How to become a Midwife

"Midwifery is an amazing career, with the opportunity and privilege to be a part of someone’s most special but also most vulnerable time in their life."

Student Midwife, Louisa, takes a comprehensive look at the job of a Midwife and outlines how to become one in this complete guide.

Updated 27th July 2020

Topics covered in this article

A brief history of midwifery

Did Midwives only assist those who could afford it before the NHS?

How much do Midwives get paid in the NHS?

Can I work as a Midwife in the private sector (outside of the NHS)?

Can I earn more as a Midwife in the private sector?

What are the entry requirements to study Midwifery at University?

What do I need to know about Midwifery courses (what is the qualification, how long does it take, explain placement details, when are exams etc etc)?

Interview tips for Student Midwives

Are there specific CV tips for Midwives?

What does a typical day for a Midwife look like?

Beyond the obvious, are there other types of roles available in Midwifery?

What I love about working as a Midwife?

What attracted me to working as Midwife?

What are the challenges faced by Midwives in the UK?

What is the current state of Midwifery in the UK?

What does the future of Midwifery in the UK look like?

In summary

Further reading for Midwives on Nurses.co.uk

Useful websites for Midwives

A brief history of Midwifery

Midwifery is one of the oldest recorded professions, even being mentioned in the Bible.

Midwives may not have always been called Midwives and their knowledge may have been different in the past but one thing has always stayed the same.

Midwife means 'with woman', and that is what Midwives have always done.

Been with the woman in her time of need.

Midwives skills and competence used to vary greatly in the 17th century as there was no governing body to regulate any form of training unlike there is now.

During the 19th century the high maternal and infant mortality rate caused national concern and become a driving force for change.

In 1872 there was state recognition of Midwives by the General Medical Council.

In 1881, the Midwives Institute was created, which would then lead into the Royal College of Midwives in 1941.

The first law/act to pass to help regulate Midwifery even more was in 1902 when the Central Midwives Board outlawed uncertified and untrained Midwives (also known as handywomen).

This also raised the status of Midwives.

The 20th century had a lot of milestones for Midwifery in the UK, especially to do with the training and certification of Midwives, old and new alike.

From 1902 – 1926 the main care provider for maternity care were Midwives.

Then the creation of the National Health Service in 1948 caused home birth rates to decrease and hospital birth rates to increase.

This leads into the reason for the normality of having a hospital birth in today’s climate, as during the hospital boom from 1963 to 1972 the hospital birth rate went from 68.2% to 91.4% of all births in the UK and it has steadily increased ever since.

Did Midwives only assist those who could afford it before the NHS?

Midwives have always assisted everyone, even before the creation of the National Health Service in 1948.

Before the NHS and any type of regulations, Midwives varied in their skills and knowledge.

Especially in the 19th century traditional Midwives primarily looked after the lower class women, as middle class women were seeking obstetric care.

How much do Midwives get paid in the NHS?

Within the NHS there are different levels of responsibility and salary payments known as bands.

As a Newly Qualified Midwife you will general start out as a Band 5 and on completion of a NQM’s preceptorship period (varying from 6 months to 1 year) you will then move to a Band 6 with more responsibility and a higher pay grade.

However, some trusts may offer NQM’s a Band 5 position with a Band 6 salary or a Band 6 position depending on skill level.

Each band has a varied salary range depending on the location of the trust offering the job.

If working in a London NHS trust, then there will be an added bonus sometimes called London weighting or High cost area supplements.

Find out exactly what you can earn within each banding here.

Can I work as a Midwife in the private sector (outside of the NHS)?

Midwives that work outside of the NHS are known as either Private Midwives or Independent Midwives.

Private Midwives are hired by a private company or hospital whereas Independent Midwives are self-employed either working by themselves or within a small team.

In recent years the jobs of Independent Midwives have been threatened due to a legal technicality with the type of insurance need to practice outside of a hospital and the NHS.

