Envisaging Midwifery Models of care 

This is the third article in a series on midwifery models of care. The first explored the long-awaited boost in recognition for the midwifery profession and women’s right to respectful care following the release of WHO’s Transitioning to Midwifery Models of Care: Global Position Paper  and The Midwifery Accelerator. The second examined the Implementation Guidance on transitioning to midwifery models, launched in June 2025 by ICM, UNICEF, UNFPA, WHO and partners. 

This final article looks at midwives’ aspirations for different Midwifery Models of Care and calls on all countries to adopt innovative models that address local challenges, strengthen the profession and expand choices for women and gender-diverse people. 

Midwifery Models of Care: Flexible, Woman-Centred Solutions Across the Globe 

Midwifery models of care are uniquely adaptable, capable of meeting the needs of women across a wide range of settings, from community clinics to hospitals, and from well-resourced public health systems to humanitarian or crisis environments. Unlike rigid, standardised medical models, Midwifery Models of Care can be tailored to the specific context of a country, region, or population.  

The concept of the midwife as the primary care provider is not new; diverse midwifery models exist worldwide, each shaped by local needs, resources, and cultural norms. 

The Implementation Guidance on Transitioning to Midwifery Models of Care offers compelling real-world examples. In Bangladesh, a new cadre of midwives was deployed to expand access to skilled care. In the Democratic Republic of Congo, continuity of midwife care models was developed specifically for survivors of sexual violence. Meanwhile, countries such as the United Kingdom and Ethiopia, as well as the West Bank in the occupied Palestinian territory, have strengthened continuity of midwife care programmes. These examples illustrate the growing recognition that midwives, when positioned as primary providers, can drive meaningful improvements in maternal and reproductive health outcomes worldwide. 

Voices from Africa and the Eastern Mediterranean 

Challenges in maternal and reproductive health vary widely across Africa and the Eastern Mediterranean. In some urban, high-resource areas, women experience over-medicalisation, with excessive interventions during pregnancy and birth. In contrast, women in remote or underserved areas may have limited access to even the most basic sexual and reproductive health (SRH), antenatal, intrapartum, and postnatal services. 

At the ICM Regional Conference for Africa and the Eastern Mediterranean in September 2024, midwives from across the regions explored these disparities firsthand. In a participatory workshop, they mapped a woman’s journey through pregnancy, labour, birth, and postnatal care within their countries. Most reported that continuity of midwife care was lacking and women typically encountered five to ten different healthcare providers throughout the continuum of care from pregnancy to the postnatal period. 

When asked to envision redesigned maternity services, participants highlighted both systemic challenges and opportunities. Many described both health systems with minimal antenatal and postnatal care, high midwife-to-patient ratios during labour and delivery or over-medicalisation reflected by increasing caesarean birth rates. Further challenges faced by the midwives included ongoing humanitarian crises and low professional status. Yet, despite these obstacles, midwives displayed remarkable dedication, a broad scope of practice, and a strong commitment to all aspects of sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH). Their visions reflected the principles of the Philosophy and Model of Midwifery Care: holistic, woman-centred, and community-informed. 

Building Functional Health Infrastructure 

Midwives’ aspirations extended beyond clinical care to encompass improved infrastructure and supportive working conditions. One participant shared, “Our dream is to have a one-stop centre where the woman can get all the care she needs, attended by a midwife in the way she chooses, and where a woman can also decide who will attend her.” Professional recognition and fair remuneration were also emphasised: “Recognition of my midwifery profession, remunerated accordingly.” 

Participants highlighted the importance of involving midwives in service design and procurement decisions, advocating for accessible diagnostics, robust consultation and referral systems, and rigorous quality assurance. To support physiological birth, midwives proposed innovations such as birth pools, flexible birthing spaces, companions of choice, and, in remote areas, “waiting homes” to keep families near hospitals when needed. 

Practising to Full Scope 

A central theme emerged: midwives must be empowered to work to their full scope of practice according to The Essential Competencies for Midwifery Practice. Pre-conceptual care lays the foundation for lifelong sexual and reproductive health, pre-conceptual-friendly services foster informed reproductive choices among young people. Pregnancy care should include structured antenatal visits covering self-care, birth options, and newborn care, followed by supported home-based postnatal care for mothers, newborns, and families. To deliver this full spectrum of care effectively, midwives expressed the need for authority to prescribe medications, access diagnostics, and maintain reliable connections to obstetricians and emergency services. If fully empowered, midwives can provide comprehensive culturally appropriate care that respects women’s choices. 

