MIDWIFERY: An International Perspective


Throughout the world, professional midwives feel pushed to the limit and beyond. For them, a 40-hr week does not seem to exist. Educational programs struggle to maintain funding, provide adequate clinical experience, and keep qualified dedicated faculty. Professional organizations continue to work toward the improvement of health care and the security of professional privileges. This is not only happening in the United States but also to midwives and their professional organizations in other countries. Yet, most mid-wives tend to ignore the painfully similar reality of their colleagues at home and abroad because they have more than enough to handle within their own work settings. All too often, they withdraw from the challenge of looking outside of their own established world of work and lose sight of the future, a future of growth and change.

American midwives, for example, appear to have become consumed with the internal struggle of protecting and defending our profession. Our attempts to solidify our legislative base and to reconcile divisions within the American College of Nurse-Midwives with regard to the practice and education of midwives may prevent us from seeing midwifery from an international perspective. But where are the mechanisms to unite midwives, internationally and within the United States? If we can only look at a worldwide view, perhaps we will be able to see our own divisions, problems and accomplishments in a new and potentially therapeutic light.

In Great Britain, the struggle to keep the role and function of the midwife alive, a semblance of the in-dependent practice it once was, is so all-consuming, that a look beyond this immediate crisis is felt to be asking too much. Midwives who have been hospital-trained in their vocation have mixed feelings about the changes in their jobs and status. Some midwives prefer less responsibility and fewer demands, relinquishing those areas of management to the physicians and accepting the role of maternity nurse while maintaining the title of midwife. Other midwives are struggling to maintain the independent role and practice, finding support within the Royal College of Midwives and in the splinter groups of the Association of Radical Midwives and the Active Birth Movement. Other midwives in Great Britain are entangled in the economic net of a National Health Service that incorporates midwifery jobs along with thousands of others. Salaries, status, and existence involve governmental sanction and depend upon the economic status of the country. All these factors force the British midwife into a stance of self-preservation.

Elsewhere, midwives are fighting to maintain and secure their role and function. In Spain, the government placed midwives within a larger body of health services where their voice is a tiny minority. This has led some groups of Spanish midwives to form their own association thereby enabling them to have an independent voice. Other factions of midwives, however, are trying to work within the newly formed government system. These internal divisions weaken their collective voice and confuse their public image.

French midwives have legally established their position as separate health-care providers. They find it difficult to accept that midwives in other countries have not also accomplished this.

Midwives in Iceland are looking at the additional component of nursing to see if it fits into their practice of midwifery. This raises many concerns about their structure, education, and practice.

In Canada, where there is no legalized form of midwifery, they are trying to establish a formula for their own brand and style of midwifery to suit the needs of the Canadian people.

These are but a few examples. Everywhere you look, there are mid-wives who are working hard within their own practices and who are fighting to improve the standards and status of midwifery. However, we must now stop our introspective meditations and begin to look outside ourselves, individually, nationally, and internationally. By developing such an international focus, we may well be able to develop a suitable platform from which we will all be able to approach our own internal problems with appropriate empathy and flexibility.

Certain individuals and organizations in the European community have already taken steps in this direction. After tremendous effort the European Economic Community (EEC) has agreed on standards of reciprocity for midwives in their nine member countries, beginning in 1983. The Scandinavian countries have already developed standards for professional mobility between their midwifery organizations. These efforts resulted from looking at the essence of midwifery, since each country had different qualifications and standards that needed to be synthesized. This phenomenal task has united these midwives; nurses and non-nurses, those hospital-trained and those educated in midwifery schools. They have joined together in support of each other to improve health care and midwifery within their individual countries and within the European community.

In 1979, Roger Fenney (then the Secretary of the Central Midwives Board in England) stated the need for “… a universal system of licensure for midwives … which should provide for (a) an international code of practice within agreed limits, (b) internationally accepted standards of training, and (c) international recognition of rights to practice.”1 The adoption of such a platform would provide an international professional exchange within midwifery that could be a unifying force in directing worldwide health-care for women and families, as well as promoting and supporting the international role and function of midwifery.

The time has come for midwives to open themselves, individually and through their professional organization, to midwives throughout the world. Surely this is possible without destroying their respective organizations and the mechanisms of support already established. Instead, such mechanisms need only to be redesigned to allow for greater flexibility. Now, indeed, is the time to help ourselves and others to grow and change. If we hesitate, if we build barriers, we may find ourselves insulated from the very forces that might provide us with growth and healing.