Authors:

Lynda Belmehdi, Manager, International Consultants of Delaware

Kimberly Wheeler, Sr. International Credentials Evaluator, International Consultants of Delaware

Submission Date: April 3, 2026

Healthcare systems around the world rely on a wide range of highly trained professionals, each playing a critical role in patient care. Among these, nurses and midwives are often closely associated-yet they represent distinct professions with different scopes of practice, education pathways, and regulatory considerations.

For internationally educated professionals seeking credential evaluation, understanding these differences is essential for navigating licensure, employment opportunities, further education opportunities, and professional mobility.

Defining the Professions

Nursing

Nursing is a broad healthcare profession focused on the care of individuals, families, and communities across the lifespan. Nurses are trained to:

• Assess and monitor patient health
• Administer medications and treatments
• Collaborate with physicians and other healthcare professionals
• Provide patient education and emotional support

Nursing roles vary widely and may include specialties such as critical care, pediatrics, oncology, and public health.

Midwifery

Midwifery is a specialized field dedicated to the care of women during pregnancy, childbirth, and the postpartum period, as well as newborn care. Midwives typically:

• Provide prenatal care and education
• Manage labor and delivery (in low-risk pregnancies)
• Offer postpartum and newborn care
• Promote reproductive and maternal health

Key Differences in Scope of Practice

While both professions share a commitment to patient care, their scopes differ significantly:

• Patient Population: Nurses care for patients of all ages and conditions; midwives focus primarily on women and newborns.
• Clinical Responsibilities: Nurses provide general and specialized care; midwives are trained specifically in childbirth and reproductive health.
• Autonomy: In many countries, midwives practice independently for low-risk pregnancies, while nurses typically work within collaborative care models.

Education and Training Pathways

Nursing Education

Nursing education varies globally but typically includes:

• Diploma or associate degree programs
• Bachelor of Science in Nursing (BSN)
• Clinical training across multiple healthcare settings

Midwifery Education

Midwifery pathways differ significantly by country:

• Direct-entry midwifery programs (no prior nursing required)
• Post-nursing midwifery certifications or degrees
• Specialized clinical training in maternal and newborn care

Midwifery Across the Globe 

These variations defined above can create challenges when comparing midwifery and nursing credentials across borders. Entry requirements, length of study, curriculum structure, clinical requirements, and even learning outcomes can vary globally though similar titles are often used in the professions. 

Assessing midwifery education globally can be particularly challenging as some countries offer midwifery programs that are integrated with nursing education and others offer distinct, independent programs. Another key difference is that some countries offer direct-entry midwifery programs and others offer programs that are post-graduate entry only. To better understand these variations, this article will briefly highlight midwifery across a selection of countries. 

United States

Certified nurse-midwives (CNMs) and certified midwives (CMs) provide comprehensive, independent care encompassing pregnancy, childbirth, the postpartum period, sexual and reproductive health, gynecologic care, family planning, and preconception services. Midwifery practice also includes primary care across the lifespan and care of the healthy newborn during the first 28 days of life, delivered in an inclusive manner to individuals of all gender identities and sexual orientations. Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) are educated in graduate-level midwifery programs accredited by the Accreditation Commission for Midwifery Education (ACME). CNMs and CMs pass a national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM (if they have an active RN at the time of the certification exam) or CM. CNMs are legally recognized to practice in every state in the United States and in the District of Columbia. CMs are currently legally recognized to practice in Arkansas, Colorado, Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and the District of Columbia (American College of Nurses-Midwives).

The educational routes to midwifery are dependent upon the applicant’s prior educational background. If the applicant has not obtained an undergraduate degree, the applicant can choose the Certified Nurse-Midwife (CNM) route by first obtaining a Bachelor of Science in Nursing degree and then entering a graduate midwifery education program. Alternatively, the applicant could choose the Certified Midwife (CM) route by obtaining a bachelor’s degree that includes the required science prerequisites and then entering a graduate midwifery education program.

For those applicants who have already obtained an undergraduate degree in a non-nursing major, the Certified Nurse-Midwife route requires the applicant to obtain a bachelor’s or master’s degree in nursing. This is achieved by either taking an accelerated program and entering a graduate midwifery education program, taking an accelerated program that provides both nursing and midwifery education, or by taking a bachelor’s degree in nursing and then entering a graduate midwifery education program. To take the Certified Midwife route, the applicant must complete the science prerequisites and then enter a graduate midwifery education program.