Independent Midwives are on the NMC registration just like NHS Midwives, however, some independent Midwives will tend to become experts in and specialise in certain areas of women’s health or birth, for example, breech specialist.

Usually private and independent Midwives control their own caseload and who they work with.

This typically consists of working with women or families throughout pregnancy, labour and the first few weeks after birth, with most of the care taking place inside the woman’s home.

However, in some areas private Midwives work inside a private hospital or wing, and both private and independent Midwives can be brought into hospital labour wards as additional support.

Private and independent Midwives will charge for their services.

Can I earn more as a Midwife in the private sector?

Yes, working in the private sector, just like any other job, can increase your income.

Just like in the NHS, what a private Midwife earns can vary and depend on a range of factors such as location and if they are working by themselves or as part of a Midwifery service.

As a self-employed Midwife you can offer a range of services that can range in price from £2,000 to £5,000.

Working for a private hospital can bring in an hourly rate ranging from £21 - £36 an hour depending on your equivalent NHS band level and experience.

An example of a private Midwife salary comes from a job post for a band 6 position at Chelsea and Westminster hospital.

It was a full time position at 37.5 hours a week, with a salary of £36,481- £44,044 per annum including HCAS.

What are the entry requirements to study Midwifery at University?

As there are no academic national minimum requirements for entry onto a pre-registration degree, each university will require different subjects and grades for entry.

However, here are some of the main subjects and average grades:

• Five GCSEs in English language or literature, Maths, and a science related subject at grade 9-4 or C or above. With either…

• Two to Three A Levels with Biology, Chemistry, Human Biology, Physics, Psychology, and Sociology being preferable.

• BTEC Extended Diploma in Health and Social Care, Health and Social Care (Health Studies)

• Access to Higher Education in Nursing, Health & Social Care, Midwifery, or Nursing and Midwifery Every pre-registration program will require the applicants to have an Enhanced DBS check and have Occupational Health Clearance.

At my university, Kingston and St George’s University of London, the entry requirements are as followed:

• Five GCSEs at grade 4/C including English, Maths and Science

• A-levels - ABB (General Studies not accepted)

• BTEC Extended Diploma – Distinction, Distinction and Merit

• Access to HE course to value of 128 UCAS points normally achieved with 33 Distinctions and 9 Merits

At the interview, successful applicants will need to demonstrate their literacy and numeracy skills.

If an applicant has any form of disability, reasonable adjustments should be made.

What do I need to know about Midwifery courses (what is the qualification, how long does it take, explain placement details, when are exams etc etc)?

At the end of an accredited pre-registration Midwifery program you will graduate with a Bachelor’s of Science (BSc) university degree.

Some programs are with Honours (Hons).

Depending on how you are entering Midwifery the length of the course will change.

For direct entry - if you’re coming straight from sixth form or college with no nursing background – it will take 3 years to graduate.

If you have done a nursing degree or are a nurse, then you can do an 85 week (1.5 year) degree shortened course.

A Midwifery degree will be based on the development of basic Midwifery and nursing skills in a range of settings.

The programme should be based around women cantered care during pregnancy, Labour and birth, and during the postnatal period as well as educating and supporting parents with up-to-date information and research.

With the degree course being 50% clinical practice (placement) supervised by a registered Midwife and 50% theory based it gives students the opportunity to have hands on experience in the NHS.

Clinical practice placement varies for every university, some universities will have placement and university lectures within the same week whilst other universities have them separated into block, i.e. 3 weeks at university having lectures and then 3 weeks on placement.

A clinical practice placement will involve you working with a registered Midwife in either a hospital or community based setting.

You will be working regular 11.5 / 12.5 hour Midwife shifts, whether during the week or on the weekend, or a day or night shift.

The first year of the degree students will be centring their learning and practice around normality when caring for women and babies during pregnancy, birth and during the postnatal period, which can be up to the end of the first month after birth.

