Enabling Environment

Midwives and Nurse-Midwives: A Question of Professional Identity 

ICM
3 February 2025

“Professional identity” is about how professionals see themselves in their jobs. It is based on their values, motivations, experiences, and beliefs about their work. How society views such professionals can also have an impact. 

When healthcare professionals have a poor sense of professional identity, or are not recognised for their skills, this can lead to lower quality care, professional burnout and staff shortages, as people are discouraged from joining or remaining in the profession. 

To address this issue, recent research including over 100 countries measured and explored the professional identity of midwives and nurse-midwife populations, whilst also exploring how the midwifery profession may be best represented in public spaces. 

The distinction between midwifery and nursing 

Societies do not always understand what midwives do or how important they are. This is partly because midwifery is sometimes confused with nursing, though they are distinct professions with different skills and training. For example, though both nurses and midwives play key roles in the promotion of health and the prevention of illness, midwifery aligns with a holistic model of care in the context of childbearing (a physiological event), sexual and reproductive health, while nursing incorporates various models pertaining largely to ill health. The professional title of ‘nurse-midwife’ suggests a duality of roles with a wide variety of training and responsibilities given to midwives around the world. This duality is largely based on country specific demographic profile needs and regulatory processes.  

For example, in some countries, one has to be a nurse before becoming a midwife, while in other places, a person can train as a midwife directly. Another example can be seen in the differing ability of midwives and nurse-midwives to deliver all of the components of essential lifesaving skills based on locality.   

Midwifery, public space and culture 

Public statues and monuments also serve as historical reminders for professional identities, connecting persons to important figures and events. This helps them feel like they are part of a shared history and a larger professional community, strengthening their sense of belonging and professional identity.  

Currently in public spaces and culture, representations of midwifery are rare and predominantly drawn from fiction or dramatized media. Think of the popularity of the ‘Call the Midwife’ Series or the novel ‘Midwives’ by Chris Bohalian.  

Nursing represented in public space and culture is more pervasive and known for respected historical characters such as Florence Nightingale who may also mistakenly be drawn upon to represent midwives. A key differentiator being the earlier recognized formal professionalization of nursing heavily influenced by structures of Victorian class and culture. This is in stark contrast to midwifery which claims no one central historical uniting figure.  

As midwifery is arguably the world’s oldest profession, we applaud the public recognition as part of world heritage in 2023.  

We know that Midwives working in a supportive system are key to reducing the majority of preventable perinatal deaths worldwide.  We also know that professional identity matters in terms of our ability to recruit and retain into the profession, increasing the numbers of midwives needed to positively impact the range of reproductive health care in the long term. Considering these factors, it is crucial to understand midwives and nurse- midwives’ professional identity, and how societies, artists and health systems may better recognise their expertise. This can lead to better perinatal care, more midwives entering and remaining in the profession, more public support and midwives feeling more satisfied in their work.  

What did the researchers do? 

This project was led by the ‘Midwives in Focus’ programme team, an initiative aiming to raise the profile of midwives and midwifery in this context. To collect data, an online survey with questions about professional identity and open-ended questions about how midwives should be represented in the public realm was used. 

What did they find? 

  • Nurse-midwives had a stronger sense of professional identity than midwives. This might be because nursing has been given precedence over midwifery due to nurses’ integration into the medical model, where professional hierarchies often reflect and reinforce gendered stereotypes and power structures
  • Midwives felt pride and passion for their work but also faced barriers to feeling good about their profession. Barriers included a lack of recognition and respect from other healthcare professionals and the public. 
  • Reduced professional identity and the conflation of midwifery with nursing were negatively associated with the recruitment and retention of midwives.Some did not want to practise as nurses but had no other choice if they wanted to practice midwifery in some settings.  
  • Many participants felt that separating midwifery from nursing would improve their professional identity. This would assist clarification of their distinct roles and expertise. 
  • Linked to expressions of service and sacrifice, some participants demonstrated an overly strong (rather than healthy) professional identity.  This is concerning, as this can lead to poor teamwork, incivility and bullying. Rigid ideas about professional identity can also prevent innovations and improvements in healthcare. 
  • Some participants had been motivated by faith to practise midwifery, sometimes describing this as a ‘calling’.Historical and contemporary images of nurses and midwives marked by angelical and heroic figures, strongly influenced by religiosity can problematically feminise and undermine workforce expertise  
  • Midwives wanted to see their profession represented in the public realm through images and symbols, such as statues. This could help raise awareness and appreciation for midwifery work, as well as enhance midwives’ professional identity.
  • Many participants suggested representing midwifery and childbirth together via arts-based approaches, but this was somewhat at odds with other participants’ desire to be respected in areas of practice outside of clinical practice (e.g., research). This suggested a tension between celebrating the ‘art and science’ of midwifery. 
  • Highly gendered images were suggested by participants to represent midwives (e.g., women being with women).  This may not be surprising where professional identity construction is shaped by societal gender stereotypes. Yet this may also delay progress toward reproductive justice and improved perinatal outcomes, where oppressive norms prevail 

 

Why is professional identity important for midwives? 

This study highlights the importance of professional identity for midwives. When midwives feel good about their work and are recognized for their skills and professional identity, it can lead to: 

  • Improved perinatal care
  • More midwives
  • Improved job satisfaction
  • Reduced burnout 

How can we strengthen the professional identity of midwives? 

The research team recommends that change makers:  

  • Separate Midwifery from Nursing to clarify its unique role (e.g. in educational programmes, career progression and job titles)
  • Actively initiate and support initiatives celebrating midwifery and midwives in public and cultural spaces (e.g., via monuments, street names, literature)
  • Celebrate current and historic midwifery leaders through public and cultural events and student projects
  • Record and promote the history of midwifery and midwives in your country or region, including through public Internet platforms like Wikipedia and professional journals
  • Partner with cultural institutions to create events celebrating midwifery
  • Foster collaboration and respect between Midwives and other healthcare professionals
  • Align midwives’ professional identity to excellence in perinatal care and reproductive justice
  • Demonstrate the diversity of roles available to midwives (e.g. in research, education, policy, leadership)
  • Ensure that the representation of midwives in public and cultural spaces balances the lived experiences of midwives and the communities they serve while also balancing both the art and science of midwifery and avoiding stereotypes.

A new project initiative FindTheMidwife.com delves into the traditions and history of Midwifery from the perspective of midwives and research, re-examining the significance of an ages- old profession and its necessity in the modern world. 

What are your thoughts on this? The research team would love to hear about how this research is making a difference in your area. 

The research team 

This work was published as a collaboration between the Research Centre for Healthcare and Communities at Coventry University, the Nursing Now Challenge and Jhpiego.  

The team would like to thank all of the participants for their contributions to this important work along with both Hannah Finch and Andrea Latham from the Nursing Now Challenge team, for vital organisational support. 

 

Blog by Dr Sally Pezaro and Dr Pandora Hardtman