There is a moment during birth that Midwife and Spinning Babies® Continuing Education Manager Kara says has never become routine. “Just before a newborn’s first cry, everyone in the room seems to hold their breath” After years working as a nurse and midwife, she still feels the significance of that moment.
It’s one reason she describes midwifery as “the perfect mix of science and art.”
Midwives have supported families through pregnancy and birth for generations, sharing their clinical knowledge and experience while caring for families in their communities. Yet the profession looks very different today depending on where and how a midwife practices.
Through conversations with three of our Spinning Babies® midwives Venus in the United States, Kara, whose experience spans the United States and the Netherlands, and homebirth midwife Claire, based in New Zealand and teaching across Europe, we explore how midwifery has evolved, the challenges midwives face today, and the ways they continue to shape maternity care.
Midwifery’s Roots: Skilled Care Across Generations
The history of midwifery stretches back thousands of years, long before hospitals, formal medical education, or professional licensing existed.
Across cultures, birth knowledge was shared through families, communities, observation, and hands-on experience. Traditional and Indigenous midwives developed practices shaped by their communities’ needs, beliefs, and understanding of birth.
The International Confederation of Midwives recognizes this long history, tracing midwifery traditions across Africa, Asia, Europe, and Indigenous communities worldwide.1
As organized medicine expanded, the place of midwives within healthcare changed. In some regions, midwifery became integrated into formal maternity care, with established education pathways and professional autonomy. Elsewhere, midwives faced increasing restrictions, exclusion from hospitals, or the displacement of longstanding community-based practices.
In the United States, Black midwives played a particularly important role in providing maternity care within communities where segregation and discrimination restricted access to hospitals. Venus reflects on the legacy of traditional Black midwives, including the community matriarchs often known as Grand “granny” midwives, whose knowledge and experience were passed between generations. Their contributions to maternity care, particularly in rural Southern communities where hospitals and physicians were often inaccessible, are documented by the Smithsonian National Museum of African American History and Culture.2
Today’s formal education and professional standards have shaped how midwives practice, but the profession’s history is not a simple progression from traditional knowledge to modern expertise.
The question of whose expertise is recognized remains relevant today. At the International Confederation of Midwives’ June 2026 Congress in Lisbon, Indigenous midwives and their supporters protested the organization’s decision to temporarily suspend its position statement on partnerships between Indigenous and non-Indigenous midwives.3,4 The decision raised concerns about who has the right to be recognized as a midwife, particularly when professional definitions emphasize formal education and licensing. ICM has acknowledged these concerns and committed to reviewing the statement, with a revised version expected in 2027.
For traditional and Indigenous practitioners, the issue goes deeper than professional titles. They touch on the recognition, respect, and preservation of knowledge that communities have carried through generations.
What Does It Mean to Be a Midwife Today?
Ask three midwives what a typical workday looks like, and you may hear three very different answers.
Venus practices as a hospital-based nurse-midwife in North Carolina. Her schedule combines clinical appointments with overnight hospital calls, usually within the same day. She works alongside obstetric teams in a healthcare environment where the midwife’s responsibilities and autonomy are shaped by institutional structures and state regulations.
Kara trained as a certified nurse-midwife in the United States and has worked in both independent birth-center and hospital settings. Her experience also extends to training in the Netherlands, where midwives hold a more established position within maternity care.
For Kara, the contrast has been striking. In the Netherlands, people readily recognize midwifery as an important part of pregnancy and birth care. For uncomplicated pregnancies, midwives are typically the primary care providers, with obstetricians becoming involved when additional medical care is needed. In the United States, she has often had to explain that midwives can attend hospital births, work alongside physicians, and care for people receiving medical interventions.
Claire brings another perspective. She moved from Australia to New Zealand to study midwifery and describes a continuity-of-care model in which she may accompany a family from early pregnancy through the first several weeks after birth.
The International Confederation of Midwives defines midwives as responsible, accountable professionals whose work encompasses pregnancy, labor, birth, postpartum care, newborn care, health education, recognition of complications, and appropriate medical referral or emergency care.3
Their practice settings, credentials, and legal responsibilities vary, but clinical judgment, education, and individualized care remain central to the profession.
