What Is Midwifery and Maternal Health Research? Areas, Funding, and Careers

Midwifery is the profession, and the body of research, concerned with care during pregnancy, childbirth and the postpartum period, together with the wider sexual, reproductive and gynecologic health of the people midwives serve. It is a health profession with its own education, regulation and professional societies, and it is also a research field that studies how care before, during and after birth affects the health of birthing people and their infants. This page is a general orientation for researchers, students and research administrators. It is not medical advice and does not describe how any individual should be cared for.

What Is Midwifery?

The American College of Nurse-Midwives (ACNM) describes midwifery as the independent provision of care during pregnancy, childbirth and the postpartum period, sexual and reproductive health, gynecologic health and family planning services. ACNM says its midwives serve people from adolescence throughout the lifespan, in settings that include clinics, homes, hospitals, birth centers and telehealth. That description is a useful correction to a common assumption: midwifery is not limited to the delivery itself, and in many systems a large share of a midwife’s work happens in prenatal, postpartum and well-person visits.

Internationally, the International Confederation of Midwives (ICM) maintains a published definition of a midwife and the scope of practice, along with standards for midwifery education and regulation. Because the exact wording of that definition and the requirements differ by country, anyone citing it in a protocol or a grant application should quote the current text from the ICM directly.

Who counts as a midwife?

The answer depends on the country, and this is one of the first things a researcher has to pin down, because it determines who is in a study population and which workforce data apply.

• United States. ACNM represents two credentials: certified nurse-midwives (CNMs) and certified midwives (CMs). Both are advanced-practice midwives in ACNM’s description. The United States also has other routes to practice, including certified professional midwives, whose pathway and legal status vary by state. Authority to practice, prescribe and attend births at home, in birth centers or in hospitals is set largely by state law and by facility privileges.
• United Kingdom and many Commonwealth countries. Midwifery is generally a distinct, regulated profession in its own right, and a midwife is commonly the lead professional for low-risk pregnancy and birth. Titles, registers and routes into the profession are set nationally.
• Elsewhere. The ICM describes a global profession represented by midwives’ associations in many countries, and its membership figures give a sense of the scale: on its own site the ICM reports more than 131 midwives’ associations in 116 countries, representing over one million midwives.

When a study compares “midwife-led” and “physician-led” care, the term has to be defined operationally, because the same label can describe quite different training, scope and referral arrangements in different health systems.

Midwifery vs. Obstetrics

Obstetrics is the medical specialty concerned with pregnancy, childbirth and the postpartum period, practiced by physicians who complete medical school and residency. Midwifery is a separate profession with a separate educational and regulatory path. The two overlap in the care they provide and frequently work in the same hospitals, but they are not points on a single ladder. The usual way to describe the relationship is collaboration and referral: midwives and obstetricians share care, with consultation and transfer when a pregnancy or birth moves outside a practitioner’s scope.

The research traditions also differ in emphasis. Obstetric research, including maternal-fetal medicine, often concentrates on complications, high-risk pregnancy and clinical interventions; see CASRAI’s guide to obstetrics and gynecology. Midwifery research often concentrates on models of care, continuity of the caregiver relationship, normal physiologic birth, person-centered experience, and the organization of services. In practice the fields share data, trials and journals, and many studies are conducted by mixed teams. Midwifery also sits close to nursing science, since in the United States many midwives are first educated as nurses, and to pediatrics on the neonatal side.

What Maternal and Perinatal Health Research Studies

“Maternal health” research concerns the health of people during pregnancy, childbirth and the postpartum period. “Perinatal” research concerns the period surrounding birth and the health of both the pregnant person and the baby. The terms are used loosely and are defined differently across agencies and countries, so a study should state its own time window, for example how many weeks of pregnancy and how many days or months postpartum it covers.

The National Institute of Child Health and Human Development (NICHD) lists a wide set of topics under its pregnancy and maternal health work, including pregnancy and prenatal care, maternal morbidity and mortality, preeclampsia and eclampsia, preterm labor and birth, high-risk pregnancy, labor and delivery, pregnancy loss, and breastfeeding. That list is a reasonable map of the field.

