RESEARCH PAPER
Failure or progress?: The current state of the professionalisation of midwifery in Europe
Joeri Vermeulen 1  
,  
Ans Luyben 2, 3, 4
,  
Patricia Gillen 6, 7
,  
Ramon Escuriet 8, 9
,  
 
 
More details
Hide details
1
Department of Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
2
Centre for Midwifery, Maternal and Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, United Kingdom
3
Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
4
Cantonal Hospital Graubünden, Chur, Switzerland
5
School of Nursing and Midwifery, University College Cork, Cork, Ireland
6
Southern Health and Social Care Trust, Northern Ireland, United Kingdom
7
Institute of Nursing and Health Research, Ulster University, Northern Ireland, United Kingdom
8
Catalan Health Service, Barcelona, Spain
9
National Commission of Midwives, Ministry of Health, Barcelona, Spain
10
School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, United Kingdom
CORRESPONDING AUTHOR
Joeri Vermeulen   

Department of Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
Publication date: 2019-12-17
Submission date: 2019-11-22
Final revision date: 2019-12-01
Acceptance date: 2019-12-04
 
Eur J Midwifery 2019;3(December):22
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Throughout Europe midwives called for increasing professionalisation of midwifery during the 1980s and 1990s. While the Bologna Declaration, in 1999, supported this development in education and research, it remains unclear how other fields, such as practice, have fared so far. This study therefore aimed to explore the current state of professionalisation of midwifery in Europe.

Methods:
An exploratory inquiry was conducted with an on-line semistructured questionnaire. Its content was based on the Greenwood sociological criteria for a profession. Descriptive statistics and thematic content analysis were used to analyse the data. Participants were national delegates from member countries to the European Midwives Association.

Results:
Delegates from 29 European countries took part. In most countries, progress towards professionalisation of midwifery has been made through the move of education into higher education, coupled with opportunities for postgraduate education and research. Lack of progress was noted, in particular in regard to midwifery practice, regulation, and leadership in health care provision and education. Most countries had a code of ethics for midwives as well as a midwifery association. Based on organisational collaborations with other disciplines, the sustainability of a distinct professional culture was unclear. An increased focus on future development of midwifery practice was proposed.

Conclusions:
Progress in midwifery education and research has taken place. However, midwives’ current roles in practice as well as leadership and their influence on healthcare culture and politics are matters of concern. Future efforts for advancing professionalisation in Europe should focus on the challenges in these areas.

ACKNOWLEDGEMENTS
The authors thank the European Midwives Association (EMA) for supporting and facilitating the study. In particular, we thank the delegates from all associations in the 29 European countries for participating in this study and providing us with all available information.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (39)
1.
Kethler U. Professionalisierung - ein relevanter Weg für Hebammen!. In: Deutsche Hebammenzeitschrift. 1998a(7):336-340.
 
2.
Zoege M. Die Professionalisierung des Hebammenberufs: Anforderungen an die Ausbildung. Bern, Switzerland: Verlag Hans Huber; 2004.
 
3.
Keogh J. Professionalization of nursing: development, difficulties and solutions. J Adv Nurs. 1997;25(2):302-308. doi:10.1046/j.1365-2648.1997.1997025302.x
 
4.
Gerrish K, McManus M, Ashworth P. Creating what sort of professional? Master's level nurse education as a professionalising strategy. Nurs Inq. 2003;10(2):103-112. doi:10.1046/j.1440-1800.2003.00168.x
 
5.
Larkin G. Health professions and the state in Europe. London, United Kingdom: Psychology Press; 1995.
 
6.
Manzano-García G, Ayala-Calvo JC. An overview of nursing in Europe: a SWOT analysis. Nurs Inq. 2014;21(4):358-367. doi:10.1111/nin.12069
 
7.
Hamilton PM. Realities of contemporary nursing. New York, NY: Addision-Wesley Nursing; 1996.
 
8.
Kethler U. Professionalisierung- ein relevanter Weg für Hebammen!. In: Deutsche Hebammenzeitschrift. 1998b(6):278-280.
 
9.
Mander R, Fleming V. Failure to progress: the contraction of the midwifery profession. London, United Kingdom: Routledge; 2002.
 
10.
World Health Organization. European strategic directions for strengthening nursing and midwifery towards Health 2020 goals. Copenhagen, Denmark: WHO Regional Office for Europe; 2015. http://www.euro.who.int/__data.... Accessed November 22, 2019.
 
11.
Directive 2013/55/EU of the European Parliament and of the Council: of 20th November 2013, amending Directive 2005/36/EC on the recognition of professional qualifications and Regulation (EU) No 1024/2012 on administrative cooperation through the Internal Market Information System. Official Journal of the European Union. 2013. https://eur-lex.europa.eu/LexU.... Accessed November 22, 2019.
 
12.
European Ministers in charge of Higher Education. The Bologna Declaration of 19 June 1999: Joint declaration of the European Ministers of Education. https://www.eurashe.eu/library.... Accessed November 22, 2019.
 