For parents, these differences matter. Choosing midwifery care does not necessarily mean choosing a particular birth location, declining pain medication, or avoiding medical intervention. It means working with a professional whose education and scope of practice are centered on caring for families throughout the childbearing experience.
Beyond Birth: Caring for the Whole Person
For all three midwives, the responsibilities of midwifery reach far beyond helping a baby arrive safely.
Venus challenges the idea that a healthy parent and healthy baby are the only measures of a successful birth experience.
She believes families deserve to feel heard, respected, and cared for throughout the experience. And that care cannot end once the baby is born.
During our conversation, she asked a question that captures this beautifully:
“Who’s holding the mom?”
Attention often shifts quickly to the newborn, while the person who has just given birth is still recovering, adjusting, and beginning a new chapter of life.
Midwifery care, as Venus describes it, holds space for both.
That connection with families is part of what drew Kara to midwifery. She wanted a career that combined scientific knowledge with personal connection, allowing her to walk alongside people during one of the most vulnerable experiences of their lives.
Claire sees those relationships grow through ongoing care and the time she spends with families.
In New Zealand, her work considers not only the physical changes of pregnancy but also the relationships, circumstances, and family dynamics surrounding a birth. She recalls caring for her own daughter and daughter-in-law, with little ones and extended family participating in prenatal visits and learning about the baby together.
Those visits show how pregnancy and birth are woven into the life of a family.
Supporting a positive birth experience means recognizing those lives, listening to individual preferences, and treating each family with dignity.
Excellent maternity care considers both physical wellbeing and the experience of the person receiving care.
The Challenges Behind the Calling
For Venus, a workday can begin with clinic appointments and continue through overnight hospital call. She’s found a schedule that gives her time to recover, but that kind of flexibility isn’t available to every midwife.
Long shifts, emotional demands, financial pressures, and limited access to continuing education can make an already demanding profession harder to sustain.
For Venus, professional recognition is particularly significant.
She describes working within systems where the knowledge and responsibilities of nurse-midwives are not always fully understood by other healthcare professionals. Earlier in her career, physician-supervision requirements affected her ability to practice independently. In 2023, North Carolina expanded independent-practice eligibility for experienced certified nurse-midwives, allowing those who meet specific experience requirements to practice without a collaborative provider agreement.4 The change reflects one way the profession’s regulatory landscape continues to evolve.
As a Black midwife, Venus has encountered additional barriers. She recalls a nursing-school professor telling her that she would need to be “twice as good” to be considered “half as good” as her white classmates. The professor, herself a Black woman with a PhD, was explaining why she held Venus to a higher standard.
That experience stayed with Venus and reflects the additional pressure Black professionals can face to have their knowledge and competence recognized.
Her perspective brings an essential dimension to conversations about midwifery’s future: professional respect and equitable maternity care are closely connected.
Kara also sees misunderstanding of the profession as a barrier. When people are unfamiliar with what midwives do or how they fit into healthcare, aspiring professionals may struggle to envision a clear career path.
She points to the importance of community among birth workers, too. Having colleagues who understand the emotional weight of attending births has helped her process difficult experiences and remain connected to the work.
Claire describes similar pressures across the international birth community. With deep reverence and respect, she sees midwives, doulas, nurses, and physicians working within demanding environments that may make it difficult to provide the attentive and individualized care they would love to offer.
These challenges require more than personal resilience. Midwives need access to education, supportive colleagues, appropriate professional autonomy, and healthcare systems that recognize their contributions.
And despite these barriers, midwives are advocating, educating, collaborating, and helping change the environments in which they work.
Protecting Physiology Through Knowledge and Collaboration
Throughout the conversations, one idea emerged repeatedly: supporting physiological birth requires knowledge, observation, and sound clinical judgment.
Midwives must recognize when birth is progressing and when there is a clear Invitation to Act, when a change in position or another approach may be useful, and when medical assistance is needed.
As Claire asks:
“When do I need to step in and when do I need to step away?”
That question captures the skill involved in supporting birth without introducing unnecessary intervention while remaining ready to respond when circumstances require it.
