Midwifery

Midwifery encompasses the art and science of supporting women and newborns through the perinatal continuum, from pre-pregnancy through the postnatal period. Historically rooted in community-based care, contemporary midwifery is distinguished by an evidence-informed, person-centred approach that emphasises physiological labour, continuity of caregiver and respectful partnership. Midwives undertake comprehensive assessment, monitoring and timely intervention for low-risk women, referring to obstetric or neonatal specialists when complications arise. Globally, midwife-led models vary in structure—from private practice to public health systems, birth centres and home-birth services—but share core elements of autonomy, minimal intervention and psychosocial support. Robust midwifery provision has been linked to reduced caesarean and instrumental delivery rates, enhanced maternal satisfaction and improved neonatal outcomes. In low- and middle-income settings, strengthening the midwifery workforce and its enabling environments is critical to achieving Sustainable Development Goals for maternal and newborn survival. Economic evaluations demonstrate that midwife-led services often deliver superior health gains at comparable or lower cost than conventional obstetric care. Emerging research highlights the influence of the birth environment, social support and policy frameworks on practice quality. Integration of midwives within multidisciplinary teams and supportive policy contexts remains essential to realising the full potential of midwifery in improving global maternal and child health.

Research from Nature Portfolio

Recent observational research has explored the impact of delivery-room design on obstetric intervention rates. In a retrospective cohort study, first-time mothers labouring in ‘sensory’ environments—equipped with adjustable lighting, art displays and ambient soundscapes—were found to have significantly lower caesarean delivery rates and reduced need for oxytocin augmentation compared with those in standard rooms. These findings suggest that optimising the sensory and aesthetic features of birth settings can facilitate physiological labour and decrease reliance on invasive procedures, underscoring the role of environmental design in supporting midwifery-oriented care.

Research from all publishers

Economic evaluations in Bangladesh, Pakistan and Uganda compared midwife-led birthing centres with standard hospital care, revealing that half of the examined centres achieved better health outcomes at lower cost, with highly cost-effective gains per disability-adjusted life-year averted. Analysis identified midwife salaries and facility operations as primary cost drivers, emphasising the need for context-specific resource planning.

Lives Saved Tool modelling across 88 countries estimated that scaling up professional midwife-delivered interventions could avert up to two-thirds of maternal and neonatal deaths and stillbirths by 2035, potentially saving over four million lives annually with universal coverage. Even modest increases in intervention coverage were projected to prevent more than one million deaths per year, highlighting the substantial impact of midwife capacity building.

A global ecological study of low- and middle-income countries found that higher availability of midwives per 10 000 population correlates with significant reductions in maternal and neonatal mortality and with caesarean rates aligning with recommended thresholds. Strong professional structures and enabling work environments amplified these mortality declines, though broader health-system factors also influenced outcomes.

Midwifery publication trend

The graph below shows the total number of articles in midwifery across all publications each year (not limited to Nature Index journals).

Technical terms

Midwife-led continuity of care: A service model in which a known midwife or small team provides seamless support and case management for a woman throughout pregnancy, birth and the postnatal period.

Disability-adjusted life-year (DALY): A composite metric quantifying disease burden by combining years of life lost due to premature mortality with years lived with disability.

Sensory delivery room: A birth environment designed with programmable lighting, visual displays and soundscapes to promote relaxation and support natural labour progression.

Lives Saved Tool (LiST): A mathematical modelling framework used to estimate the impact of scaling health interventions on mortality and morbidity in maternal, neonatal and child health.

References

1. Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries. Human Resources for Health (2024).
2. Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites. BMJ Global Health (2024).
3. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. The Lancet Global Health (2020).
4. The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions – an observational retrospective cohort study. Scientific Reports (2019).
5. Midwifery in Global Health.