Why the field exists: the global burden

The World Health Organization reports that about 287,000 women died during and following pregnancy and childbirth in 2020, and describes that number as unacceptably high. WHO identifies the most common direct causes as excessive blood loss, infection, high blood pressure, unsafe abortion and obstructed labour, with indirect causes including anemia, malaria and heart disease. WHO also reports that the proportion of births attended by skilled health personnel rose from 58% in 1990 to 81% in 2019, and states that most maternal deaths are preventable with timely management by a skilled health professional in a supportive environment. These figures drive much of the funding and the policy attention that midwifery and maternal health research receives, and they are the kind of statement that should be re-checked against the latest WHO release before it is quoted.

Major subfields

• Models of maternity care. Comparisons of midwife-led, physician-led and shared care, continuity of carer, group prenatal care, and birth-setting research (hospital, birth center, home). Outcomes include clinical results, satisfaction and costs.
• Normal birth and labor support. Research on labor, mobility, pain relief options, and the effects of intervention rates.
• Perinatal and neonatal outcomes. Preterm birth, birth weight, infant feeding and early newborn transition.
• Maternal morbidity and mortality. Surveillance, review of deaths and near-misses, and the study of hemorrhage and hypertensive disorders.
• Health equity and social determinants. Differences in outcomes by race, income, geography and access to care, and community-based or doula-supported models. This work draws on public health and epidemiology.
• Postpartum and reproductive health. Postpartum recovery, mental health, contraception and family planning, and gynecologic care provided by midwives.
• Workforce and education. Midwifery supply, distribution, scope-of-practice regulation and training models.
• Global midwifery. Health-system strengthening, task-sharing and the quality of care in low-resource settings.

Research Methods Used

Midwifery and maternal health research uses nearly every design in the clinical and social sciences, and the choice follows the question.

• Randomized trials of care strategies, timing of interventions and educational programs. Pragmatic and cluster designs are common when the intervention is a model of care rather than a drug; see clinical study design and designing a clinical trial protocol.
• Cohort and registry studies using birth records, hospital discharge data and national registries to follow outcomes across large populations.
• Systematic reviews and meta-analyses. Cochrane has long published systematic reviews on pregnancy and childbirth topics. Cochrane’s organization of its review groups has changed over time, so consult cochrane.org for the current arrangements rather than assuming a particular group still exists.
• Qualitative and mixed-methods research. Interviews, focus groups and ethnography are central to studying experience of care, respectful maternity care and decision making; see qualitative research and qualitative data.
• Quality-improvement and implementation research that tests how evidence reaches routine practice, including indicator development comparable to nurse-sensitive indicators.
• Biobehavioral and biomarker studies of conditions such as preeclampsia and preterm labor.

Two methodological cautions recur. First, selection: people who choose midwife-led or home-birth care differ from those who do not, so unadjusted comparisons mislead and careful design or adjustment is needed. Second, rare outcomes: events such as maternal death or severe morbidity are uncommon in any single study, so large registries or pooled data are usually required.

Research With Pregnant Participants

Pregnancy raises specific ethical and regulatory questions, because research may affect both the pregnant person and the fetus. In the United States, federally supported human-subjects research falls under the Common Rule (45 CFR 46), and Subpart B adds protections for pregnant women, human fetuses and neonates. CASRAI’s dictionary entry on 45 CFR 46 Subpart B explains the framework, and the guide on what each Common Rule subpart covers places it alongside the others. Pregnancy is among the groups discussed under vulnerable populations in research; see also vulnerable populations under the Common Rule and undue influence and vulnerable populations.

For a study team, the practical consequences are typically these, though the governing text and the local IRB decide:

• The IRB must consider the risk to the fetus as well as to the participant, and the protocol must explain the risk-benefit reasoning clearly.
• Consent procedures need to cover the participant’s own decision and, for some designs, the role of the father or partner as the regulations describe; see informed consent in research.
• Inclusion and exclusion criteria should justify any exclusion of pregnant people rather than defaulting to it; see inclusion and exclusion criteria. Blanket exclusion leaves clinicians without evidence for the people they treat.
• Studies of fetal tissue are governed by separate policy; see human fetal tissue research.
• Postpartum and lactation periods are often forgotten in protocol design and deserve explicit treatment.

