World Health Organization Calls for Transition to Midwifery Models of Care to Improve Outcomes for Women and Newborns

Abstract

As we welcome 2025 and begin celebrating 70 years of the American College of Nurse-Midwives (ACNM) and the Journal of Midwifery & Women's Health (JMWH), a recent World Health Organization (WHO) report¹ should be in the hands of every practicing midwife. In the United States in particular, this position paper can help promote midwifery care models at the federal, state, local, and health system practice levels. WHO recommends a transition to midwifery care models worldwide, linked to a strategy of primary health care as part of attaining universal health coverage.

WHO urges moving from fragmented and risk-focused care approaches to midwifery models of care so that women and newborns receive “equitable, person-centred, respectful, integrated and high-quality care, provided and coordinated by midwives working within collaborative interdisciplinary teams”^1(p8) prior to pregnancy through the postpartum period. The report notes that while the terms women and mothers are used, the recommendations are inclusive of all individuals identifying as women and all persons who give birth. Although improvements have been made in maternal and neonatal outcomes globally, many challenges remain. Improvements are needed in both access to health care and the provision of high-quality care. In addition, inappropriate use of medical interventions is highlighted as a barrier to improving perinatal outcomes.

Midwifery models of care are defined as those consistent with midwifery philosophy and where the care is provided by autonomous midwives who are educated, licensed, and regulated. Midwives provide high-quality care that is person-centered, based on a relationship between the midwife and the woman, promotes physiologic processes, with interventions used only when needed. Care is coordinated within resourced and functional health systems where interprofessional teams function with respect and trust. These care models are modifiable to be used in all care settings and related contexts.¹

Principles of midwifery models of care include (1) access to equitable and human rights–based care for all women and newborns, (2) person-centered and respectful care in a partnership between women and midwives, (3) high-quality care consistent with midwifery philosophy, (4) care provided by autonomous, educated, regulated midwives throughout health systems, and (5) midwives are integrated into interprofessional care teams.¹ By using models incorporating these principles, WHO believes a transition to midwifery models can save lives, improve women's and newborns' health outcomes, improve satisfaction with care, reduce health inequities, promote women's rights, and maximize the use of health care resources.¹

In making the case for midwifery care models, the WHO report synthesizes recent research and other reports that exemplify the value of transitioning to midwifery models of care. A majority of maternal and newborn deaths and stillbirths could be prevented. Short- and longer-term outcomes would be improved for women and newborns. Midwives provides a more positive experience, providing what women want and resulting in greater satisfaction with care.¹ The important role midwives play in societies at large is demonstrated through “midwifery: knowledge, skills, and practices” being named on the United Nations Educational, Scientific and Cultural Organization (UNESCO) Representative List of the Intangible Cultural Heritage of Humanity.^{1, 2}

Midwifery care principles identified in the WHO report are consistent with definitions of midwifery care and philosophy statements in the United States. Midwives are professionals who are educated and regulated, and practice autonomously in partnership with their patients within their scope of practice.³ A recent expanded definition of US midwifery-led care includes care led by midwives, partnership between midwives and their care recipients, and care consistent with midwifery philosophy.⁴ Midwives respect basic human rights and believe in access to quality care for all, patient participation and making the final decisions about their health care, partnership between patients and midwives, promotion of physiologic care, and interprofessional care.⁵

Most of the research undergirding the WHO position on midwifery models of care has been conducted in high-income countries. The United States, however, is documented to have poorer perinatal health outcomes despite spending more on health care than other high-income countries.⁶ In addition, well-documented US perinatal health inequities result in worse outcomes for Black and Indigenous persons compared with White.⁷ The 2024 March of Dimes Report Card highlights the lack of change in the US prematurity rate, a recent increase in infant death, and health inequities across the country.⁸ These recent US reports by KFF and the March of Dimes identify efforts to address the inequities and poor outcomes, making clear the need for improved US perinatal care models, and highlight midwives as part of the solution.^{7, 8}

How can the WHO recommendation to transition to midwifery models of care be used in the United States? Individual midwives and midwifery practice leaders can use the document and related sources to urge needed reforms in their own institutions to ensure that midwives are fully practicing according to midwifery philosophy and approach to care. The document can be used in state legislation to move from restricted to full autonomous scope of practice legislation, including legislation to license certified midwives. Midwifery education programs can incorporate the WHO and related documents in professional issues and policy courses. At the federal level, this proposal should be immediately included in the Transforming Maternal Health program funded by the Centers for Medicare & Medicaid Services to improve maternal health outcomes.⁹ While WHO completes its work developing guidance on implementing midwifery models of care globally, US midwives can bring this document forward as we work to promote high-quality midwifery care in collaboration with our health care partners to improve US perinatal care in this ACNM and JMWH 70th anniversary year and beyond.