Centring Women, Families, and Choice 

Midwives repeatedly emphasised that care should be woman-centred and close to where she lives. One described, a dream “where the woman can have her baby at home with a midwife attending her and (the woman) choosing the position she prefers.” Community engagement was seen as essential, with calls for health education, dialogue, and sensitization about psychological health, self-care, and the pregnancy journey. 

Public awareness is equally important. Campaigns can help communities understand the risks of over-medicalisation, recognise midwives as trained and regulated professionals, and encourage families to partner with them throughout pregnancy and childbirth. Respectful care and informed choice were presented as inseparable from the status and empowerment of midwives themselves. 

Competence, Collaboration, and Leadership 

Delivering high-quality midwifery care requires a workforce that is well-trained, up-to-date, and available in all settings. Achieving this requires expanded pre-service education, mentorship, continuing professional development, and effective regulation. Midwives aspire to work in well-equipped hospitals while also leading midwife-centred facilities at all levels. 

They stressed the importance of teamwork, collaborative care, and dismantling hierarchical barriers that can limit their ability to practice fully. Midwives envisioned leadership roles in governance and emphasised capacity-building to improve assessment skills, timely identification of complications, and care coordination. Equality among midwives, combined with strong interprofessional collaboration, was highlighted as critical to achieving high-quality, woman-centred outcomes. 

Addressing Challenges and Building Solutions 

The African and Eastern Mediterranean midwives that attended the workshops articulated a bold vision which addressed the needs of under resourced and over medicalised settings where the common denominators were restricted scopes of practices, fragmentation of services and too many care providers involved in the care needed by women throughout their reproductive life course. Solutions to these complexities can be seen in further examples of Midwifery Models of Care.   

Continuity of midwife care, when a known midwife or small team follows a woman through pregnancy, birth, and the postnatal phase, improves outcomes (1). WHO recommends that whenever possible continuity of midwife care should be prioritised as an essential component of Midwifery Models of Care, even in the event of complications (2). This approach to care strengthens the partnership between the woman and midwife and optimises physiological, biological, psychological, social and cultural processes around the birth and sexual and reproductive health continuums (2).  

Midwifery-led Birth Centers (MLBCs) are a dedicated space – either within or separate from a higher-level health facility – where care is provided for pregnant women and newborns at low risk of complications. MLBCs in Uganda, South Africa, Bangladesh, and Pakistan are providing quality care recognised by the community. When integrated into a positive policy environment, MLBCs can meet the needs of women and the community with an effective referral system, collaboration across different levels of health service and a competent workforce committed to a midwifery philosophy of care (3). 

Midwives’ scope of practice includes comprehensive sexual and reproductive health (SRH) services, such as contraception and comprehensive abortion care. However, practical challenges arise when understaffed and fragmented health systems are required to prioritise staffing of antenatal, labour, birth, and postnatal units, limiting midwives’ availability to provide SRH services.  In New Zealand community-based midwives offering early medical abortion care illustrate how service accessibility can be improved and rural communities empowered. Midwives practising close to communities can integrate sexual and reproductive health services into continuity-of-care models allowing midwives to work to a broader scope of practice without compromising care during the birthing continuum. 

Conclusion 

Transitioning to Midwifery Models of Care requires a holistic approach that empowers midwives, bridges skill and system gaps, and expands community-based and continuity-focused models. These services need to be integrated into networks of care that enable supportive working conditions and effective referral and consultation when the women or newborn require specialised care from allied health professionals. 

Midwives from all over the world are actively envisioning the implementation of Midwifery Models of Care. Accessing the conversations had by these working midwives is vital for the implementation of innovative solutions for the provision of SRMNAH care. Midwives create solutions that address system fragmentation. They emphasise the importance of expanding community-based and continuity-focused models, and strong referral systems for the provision of woman-centred care throughout the reproductive life course. 

The responsibilities of the global health community and national health services are to listen to midwives’ voices, to continue to advance our collective understanding of Midwifery Models of Care and to reinforce midwifery as a cornerstone of well-prepared health systems that can face any crisis, focused on equitable access, enhancing women’s autonomy and improving outcomes. 

References 

1. Sandall J, Fernandez Turienzo C, Devane D, Soltani H, Gillespie P, Gates S et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2024;2024(4):CD004667. (https://doi.org/10.1002/14651858.CD004667.pub6).
2. World Health Organization (WHO). Implementation guidance on transitioning to midwifery models of care. Published June 17, 2025. 
3. Turkmani S, Nove A, Bazirete O, et al. Exploring networks of care in implementing midwife-led birthing centres in low- and middle-income countries: A scoping review. PLOS Glob Public Health 2023; 3(5): e0001936.