WHO releases new guidance to expand midwifery care worldwide

The World Health Organization (WHO) today released new guidance to help countries adopt and expand midwifery models of care - where midwives serve as the main care provider for women and babies throughout pregnancy, childbirth, and the postnatal period.

The guidance promotes strong communication and partnership between women and midwives, and offers proven health benefits for both women and their babies. Women who received care from trusted midwives are statistically more likely to experience healthy vaginal births and report higher satisfaction with the services they receive.

"Expanding and investing in midwifery models of care is one of the most effective strategies to improve maternal and newborn health globally," said Dr Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO. "These approaches improve outcomes, maximize resources, and can be adapted to all countries. Crucially, they also enhance women's and families' experiences of care– building trusted partnerships for health at this critical life stage."

A proven, cost-effective solution

Despite progress, maternal and newborn deaths remain unacceptably high-particularly in low-income and fragile settings. Recent modelling suggests that universal access to skilled midwives could prevent over 60% of these deaths, amounting to 4.3 million lives saved annually by 2035.

Midwifery care models emphasize informed choice as well as communication and non-invasive techniques-such as mobility during labour, breathing guidance, varied birthing positions and emotional support- that seek to empower women, and reduce the likelihood of invasive procedures.

Midwifery models of care are also an important response to the growing concern of over-medicalization in childbirth. While medical interventions such as caesarean sections, inductions, and use of forceps are essential and life-saving when clinically indicated, their routine or excessive use creates short and long-term health risks. In some countries, caesarean rates now exceed 50%, suggesting high rates of medically unnecessary procedures.

Skilled midwives help women trust in their bodies, their abilities, and their care. This is why investing in midwifery models of care is so important – it not only improves health but builds a cadre of experts equipped to provide individualized, respectful care, ensuring women are consistently part of decision making and have access to the information they need as well as vital emotional support."

Ulrika Rehnstrom Loi, Midwifery expert at WHO and technical lead for the guidance

Practical tools for implementation

The new guidance provides practical tools and real-life examples to help countries structure a transition toward midwifery models of care. As part of this process, it calls for strong political commitment, strategic planning and long-term financing for implementation -- with dedicated budget lines. It also stresses the importance of high-quality midwifery regulation and education in line with international standards, supporting autonomous, evidence-based practice.

Successful implementation requires strong collaboration, the guidance notes. Midwives should be empowered to work independently while also integrated into broader healthcare teams alongside doctors and nurses. In the event of complications, midwives should be able to work in partnership with these other professionals to ensure quality multidisciplinary care for every woman and baby.

A global imperative

Globally, millions of women still give birth without a skilled health worker by their side, and one-third do not receive even four of WHO's recommended eight pregnancy checks. Progress in reducing maternal and newborn mortality has largely stagnated since 2016.

"Midwifery models of care are not just smart solutions - they are a necessity," said Anna Ugglas, Chief Executive of the International Confederation of Midwives, which supported the development of the guidance. "In a world where childbirth is increasingly medicalized, they offer a person-centred, evidence-based approach that respects the physiological process of birth, restores dignity and autonomy to maternity care, and helps ensure safety for women and newborns everywhere."

The guidance outlines several adaptable models of midwifery care, including:

• Continuity of care, where women are supported by a known midwife, or small team of midwives, throughout pregnancy, birth, and the postnatal period.

• Midwife-led birth centres, dedicated facilities where midwives provide intrapartum care for women at low risk of complications. They sometimes offer other services such as antenatal and postnatal care or family planning.

• Community-based approaches where midwives deliver services directly in communities-for example, via mobile units or local health centres.

• Private practice, where private midwives operate independently or through organizations. To be effective, these services must be regulated and integrated into national health systems.