13.
Van der Wende MC. The Bologna Declaration: Enhancing the transparency and competitiveness of European higher education. Journal of Studies in International Education. 2000;4(2):3-10. doi:10.1177/102831530000400202
 
14.
Plappert C, Graf J, Simoes E, Schönhardt S, Abele H. The Academization of Midwifery in the Context of the Amendment of the German Midwifery Law: Current Developments and Challenges. Geburtshilfe und Frauenheilkunde. 2019;79(08):854-862. doi:10.1055/a-0958-9519
 
15.
Vermeulen J, Luyben A, Jokinen M, Matintupa E, O'Connell R, Bick D. Establishing a Europe-wide foundation for high quality midwifery education: The role of the European Midwives Association (EMA). Midwifery. 2018;64:128-131. doi:10.1016/j.midw.2018.06.009
 
16.
Fleming V, Pehlke-Milde J, Davies S, Zaksek T. Developing and validating scenarios to compare midwives’ knowledge and skills with the International Confederation of Midwives’ essential competencies in four European countries. Midwifery. 2011;27(6):854-860. doi:10.1016/j.midw.2010.09.003
 
17.
Praxmarer-Fernande S, Maier CB, Oikarainen A, Buchan J, Perfilieva G, Organization WH. Levels of education offered in nursing and midwifery education in the WHO European region: multicountry baseline assessment. Public Health Panorama. 2017;3(03):419-430.
 
18.
Fleming V, Luyben A. Establishing a Master׳s for Europe-A transnational model for higher education. Midwifery. 2016;33:52-54. doi:10.1016/j.midw.2015.11.015
 
19.
EU Executive Agency for Health and Consumers. Study Concerning the Review and Mapping of Continuous Professional Development and Life- long Learning for Health Professionals in the EU: Final Report. 2015. https://ec.europa.eu/health/si.... Accessed November 22, 2019.
 
20.
World Health Organization. Having a baby in Europe: Public Health Europe 26. Copenhagen, Denmark: WHO Regional Office for Europe; 1985.
 
21.
Kahl CM. Stand der Entwicklung der Hebammenwissenschaft-Beschreibung der Ist-Situation anhand der Diskursuntersuchung der Forschungslage. Kirchlicher Documenten Server; 2013.
 
22.
Robinson S, Thomson A. Midwives, research and childbirth. London, United Kingdom: Springer; 1993.
 
23.
Luyben A, Wijnen H, Oblasser C, Perrenoud P, Gross M. The current state of midwifery and development of midwifery research in four European countries. Midwifery. 2013;29(5):417-424. doi:10.1016/j.midw.2012.10.008
 
24.
Goyet S, Sauvegrain P, Schantz C, Morin C. State of midwifery research in France. Midwifery. 2018;64:101-109. doi:10.1016/j.midw.2018.06.021
 
25.
Clesse C, Lighezzolo-Alnot J, de Lavergne S, Hamlin S, Scheffler M. The evolution of birth medicalisation: A systematic review. Midwifery. 2018;66:161-167. doi:10.1016/j.midw.2018.08.003
 
26.
Feeley C. The medicalisation of women’s bodies. The practising Midwife. 2019;22(5):1-8.
 
27.
Van Teijlingen E. A critical analysis of the medical model as used in the study of pregnancy and childbirth. Sociological Research Online. 2005;10(2):63-77. doi:10.5153/sro.1034
 
28.
Brailey S, Luyben A, Van Teijlingen E, Frith L. Women, Midwives, and a Medical Model of Maternity Care in Switzerland. International Journal of Childbirth. 2017;7(3):117-125. doi:10.1891/2156-5287.7.3.117
 
29.
Prosen M, Krajnc MT. Perspectives and experiences of healthcare professionals regarding the medicalisation of pregnancy and childbirth. Women Birth. 2019;32(2):e173-e181. doi:10.1016/j.wombi.2018.06.018
 
30.
Kirkham M. Midwives should... In: Birth Practice and Politics Forum, 2019. https://www.birthpracticeandpo.... Accessed November 22, 2019.
 
31.
Edwards N, Mander R, Murphy-Lawless J. Untangling the Maternity Crisis. London, United Kingdom: Routledge; 2018.
 
32.
Creswel JW. Research design: Qualitative, quantitative, and mixed methods approaches. 3rd rd. Thousand Oaks, CA: Sage Publications; 2009.
 
33.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
 
34.
Luyben A, Barger MK, Avery MD, Bick D. What is next? Midwifery education building partnerships for tomorrow's maternal and neonatal health care. Midwifery. 2018;64:132-135. doi:10.1016/j.midw.2018.06.014
 
35.
Beier L. Was brauchen Hebammen in Österreich und der Schweiz, damit sie im Beruf bleiben? Masterthesis MSc Advanced Midwifery Practice. Innsbruck: fhg- Zentrum für Gesundheitsberufe GmbH; 2016.
 
36.
Hunter B, Fenwick J, Sidebotham M, Henley J. Midwives in the United Kingdom: Levels of burnout, depression, anxiety and stress and associated predictors. Midwifery. 2019;79:102526. doi:10.1016/j.midw.2019.08.008
 
37.
O’Riordan S, O'Donoghue K, McNamara K. Interventions to improve wellbeing among obstetricians and midwives at Cork University Maternity Hospital. Irish Journal of Medical Science (1971-). 2019:1-9. doi:10.1007/s11845-019-02098-1
 
38.
Renfrew MJ, Homer C, Downe S, et al. Midwifery: an executive summary for The Lancet’s series. Lancet. 2014;384(1):8.
 
39.
Buscher A, Sivertsen B, White J. Nurses and Midwives: A Force for health: Survey on the situation of nursing and midwifery in the Member States of the European Region of the World Health Organization 2009. Copenhagen, Denmark: World Health Organization; 2010. http://www.euro.who.int/__data.... Accessed November 22, 2019.
 
eISSN:2585-2906