to an accredited master's degree in midwifery (diplôme d'etat de sage-femme). midwives in france must be registered with the ordre des sages-femmes to practice midwifery and use the title sage-femme. professional associations/colleges: l'ordre des sages-femmes, conseil national. collège national des sages-femmes de france (cnsf). société française de maïeutique (sfma). ireland education, training and regulation the undergraduate midwifery programs are four-year full-time university programs, with an internship in the final year, leading to an honours bachelor's degree in midwifery (bsc (hons) midwifery). the postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (msc midwifery, msc midwifery practice). there are also postgraduate midwifery programs (for registered general nurses who wish to become midwives) leading to a qualification in midwifery (higher diploma in midwifery). midwives must be registered with the nursing and midwifery board of ireland (nmbi) to practice midwifery, and use the title midwife or registered midwife. japan education, training and regulation midwifery was first regulated in 1868. today midwives in japan are regulated under the act on public health nurse, midwife and nurse (no. 203) established in 1948. japanese midwives must pass a national certification exam. on 1 march 2003 the japanese name of midwife officially converted to a gender neutral name. still, only women can take the national midwife exam. professional associations/colleges japanese midwives association (jma). japan academy of midwifery (jam). japanese nursing association (jna), midwives' division. tanzanian midwife weighing an infant and giving advice to the mother mozambique when a 16-year civil war ended in 1992, mozambique's health care system was devastated and one in ten women were dying in childbirth. there were only 18 obstetricians for a population of 19 million. in 2004, mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth. the newly introduced midwives system now perform major surgeries including cesareans and hysterectomies. as the figures now stand, mozambique is one of the few countries on track to achieve the mdg of reducing the maternal death rate by 75% by 2015. netherlands education, training and regulation the undergraduate midwifery programs are four-year full-time university programs leading to a bachelor's degree in midwifery (hbo-bachelor verloskunde). there are four colleges for midwifery in the netherlands: in amsterdam, groningen, rotterdam and maastricht. midwives are called vroedvrouw (knowledge woman), vroedmeester (knowledge master, male), or verloskundige (deliverance experts) in dutch. practice midwives are independent specialists in physiologic birth. in the netherlands, home birth is still a common practice, although rates have been declining during the past decades. between 2005–2008, 29% of babies were delivered at home. this figure fell to 23% delivered at home between 2007-2010 according to midwifery in the netherlands, a 2012 pamphlet by the royal dutch organization for midwives. in 2014 it has dropped further to 13.4%. perined.nl/jaarboek2104.pdf. midwives are generally organized as private practices, some of those are hospital-based. in-hospital outpatient childbirth is available in most hospitals. in this case, a woman's own midwife delivers the baby at the delivery room of a hospital, without intervention of an obstetrician. in all settings, midwives transfer care to an obstetrician in case of a complicated childbirth or need for emergency intervention. apart from childbirth and immediate postpartum care, midwives are the first line of care in pregnancy control and education of mothers-to-be. typical information that is given to mothers includes information about food, alcohol, life style, travel, hobbies, sex, etc. some midwifery practices give additional care in the form of preconceptional care and help with fertility problems. all care by midwives is legal and it is totally reimbursed by all insurance companies. this includes prenatal care, childbirth (by midwives or obstetricians, at home or in the hospital), as well as postpartum/postnatal care for mother and baby at home. professional associations/colleges royal dutch organisation of midwives | koninklijke nederlandse organisatie van verloskundigen (knov). new zealand midwifery is a regulated profession with no connection to nursing. midwifery is a profession with a distinct body of knowledge and its own scope of practice, code of ethics and standards of practice. the midwifery profession has knowledge, skills and abilities to provide a primary complete maternity service to childbearing women on its own responsibility. education, training and regulation the undergraduate midwifery programmes are three-year full-time (three trimesters per year) tertiary programmes leading to a bachelor's degree in midwifery (bachelor of midwifery or bachelor of health science (midwifery)). these programmes are offered by otago polytechnic in dunedin, ara institute of canterbury (formally cpit) in christchurch, waikato institute of technology in hamilton and auckland university of technology (aut) in auckland. several schools have satellite programmes such as otago with a programme in southland, wanaka, wellington, palmerston north, wanganui, and wairarapa - and aut with student cohorts in various sites in the upper north island. the postgraduate midwifery programmes (for registered midwives) lead to postgraduate degrees or equivalent qualifications in midwifery (postgraduate certificate in midwifery, postgraduate diploma in midwifery, master of midwifery, phd professional doctorate). the midwifery first year of practice programme (mfyp) is a compulsory national programme for all new zealand registered midwifery graduates, irrespective of work setting. the new zealand college of midwives (the nzcom) is contracted by the funder, health workforce new zealand (hwnz), to provide the programme nationally in accordance with the programme specification. midwives in new zealand must be registered with the midwifery council of new zealand to practice midwifery, and use the title midwife. practice women may choose a midwife, a general practitioner or an obstetrician to provide their maternity care. about 78 percent choose a midwife (8 percent gp, 8 percent obstetrician, 6 percent unknown). midwives provide maternity care from early pregnancy to 6 weeks postpartum. the midwifery scope of practise covers normal pregnancy and birth. the midwife either consults or transfers care where there is a departure from a normal pregnancy. antenatal care is normally provided in clinics, and postnatal care is initially provided in the woman's home. birth can be in the home, a primary birthing unit, or a hospital. midwifery care is fully funded by the government. (gp care may be fully funded. private obstetric care incurs a fee in addition to the government funding.) professional