For those applicants who are already registered nurses (RNs), the route is direct and requires the applicant to enter an accredited graduate midwifery education program by the Certified Nurse-Midwife route (American College of Nurse-Midwives).

Ghana

Ghana offers both diploma and bachelor’s degree pathways in midwifery:

• 3-year Diploma in Midwifery
• 4-year Bachelor of Science in Midwifery

Both pathways prepare graduates for licensure and practice, with increasing emphasis on degree-level education for expanded competencies and professional mobility.

The curriculum has been designed to meet societal challenges and needs. Emphasis is placed on Family-Centered Maternity Care, which is a systematic approach to the nursing care of an expectant mother and her family based on a thoughtful understanding of a client as a unique individual (Nursing & Midwifery Council of Ghana).

To be admitted into the Diploma in Midwifery program, the student needs to pass English, Mathematics, and Integrated Science with the relevant aggregate of 36 or more in the WASSCE or 24 or more in the SSSCE. Also, they must pass either General Science, General Arts, Home Economics (Food and Nutrition), or General Agriculture with Chemistry or Physics. The student can be admitted with five credits at the G.C.E. O-Level in English, Mathematics, Integrated Science, together with three passes at the G.C.E. A-Level.

For the bachelor’s degree, there are multiple entry options. For direct entry, WASSCE candidates need credit passes in the aggregate with grades ranging from A1 to C6 with an aggregate of 36 or better in General Science, General Arts, Home Economics (Food and Nutrition), or General Agriculture with Chemistry, Physics or Biology, and Elective Mathematics. Diploma Midwives need a recognized diploma in Midwifery and license as registered midwife with NMC-Ghana, and WASSCE or SSSCE results.

The first year of the Midwifery program is similar to the first year of the nursing diploma offered in Ghana. The second year of the Midwifery program focuses on areas such as Physiology and Management of Normal Pregnancy, Physiology and Management of Normal Labor, Physiology and Management of Normal Puerperium and Neonate, Physiology and Management of the High-Risk Neonate. Graduates sit for a licensure examination with the Nursing & Midwifery Council of Ghana and receive a title of Registered Midwife upon passing the exam. The full 3-year Midwifery curriculum requires completing 6,732 hours of theory and clinical combined (Nursing & Midwifery Council of Ghana, Diploma in Midwifery Curriculum).

Türkiye

Midwifery and nursing are distinct bachelor’s-level professions in Türkiye:

• Bachelor’s in Midwifery (Ebelik Lisans Programı)
• Bachelor’s in Nursing (Hemşirelik Lisans Programı)

These programs differ in curriculum focus, with midwifery emphasizing maternal and reproductive health and nursing covering broader clinical care.

The 4-year Bachelor’s in Midwifery (Ebelik Lisans Programı) requires 240 ECTS and is a Level 6 education program within the scope of the National Qualifications Framework for Higher Education in Türkiye (NQF-HETR). The program emphasizes comprehensive midwifery education with strong clinical training, maternal and newborn health, reproductive and community health, and foundational medical sciences, consistent with European and international midwifery standards. Admission to this program is based on different criteria for domestic and international applicants. Turkish nationals are admitted according to their results on the Higher Education Institutions Exam (YKS), administered by the Student Selection and Placement Center (ÖSYM). International applicants are admitted through a direct application process and are evaluated in accordance with the university’s undergraduate and admission criteria.

In Türkiye, graduate midwives are authorized to practice upon completion of the program and issuance of the diploma. The diploma is registered with the Türkiye Cumhuriyeti Sağlık Bakanlığı (Republic of Türkiye Ministry of Health).

India

The role of the midwife in India is critical to the national healthcare landscape. They provide community education and support for mothers and newborns, especially in those areas where access to a physician is limited or not possible. They conduct examinations and provide care for pregnant/postpartum women and newborns, identifying issues and possible complications for referral. They also deliver routine vaccinations, provide contraceptives, and assist with labor and birth.