It’s also where the Spinning Babies® approach connects naturally with the work these midwives already do.
Spinning Babies® emphasizes a physiology-first understanding of birth, exploring how body balance, fetal positioning, and movement may influence comfort and the way baby navigates the pelvis.
For Claire, one of the approach’s greatest contributions is the anatomical language it brings to conversations about birth.
Midwives may recognize through experience that certain positions or movements deserve consideration. Understanding the anatomy and biomechanics involved helps them explain their observations and clinical reasoning to colleagues, including nurses and physicians.
Kara describes how Spinning Babies® changed the questions she asks when labor is not progressing as expected.
Rather than immediately considering additional medical intervention, she may first ask, “Where is baby?” That question encourages her to consider fetal position, movement, and what she is observing before deciding which options may be appropriate.
She is equally clear that physiology-first care is not an all-or-nothing philosophy.
Movement, positioning, and other comfort measures can remain part of care when induction, epidural analgesia, monitoring, or other medical interventions are involved, provided they are appropriate for the individual and clinical circumstances.
Venus brings the same commitment to professional education. When teaching Spinning Babies® workshops, she encourages nurses to reconsider familiar positioning practices through a greater understanding of anatomy and body mechanics.
She approaches this as shared learning, including herself in the conversation. Her message is that education allows everyone to revisit established habits and make more informed decisions together.
Midwives, doulas, nurses, and physicians do not have identical scopes of practice. Nor does every technique belong in every clinical situation. But a common understanding of anatomy, body balance, and fetal positioning can strengthen communication and encourage more thoughtful, individualized care.
Spinning Babies® builds on the expertise midwives already bring to birth, offering additional knowledge and practical approaches they can consider within their professional responsibilities.
The Future of Midwifery Is Already Taking Shape
Venus, Kara, and Claire have different hopes for the future of midwifery, shaped by the communities and healthcare systems she’s worked within.
The World Health Organization’s guidance on transitioning to midwifery models of care recognizes the importance of person-centered, evidence-informed care coordinated by midwives, alongside appropriate professional education, regulation, and integration within health systems.5
For Venus, progress begins with education and mutual respect. She wants nurses, physicians, and other healthcare professionals to better understand midwives’ capabilities and the contribution they make to maternity care. Greater recognition must also include addressing bias and improving representation.
Kara hopes to see more families able to access midwifery care and more people able to enter the profession without unnecessary barriers. She also wants midwives to have the time and professional community needed to provide thoughtful, individualized care.
For Claire, the future must preserve something that can be lost within demanding clinical environments: the ability to be fully present with another person.
She reminds birth professionals that even when they cannot change the wider healthcare system, their communication, touch, attentiveness, and respect for consent still matter deeply to the person in front of them.
Their hopes reflect the same commitment that has carried midwifery through generations: skilled care that recognizes the needs of the whole person.
Today’s midwives are clinicians, educators, advocates, collaborators, and leaders. They continue to influence how maternity care is delivered while remaining connected to the families and communities they serve.
Continuing to Learn Across Settings
Whether you practice in a hospital, birth center, community setting, or attend births at home, continuing education offers opportunities to build on the knowledge and experience you already bring to birth.
Our Spinning Babies® Foundational Workshops bring together midwives and other birth professionals working across a variety of disciplines and settings. Participants explore body balance, fetal positioning, and movement through a physiology-first approach, with practical applications appropriate to their individual scopes of practice.
The physiology of birth provides common ground, even when the environments in which we practice look very different.
Explore Spinning Babies® Workshops and Trainings.
References
- International Confederation of Midwives. The origins of midwifery. 2022 Jan 31.
- Smithsonian National Museum of African American History and Culture. The historical significance of doulas and midwives. Smithsonian Institution.
- International Confederation of Midwives. International definition and scope of practice of the midwife. Revised 2024.
- North Carolina General Assembly. North Carolina General Statutes § 90-178.5: Qualifications for approval; independent practice. Amended 2023.
- World Health Organization. Implementation guidance on transitioning to midwifery models of care. Geneva: World Health Organization; 2025.
