Pew Recommendations for




1.        Midwives should be recognized as independent and collaborative practitioners with the rights and responsibilities regarding scope of practice authority and accountability that all independent professionals share.


2.        Every health care system should integrate midwifery services into the continuum of care for women by contracting with or employing midwives and informing women of their options.


3.        When integrating midwifery services, health care organizations should use productivity standards based on the midwifery model of care and measure the overall financial benefits of such care.


4.        Midwives and physicians should ensure that their systems of consultation, collaboration and referral provide integrated and uninterrupted care to women.  This requires active engagement and participation by members of both professions.


5.        State legislatures should enact laws that base entry-to-practice standards on successful completion of accredited education programs, or the equivalent, and national certification; do not require midwives to be directed or supervised by other health care professionals; and allow midwives to own or co-own health care practices.


6.        Hospitals, health systems, and public programs, including Medicare and Medicaid, should ensure that enrollees have access to midwives and the midwifery model of care by eliminating barriers to access and inequitable reimbursement rates that discriminate against midwives.


7.        Health care systems should develop hospital privileging and credentialing mechanisms for midwives that are consistent with the profession’s standards, recognize midwifery as distinct from other health care professions, and recognize established processes that permit midwives to build upon their entry-level competencies within their statutory scope of practice.


8.        Education programs should provide opportunities for interprofessional education and training experiences and allow for multiple points at which midwifery education can be entered.  This requires proactive intra- and interprofessional cooperation between colleges, universities and education programs to develop affiliations and complementary curriculum pathways.


9.        Midwifery education programs should include training in practice management and the impact of health care policy and financing on midwifery practice, with special attention to managed care.


10.     The profession should recognize and acknowledge the benefits of teaching the midwifery model of care in a variety of education programs and affirm the value of competency-based education in all midwifery programs.


11.     The midwifery profession should identify, develop and implement mechanisms to recruit student populations that more closely reflect the U.S. population and include cultural competence concepts in basic and continuing education programs.


12.     Midwifery research should be strengthened and funded in the following areas:

§          Demand for maternity care, demand for midwifery care, and numbers and distribution of midwives;

§          Analyses of how midwives complement and broaden the woman’s choice of provider, setting, and model of care;

§          Cost benefit, cost-effectiveness, and cost utility analyses, including the relationship between knowledge of economic/cost analyses and provider practices;

§          Midwifery practice and benchmarking data (among midwives) with a goal of developing appropriate productivity standards;

§          Descriptions and outcome analyses of midwifery methods and processes;

§          Analysis of midwifery practice outcomes, from pre-conception through infancy, using an evidence-based perspective;

§          Normal pregnancy, normal labor and birth, healthy parent-infant relationships, and breastfeeding; and

§          Satisfaction with maternity and midwifery care.


13.     Federal and state agencies should broaden systematic data collection, which has traditionally focused on medicine and physicians, to include midwifery and midwives.


14.     A research and policy body, such as the Institute of Medicine, should be requested to study and offer guidance on significant aspects of the midwifery profession including:

§          Workforce supply and demand;

§          Coordination of regulation by the states;

§          Funding of research, education and training; and

§          Coordination among the federal agencies whose policies affect the practice of midwifery.


Taken from:  Joint Report of the Pew Health Professions Commissions and the USCF Center for the Health Professions, Charting a Course for the 21st Century:  The Future of Midwifery, 1999.