The foundational ethics are set out in the Belmont Report principles. Requirements differ outside the United States, and midwife researchers working internationally also deal with national ethics committees and local authorization processes.

Funders and Journals

Funders

NICHD, established in 1962, is the NIH institute most closely associated with pregnancy and maternal health. Its mission, as it states it, is to lead research and training to understand human development, improve reproductive health and enhance the lives of children and adolescents. NICHD funds investigator-initiated grants and trials. Other NIH institutes also support related work, and nursing-focused research is typically a different institute’s remit than obstetric research; see NIH paylines across institutes for the funding landscape and HRSA, a federal agency that supports maternal and child health services and workforce programs. Outside the United States, national health research councils, ministries of health, WHO-linked programs and private foundations all fund maternal and midwifery research; the mix depends on the country, and applicants should confirm current calls directly.

Journals

Midwifery research appears in dedicated midwifery journals, in obstetric and perinatal journals, in nursing and public health journals, and in general medical journals when a trial is large. Rather than relying on a single list, researchers usually search by topic and check each journal’s scope and indexing. Authors in this field should follow standard reporting guidance for their design and the usual authorship and disclosure norms.

Societies and Organizations

• American College of Nurse-Midwives (ACNM). The professional association for certified nurse-midwives and certified midwives in the United States.
• International Confederation of Midwives (ICM). A global federation of midwives’ associations. The ICM states that it was established in 1922 as the International Midwives’ Union in Belgium and became the International Confederation of Midwives in 1954. It provides technical consultation, capacity building and advocacy, and sets international standards for midwifery education, regulation and practice.
• World Health Organization. Publishes maternal health guidance, global estimates and monitoring data.
• NICHD. The research funder described above.
• Cochrane. A source of systematic reviews that inform guidelines, as noted above.

Training and Credentials in General Terms

Routes into midwifery differ widely. In the United States, ACNM-affiliated midwives are certified nurse-midwives or certified midwives, and entry generally involves graduate-level midwifery education followed by national certification; details and current requirements are set by the relevant education-accreditation and certification bodies. In the UK and many other countries, midwifery is commonly entered through a dedicated degree that leads to registration with a national regulator. Midwifery researchers usually add a research doctorate, such as a PhD, or a practice doctorate, and may combine clinical work with an academic appointment. Whether someone is trained as a nurse first, a direct-entry midwife or a physician is a defining distinction in the field, so a protocol or workforce analysis should state it.

The Research-Administration Link

Midwifery and maternal health studies raise administrative tasks that sit squarely in research administration. IRB review of research with pregnant participants, as described above, is the most visible. Others include data use agreements for birth and registry records, privacy compliance when linking health records (see what an IRB is for the review basics), clinical sites that span hospitals, birth centers and community settings, and subawards to community partners. Studies that recruit through community-based groups should plan for compensation and community advisory input. Large national cohorts such as the All of Us Research Program show how population-scale data programs intersect with this work. For a broader view of where this fits among academic fields, see branches of science.

Frequently Asked Questions

What is the difference between a midwife and an obstetrician?

An obstetrician is a physician specializing in pregnancy and birth. A midwife is a member of a separate profession with its own education and regulation. They often work together and refer patients to one another when a situation falls outside one practitioner’s scope.

What do CNMs and CMs mean?

ACNM uses these titles for certified nurse-midwives and certified midwives, the two credentials it represents in the United States.

Is maternal health the same as perinatal health?

No. Maternal health concerns the pregnant or postpartum person. Perinatal health concerns the period around birth and typically both the parent and the baby. Studies should define their own time windows.

Who funds maternal health research in the United States?

NICHD is the NIH institute most closely associated with pregnancy and maternal health research, and other NIH institutes and federal agencies such as HRSA support related work. Private foundations also contribute.

Can pregnant people be enrolled in research?

Yes, subject to the applicable regulations and IRB review. In federally supported US research, 45 CFR 46 Subpart B sets additional requirements. The specific conditions depend on the study design and the local IRB.

Where can I find systematic evidence on childbirth care?

Cochrane reviews are one source, and national guideline bodies and WHO publish guidance as well. This page does not give clinical recommendations and should not be used to make care decisions.

Does this page give medical advice?

No. It describes a research field. Anyone seeking care during pregnancy should talk with a licensed clinician.