Position Statement

Keeping Birth Normal 

Model of Practice, Practice Updates
Last Edited 2 June 2023 17:52 CEST
A midwife Hotaru Tsuchida teaches a Yoga lesson to a pregnant patient just before giving birth at Aiiku Hospital in Tokyo, Japan.


Keeping birth normal’ is an ICM strategy associated with health, midwives’ education and practice, and existing health care systems.  

Rates of interventions in normal birth have been growing steadily over the past three decades, despite the evidence showing that overuse of interventions can be harmful for the short- and long-term health of women and newborns. There is a growing global need to discuss the value and importance of normal, physiological birth for community health and health system sustainability. 

ICM’s midwifery philosophy emphasises pregnancy, birth and postpartum as normal and profound life experiences and stresses the role of the midwife in keeping them normal. Midwives optimise normal physiological processes and support safe physical, psychological, social, cultural and spiritual situations, working to promote positive outcomes and to anticipate and prevent complications.To do so, the care midwives provide must be informed by evidence-based knowledge.  

Ultimately, the way a woman or gender diverse person gives birth is up to their individual choice. These decisions are also affected by factors which midwives must respect and support, such as: 

  • Culture 
  • Socio-economic issues and health care systems 
  • Lack of information about the benefits of normal birth 
  • A fear of normal birth 
  • An inability to trust their innate ability to give birth 


The spectrum of choices health systems offer must include safe, meaningful access to normal, physiological birth, and provide midwives an enabling environment with safe and effective referral systems and positive inter-professional collaboration. 

When midwifery education is limited solely to hospitals and medicalised clinical environments,  midwives may be prevented from practicing the full scope of midwifery practice as outlined in the ICM International Definition of the Midwife and the ICM Essential Competencies for Midwifery Practice. Such experience may impact midwives’ ability to support women to achieve a normal birth. 

ICM supports the following definition of normal childbirth: 

  • A unique, dynamic process in which fetal and maternal physiologies interact with the woman’s psychosocial contexts. 
  • A process whereby the woman or gender diverse person commences, continues, and completes labour with the infant being born spontaneously at term, in the vertex position, and without surgical, medical, or pharmaceutical intervention. 



ICM supports normal childbirth, because for most women and gender diverse people, pregnancy, childbirth and postpartum are physiological life events that need to be treated as such. Midwives have a body of expertise that is essential to creating a culture where birth is considered a normal life event. The promotion of normal childbirth is included in the ICM Scope of Practice. Therefore, midwives should be competent in all means of supporting the normal birth physiology. Women and gender diverse people should have access to midwife-led care, one-to-one support, including the choice of place of birth (home, hospital, birth centre)  and choice of comfort measures that do not involve pharmaceutical pain relief (e.g. water immersion, choice of position). 



ICM Member Associations are encouraged, in partnership with women and communities, to: 

  • Educate the public, especially adolescents and people of reproductive age on normal childbirth 
  • Promote normal childbirth within the health system’s maternity service; 
  • Confirm midwives as the primary caregiver and expert in normal childbirth; 
  • Ensure midwives’ education facilitates development of skills and competencies in normal childbirth; 
  • Organise educational courses to maintain and develop midwives’ practice in normal childbirth; 
  • Increase midwives’ awareness of the benefits of normal childbirth in terms of maternal and neonatal health and outcomes; 
  • Establish and use health care indicators and evaluate the results of midwives’ practice in normal childbirth; 
  • Carry out research to demonstrate the effectiveness of midwifery care in normal childbirth;. 
  • Influence and work in collaboration with Ministries of Health and other organisations; 
  • Participate in the strategic planning and decision-making process related to maternity services, thereby encouraging politicians to support normal birth. 


The term childbirth in the list above refers to pregnancy, birth and postpartum care.

Related ICM Documents 


Adopted at Glasgow Council meeting, 2008  

Reviewed and adopted at Prague Council meeting, 2014 and Bali Council meeting, 2023 

Due for next review 2026