associations/colleges new zealand college of midwives. somalia increase in midwifery education has led to advances in impoverished countries. in somalia, 1 in 14 women die while giving birth. senior reproductive and maternal health adviser at unfpa, achu lordfred claims, "the severe shortage of skilled health personnel with obstetric and midwifery skills means the most have their babies delivered by traditional birth attendants. but, when complications arise, these women either die or develop debilitating conditions, such as obstetric fistula, or lose their babies." unfpa is striving to change these odds by opening seven midwifery schools and training 125 midwives so far. south africa education, training and regulation training includes aspects of midwifery, general nursing, community nursing and psychiatry, and can be achieved as either a four-year degree or a four-year diploma. advanced diploma in midwifery: holders of this qualification are eligible to register with the sanc as midwives. assessments are conducted in line with the assessment policy of the regulations relating to the accreditation of institutions as nursing education institutions (nei). this qualification allows international employability. postgraduate diploma in midwifery: the postgraduate diploma articulates with a master's degree in nursing at nqf level 9. this qualification allows international employability. bachelor's degree in nursing and midwifery: holders of this qualification are eligible for registration with the sanc as a professional nurse and midwife. this qualification allows international employability. the midwifery profession is regulated under the nursing act, act no 3 of 2005. the south african nursing council (sanc) is the regulatory body of midwifery in south africa. professional associations/colleges the society of midwives of south africa (somsa). tanzania education, training and regulation there are different levels of education for midwives: certificate in midwifery diploma in midwifery advanced diploma in midwifery bachelor of science in midwifery (bscm) master of science in midwifery (mscm) midwives must be licensed by the tanzania nursing and midwifery council (tnmc) in order to practice as a 'registered midwife' or 'enrolled midwife'. tnmc ensure the quality midwifery education output, develop and reviews various guidelines and standards on midwifery professionals and monitor their implementation, monitor and evaluate midwifery education programs and approve such programs to meet the council and international requirements. also it establish standards of proficiencies for midwifery education. professional associations/colleges tanzania midwives association (tama). united kingdom education, training and regulation the undergraduate midwifery programs are three-year full-time university programs leading to honours bachelor's degrees in midwifery: bsc (hons) midwifery, bachelor of midwifery (hons). the postgraduate midwifery programs (for registered midwives) lead to master's degrees in midwifery (msc midwifery, msc advanced practice midwifery). there are also undergraduate and postgraduate midwifery programs (for graduates with a relevant degree who wish to become midwives) leading to degrees or equivalent qualifications in midwifery (bsc (hons) midwifery, bachelor of midwifery (hons), graduate diploma in midwifery, postgraduate diploma in midwifery, msc midwifery). midwifery training consists of classroom-based learning provided by select universities in conjunction with hospital- and community-based training placements at nhs trusts. midwifery students in england and wales now pay tuition fees following the abolition of free tuition and the nhs bursary system for most pre-registration healthcare degree programmes in the uk. funding varies depending on the uk country. for example, there are no tuition fees in scotland for those that meet eligibility criteria. short course students, who are already registered adult nurses, have different funding arrangements, with a diminishing number being employed by the local nhs trust via the strategic health authority (sha), and are paid salaries. this varies, however, between universities and shas, with some students being paid their pre-training salaries, while others are employed as a band 5 and still others are paid a proportion of a band 5 salary. however, alterations to short course commissioning and funding is changing at the present time, with more and more short course students are being expected to self-fund in full or, at least, in part. for example, a short course student midwife who also holds registration as an adult nurse may be required to self-fund tuition, either via their own private funds, or via the student loan system while still receiving a salary - or be expected to self-fund completely throughout their entire course of study. pre-registration midwifery training via the short course is, at present, only an option to those holding registration as an adult nurse (rn - adult, rgn, or rna). mental health nurses (rmns), children's nurses (rn - child or children / rscns) and learning disability nurses (rnlds) would need to complete the full three-or-four-year programme depending on their choice of university. midwives must be registered with the nursing and midwifery council in order to practice midwifery and use the title 'midwife' or 'registered midwife', and must also have a supervisor of midwives through their local supervising authority. practice midwives are practitioners in their own right in the united kingdom. they take responsibility for the antenatal, intrapartum and postnatal care of women up until 28 days after the birth, or as required thereafter. midwives are the lead health care professional attending the majority of births, whether at home, in a midwife-led unit or in a hospital (although most births in the uk occur in hospitals). in december 2014 the national institute for health and care excellence updated its guidance regarding where women should give birth. the new guidance states that midwife-led units are safer than hospitals for women having straightforward (low risk) pregnancies. its updated guidance also confirms that home birth is as safe as birth in a midwife-led unit or a traditional labour ward for the babies of low-risk pregnant women who have already had at least one child previously. many midwives also work in the community. the role of community midwives includes making initial appointments with pregnant women, managing clinics, undertaking postnatal care in the home and attending home births. a community midwife typically has a pager, is responsible for a particular area and can be contacted by ambulance control when needed. sometimes they are paged to help out in a hospital when there are insufficient midwives available. most midwives work within the national health service, providing both hospital and community care, but a