Since 1947, midwifery in India has been integrated into nursing education “leaving the official model of maternity care centered on obstetricians as lead providers”, instead of midwives (Kalaimathi, Ani Grace, Dr., 2024).  Until 2018, only three program options existed, all direct entry into midwifery, requiring the 10+2 qualification (Completion of Higher Secondary Education) for entry (Indian Nursing Council, 2012-2013):

• 2-year Auxiliary Nurse Midwife (ANM) program
• 3-3 ½ year General Nursing and Midwifery (GNM) diploma 
• 4-year Bachelor of Science in Nursing  

All three  programs are primarily focused on nursing, with midwifery studies included as an integrated subject area or a specialization. After graduation, qualified individuals can register with the Indian Nursing Council and are granted the title of either Auxiliary Nurse Midwife (ANM) or Registered Nurse-Midwife (dual title of RN & RM). 

More recently, however, the Government of India established a new qualification of Nurse Practitioner in Midwifery (NPM) as “part of an initiative to ensure high-quality, dignified and respectful care for women and newborns” (Kalaimathi, Ani Grace, Dr., 2024). This initiative began in 2018 and is meant to align midwifery education in India more closely with the standards established by the International Confederation of Midwives.  

The NPM program is 18-months duration and only available to those already registered as a Nurse/Midwife in India. The entry requirement is a bachelor’s or master’s degree in nursing and prior clinical work experience. Unlike the ANM and RN/RM programs, the Nurse Practitioner in Midwifery (NPM) qualification requires much more in-depth midwifery studies in the form of an intensive residency program under the supervision of certified midwife mentors called Nurse Practitioner in Midwifery Educators (NPMEs). 

Graduates of the NPM program must successfully pass a competency examination to become certified with the Indian Nursing Council (Indian Nursing Council, 2020). NPMs work more independently than general Nurse/Midwives, and alongside obstetricians, pediatricians, and other healthcare professionals, deliver holistic care to maternity patients and newborns (Ministry of Health & Family Welfare Government of India, 2021).

United Kingdom

The United Kingdom offers both bachelor’s and master’s level programs in midwifery studies and length of study depends on the entrance qualification (the shortened programs are for those entering as Registered Nurses). All programs must be approved by the Nursing and Midwifery Council (NMC), and program learning outcomes must meet the requirements for the Standards of Proficiency for Midwives. These standards include requirements for the competencies that students must master. They also outline the requirements for clinical experiences, including total clinical hours, minimum number of examinations, care appointments and attended births, and the types of cases that students must work on (Nursing and Midwifery Council, 2019).

Currently, the midwifery programs available in the U.K. include:

• 3-year Bachelor’s degree (direct-entry)
• 18 to 24-month Master’s degree (for Registered Nurses)
• 3-year Master’s degree (for those with a non-nursing undergraduate degree)

The Bachelor’s degree curriculum features an even distribution of theoretical and clinical education, with students completing a minimum of 2,300 hours of training. Admission into a bachelor’s program requires the General Certificate of Secondary Education and minimum A-Level scores on specific subjects, usually in the life sciences and social sciences (NHS, n.d.).

After completing an approved program, graduates are granted the title of Registered Midwife (RM). In the United Kingdom, Registered Midwives act as a primary point of contact for women during pregnancy and postpartum, providing education and support to help them make informed choices about their care. They provide routine examinations (including ultrasounds) and monitor women and newborns to identify potential issues/complications. They also assist with birth and immediate postpartum care and work with other healthcare professionals in a variety of settings, including hospitals, clinics, birthing centers and patients’ homes (Nursing and Midwifery Council, 2019).

Canada

Midwifery education in Canada is accredited by the Canadian Midwifery Regulators Council (CMRC). The council outlines the competency-based learning outcomes required for the approved educational programs and defines the scope of practice for the Registered Midwife in Canada. The Canadian Competencies for Midwives developed by the CMRC describes the role of the midwife: “As primary care providers, midwives apply foundational knowledge, skills and abilities to provide holistic care throughout the childbearing year (i.e. antepartum, intrapartum and postpartum) and for newborns and infants. Midwives assess clients, make decisions, plan care, perform interventions and evaluate processes and health outcomes through both in-person and virtual care. Midwives also provide reproductive health care, preparation for parenthood and well-client care.” (CMRC, 2020)

Midwifery program offerings in Canada include:

• 3-to-4-year Bachelor’s degree program (direct-entry)
• 4.5-year Bachelor’s in Midwifery (Baccalauréat en pratique sage-femme) (direct-entry program in Quebec)
• Indigenous Midwifery Programs
• 2-3-year Master’s degree program (for RMs only)

The bachelor’s degree programsrequire completion of Grade 12 (high school) for admission. Many universities require minimum grades in certain subjects and/or a minimum overall GPA. Like in the U.K., approximately 50% of the program is spent in clinical training across a variety of settings. The other half of the program focuses on theoretical coursework (such as biological sciences, midwifery studies, and ethics/professional standards). The Indigenous Midwifery Programs offered in Canada focus on integrating modern healthcare with traditional indigenous midwifery practices and the master’s degree is an advanced practice program for those already registered as midwives. While the overall program structures and coursework differ slightly depending on the institution, learning outcomes must align with The Canadian Competencies for Midwives (CMRC, 2020).

While the CMRC oversees the educational programs, licensing requirements are regulated by separate authorities for each province/territory. Most authorities require passing the Canadian Midwifery Registration Examination (CMRE). There are also unique requirements for the minimum numbers of births attended as well as patient examinations and care appointments completed. After completing an approved program and meeting the individual requirements for the province/territory they wish to practice in, a candidate can apply for licensure and become a Registered Midwife (RM) (CMRC, 2021).

Evaluating International Midwifery Credentials

When evaluating international midwifery credentials for U.S. equivalencies, it’s important to consider the unique characteristics of the training programs within that country. Factors to consider include:

• Entry-to-practice 
• Scope of Practice
• Clinical hours & types of clinical experiences
• Overall structure of the education program/curriculum
• Types of educational institutions that offer the programs
• Licensure requirements and processes (if applicable)

To gather these details, evaluators may want to take some extra steps in their review. In addition to collecting and reviewing official transcripts and diplomas, it can be helpful to request primary source documentation on the curriculum structure, particularly the details of the clinical experience. Additionally, it is recommended that evaluators review reference materials developed by the regulatory bodies as these often outline regulations, standards, and the scope of practice. Most of the time, these materials can be found on the authorities’ official websites. If that information cannot be found online, another option would be to contact the authority directly for more details.

Conclusion

Nursing and midwifery are distinct, yet complementary professions, and evaluators should use careful consideration when assessing educational programs to avoid inaccurate credential comparisons. Globally, midwifery may exist as an independent profession or as a nursing specialization, resulting in significant variation in training and autonomy. Understanding these differences is essential for accurate credential evaluation, licensure decisions, and professional mobility across healthcare systems.

References

American College of Nurse-Midwives (2025). About Midwifery. American College of Nurse-Midwives (2025). https://midwife.org/about-midwifery/

Canadian Association of Midwives (CAM). (2023). How to Become a Midwife. Canadian Association of Midwives (CAM). https://canadianmidwives.org/becoming-a-midwife/

Canadian Midwifery Regulators Council (CMRC). (December 2020). Canadian Competencies for Midwives. Canadian Midwifery Regulators Council (CMRC). https://cmrc-ccosf.ca/sites/default/files/pdf/CMRC%20competencies%20Dec%202020%20FINAL_3-e_Jan%202022.pdf

Canadian Midwifery Regulators Council (CMRC). (August 2021). REQUIREMENTS FOR INITIAL REGISTRATION AS A MIDIWIFE IN A CANADIAN JURISDICTION. Canadian Midwifery Regulators Council (CMRC). https://cmrc-ccosf.ca/sites/default/files/pdf/Registration%20Requirements%20table%20Aug%202021.pdf

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Indian Nursing Council. (n.d.). Nursing Programs. Indian Nursing Council. https://indiannursingcouncil.org/nursingprograms

International Confederation of Midwives. (2025). Resources. International Confederation of Midwives. https://internationalmidwives.org/resources/

Kalaimathi, Ani Grace, Dr. (January 2024). Professional Midwife-Led Care in India. International Confederation of Midwives. https://internationalmidwives.org/professional-midwife-led-care-in-india/

Istanbul Aydin Universitesi. (n.d.)  LEVEL OF QUALIFICATION & QUALIFICATION AWARDED. Istanbul Aydin Universitesi.  https://ebs.aydin.edu.tr/en/index.iau?Page=DuzeyTemelAlan&BK=2121

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