Midwifery has been practiced across England for centuries. It is a regulated profession, with specific educational criteria and registration requirements. Posing as a midwife or health care professional is an offense punishable with an unlimited fine. Doulas are not subject to any formal educational training or registration requirements. A nonprofit organization has been established to list doulas across England, and it has a clear statement that doulas are not medical professionals and do not replace the role of midwives.
Antenatal care in England and Wales is provided free of charge to all residents through the National Health Service (NHS). It is typically provided through midwives or doctors. Every pregnant woman is offered two pregnancy ultrasound scans, with the first of these scans occurring between eight to fourteen weeks of gestation and the second occurring between eighteen to twenty-one week of gestation; screening tests to check for conditions such as Down’s syndrome; blood tests to check for HIV, hepatitis B, and syphilis; and screening for sickle cell and thalassemia.
Pregnant women typically have their antenatal care led by a midwife or doctor. If a pregnant woman who is seeing a midwife has complications during pregnancy, the midwife will refer her to an obstetrician. It is unlawful for a person other than a registered midwife or a registered medical practitioner to attend to a woman in childbirth, except in emergency situations or if the individual is in training to become a registered midwife or medical practitioner.
II. Regulation of Midwives
The Nursing and Midwifery Council is a body established by legislation that has four statutory functions: “the education of midwives, registration and revalidation, standards and guidance, and fitness to practise.”
A. Education of Midwives
The educational requirements applicable to midwives are established by the Nursing and Midwifery Council and provided at educational institutions approved in accordance with article 15(6) of the Nursing and Midwifery Order 2001. Individuals must complete a degree-level course or degree apprenticeship before they are eligible for registration as a midwife. These degrees are funded by the student, and a nationwide cap on the cost of university degrees limits the cost to no more than £9,250 per year (approximately US$12,000). In addition to government student loans that may be available, the NHS provides additional financial support, such as a small fund to help with childcare expenses and travel costs that may be incurred during the course of study.
Upon the successful completion of the degree, midwives must demonstrate they are competent across four areas:
- Effective midwifery practice.
- Professional and ethical practice.
- Developing the individual midwife and others.
- Achieving quality care through evaluation and research.
These are known as the standards of competence, and must be met by midwives before they can be registered, then maintained while they practice midwifery. The Nursing and Midwifery Council is also developing new standards of proficiency for registered midwives.
B. Registration of Midwives
All midwives that practice in England must be registered with the Nursing and Midwifery Council and abide by the Code established by the Council, which sets forth professional standards of practice and behavior for midwives.
Midwives have a separate section of the register for nurses, along with separate educational and competence standards. In order to be registered by the Nursing and Midwifery Council, qualified midwives must
[m]eet the NMC’s statutory requirements of holding an approved qualification, being capable of safe and effective practice (including meeting the Council’s requirements relating to health and character), holding an appropriate indemnity arrangement, having the necessary knowledge of English, and paying a registration fee.
Midwives must meet these criteria every three years to be revalidated and have their registration renewed with the Nursing and Midwifery Council.
C. Protected Title and Protected Legal Function of Midwives
Midwifery is a protected title with a protected legal function. It is an offense for any person who is not a registered as a midwife to practice as one, or to falsely claim to have a midwifery qualification or be registered as a midwife. This offense is punishable with an unlimited fine.
D. Role of the Royal College of Midwives
The Royal College of Midwives is a professional organization and trade union that represents the interests of midwives. Its mission “is to enhance the confidence, professional practice and influence of midwives for the benefit of childbearing women and their families.” The Royal College of Midwives has produced standard guidelines for midwifery led care during labor that aim to “outline what the RCM sees as the key features that any midwifery service can use to measure its delivery of compassionate, well-led, professional, evidence-based midwifery care.” The Guidance notes that midwifery units are available, but that many women prefer midwifery led care in a hospital setting and those “who prefer midwifery units and home births can encounter obstacles to these choices.”
Doulas in England and Wales are not required to register with a formal professional body. A nonprofit organization, known as Doula UK, aims to “promote life-changing support for women in the childbearing year, regardless of circumstance; nurture the doula community; protecting parents and health professionals; and advocate for better support for UK families.” Doula UK notes that “[d]oulas are not healthcare professionals and do not take the role of a midwife.” In order to be registered with the organization, Doula UK requires all members to complete an approved course following the core curriculum it has established.
Senior Foreign Law Specialist
 Your Pregnancy and Baby Guide, NHS, https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-midwife-care-pregnant/ (last visited May 16, 2019), archived at https://perma.cc/NZD7-5VMT.
 Nursing and Midwifery Council, Practising as a Midwife in the UK 2 (updated Jan. 29, 2019), https://www. nmc.org.uk/globalassets/sitedocuments/nmc-publications/practising-as-a-midwife-in-the-uk.pdf, archived at https://perma.cc/C4F7-6DZE.
 629 Parl. Deb. H.C. (6th ser. 2017) WS145, https://www.parliament.uk/business/publications/ written-questions-answers-statements/written-statement/Commons/2017-10-09/HCWS145/, archived at https://perma.cc/9YA5-WDHY.
 Financial Support at University, NHS England, https://www.healthcareers.nhs.uk/career-planning/ study-and-training/considering-or-university/financial-support-university (last visited May 14, 2019), archived at https://perma.cc/BL23-KFQC.
 Nursing and Midwifery Council, Standards For Competence For Registered Midwives, at 2, https://www.nmc. org.uk/globalassets/sitedocuments/standards/nmc-standards-for-competence-for-registered-midwives.pdf (last visited May 14, 2019), archived at https://perma.cc/4A6L-EMKQ.
 Future Midwife, Nursing & Midwifery Council, https://www.nmc.org.uk/standards/midwifery/ education/ (last visited May 14, 2019), archived at https://perma.cc/C59K-LEDX. See also What We Do, Nursing & Midwifery Council, https://www.nmc.org.uk/about-us/our-role/ (last visited May 13, 2019), archived at https://perma.cc/K5CW-ZKGH.
 Nursing and Midwifery Order 2001, Parts II and III. See also Midwifery Regulation, Nursing & Midwifery Council, https://www.nmc.org.uk/standards/midwifery/midwifery-regulation/ (last visited May 14, 2019), archived at https://perma.cc/MF9M-PKFB.
 Nursing and Midwifery Council, The Code: Professional Standards of Practice for Nurses, Midwives and Nursing Associates (updated Oct. 10, 2018), https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf, archived at https://perma.cc/3XGW-XXUF.
 Id. at 10.
 See further Nursing and Midwifery Council, Revalidation (Mar. 2019), https://www.nmc.org.uk/ globalassets/sitedocuments/revalidation/how-to-revalidate-print-friendly.pdf, archived at https://perma.cc/ZDX4-5AG9.
 The Royal College of Midwives, Midwifery Care in Labour Guidance for all Women an all Settings (No. 1, Nov. 2018), https://www.rcm.org.uk/media/2539/professionals-blue-top-guidance.pdf, archived at https://perma.cc/U6DB-GDCB.
 The Royal College of Midwives, Midwifery Care in Labour Guidance for All Women in All Settings: Information for Women and Families (2018), https://www.rcm.org.uk/media/2540/mothers-blue-top-guidance.pdf, archived at https://perma.cc/D9Z6-TT9F.
 Id. at 6.
Last Updated: 11/01/2019