse groups through affordable, local care (Midwives Alliance of North America, 2022). These models place midwives in neighborhoods, clinics, homes and other trusted community locations to reduce barriers like transportation costs or lack of childcare.
Being embedded offers continuity with the same midwife from preconception through postpartum as well as culturally-appropriate care. For example, Indigenous midwives in Canada facilitate traditional practices and address historical trauma in a supportive cultural context (Assembly of First Nations, 2022). As their effectiveness is recognized, community-based midwifery may expand to serve more underserved populations through medical homes, FQHCs and other partnerships.
Increased Diversity in the Profession
A diverse midwifery workforce is key to reducing inequities in maternity care. However, the field has traditionally lacked representation among communities of color (American College of Nurse-Midwives, 2021). Many professional organizations are now working to recruit more midwives from diverse backgrounds through mentorship programs and scholarships.
Having midwives who share clients’ lived experiences, language and values helps address cultural barriers, biases and mistrust in the system. It allows for nuanced understanding of each woman’s context (American College of Nurse-Midwives, 2021). As the profession succeeds in attracting more applicants of color, it will better serve increasingly diverse childbearing populations and help close disparity gaps in outcomes.
Incorporation of Digital Health Tools
Technology, if applied judiciously, has potential to enhance midwifery practice. For example, telehealth enables midwives to provide counseling, exams and lactation support virtually, expanding access in underserved areas (Midwifery Today, 2022). Apps allowing remote monitoring of blood pressure, weight gain and fetal movement between visits offer reassurance to low-risk clients.
Electronic medical records integrated across practice settings streamline communication and care coordination for women receiving prenatal care from multiple providers. Digital tools may also support remote supervision of community-based midwifery programs and distance education opportunities for students (Midwifery Today, 2022). When designed with user privacy and consent in mind, technology can boost midwifery’s reach.
Conclusion
In summary, midwifery appears poised to grow into a more woman-centered, holistic and specialized field that leverages technology and community-based models to improve access to high-quality maternity care. An increased focus on diversity and inclusion should also allow midwives to better serve all childbearing populations. If the profession continues advocating for philosophies of informed consent, cultural sensitivity and holism, it is well-positioned to make important contributions to public health in the years ahead.

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