This will start off with just observing the Midwife you are working with and then eventually lead in to getting more involved on the antenatal ward, labour ward and postnatal ward, linking theory learnt in university to practice.

They will also have the same opportunity to provide antenatal and postnatal care in the community.

During the second and third year is when students will start to have a bigger emphasis on handling complex cases and learn in depth about childbirth emergencies.

There will also be more teaching on research in Midwifery in your second and third year.

Throughout the three years an emphasis is made on students to become analytical thinkers who understand how to create and deliver an individualised care plan for pregnant women, in partnership with the woman, and how important that is to a woman.

During the Midwifery degree course some of the main skills that will be developed are:

• Observational and communication skills

• Critical thinking and decision-making skills

• Collaborative working skills, especially within a multidisciplinary team

• How to promote and improve the standards of care

• Written and oral communicating skills

• Independent and self-directed study

• Assessment and clinical examination skills.

In most pre-registration programs there is a mix between assignments and essays, and exams.

Within those exams there are written exams and practical exams called OSCE/OSCA – Objective Structured Clinical Examination/Assessment.

Assignments will be due throughout the year usually beginning around late November/early December.

Most Exams are during normal university exam times.

These practical exams are testing you on what you have learnt on your clinical placement.

Interview tips for Student Midwives

One of my main tips is to do you research!

Make sure you know what you're talking about, and also know what they (the university/Midwifery team) are looking for.

And if you've gotten an interview, you probably know what they want, and what they are looking for is probably already in your personal statement.

Therefore, know your personal statement.

Also, look at the university website to find out what they want, and see what they're looking for within a student.

Make sure you have questions.

A good tip for any interview, is to have questions, but also have answers to the questions.

With Midwifery, a lot of universities do multi-mini interviews (MMIs), where they ask you a range of scenario based questions.

Due to the nature of the questions you will be asked, it is a good skill to be able to explain yourself and how you reached a certain answer.

In a nutshell, to be able to an array of questions, usually scenario based.

Some might not even be relevant to the degree but they want to see if you are biased in any way.

They also want to see what your reasoning is for certain situations.

Most people are asked the “who would you save and who would you leave on the boat” question.

As strange as this question is in an interview, they want to know why would you choose that person over the other person?

Just make sure you explain yourself clearly with every answer you give.

Because they will be able to see if you have any unconscious biases and if you are able to reason well.

They will also be able to see what your character is.

Are you a good person?

And this may seem a bit farfetched due to the questions you will be asked but it’s true.

You can learn a lot about someone by how they answer not only the hard questions but also the questions that are so out of place but based in reality.

But the most important thing to remember about the whole interview process is that they want to see you.

That is the main thing they are trying to figure out.

What makes you, you.

Another one of my main tips is to make sure you are up to date on Midwifery today; what is being said in the news?

What are some of the main issues the maternity services are facing?

What are some of the plans the government has put in place when it comes to maternity care in the UK?

Try to watch the news or listen to the radio when they are talking about the NHS, even if it is not about maternity specifically it can be related back to maternity services.

Whatever you read or hear make sure you are looking those things up and doing your own research on it so that you can form your own opinions on it.

Knowing the latest news, information and guidelines (this last one is probably more a tip for Midwifery job interviews) are all good thing to know but during an interview – I am going to repeat myself again - they also want to see WHO YOU ARE.

What is YOUR opinion on the NHS or the maternity services?

Allow them to fully see if you have the qualities they are looking for in a future Midwife and the only way they can do that is by being nobody other than yourself.

Are there specific CV tips for Midwives?

As some of you may know getting onto a Midwifery degree and getting a job as a Midwife is a completely different experience then trying to get onto a “regular” university degree course or get a regular job.

If you don’t know you can take my word for it.

I had the pleasure of having to write a personal statement for a photography degree program as well as for my Midwifery degree.

Those were completely different experiences.

However, the basic rules for writing a good Curriculum Vitae and personal statement still apply; show your interests and show what you have done to get involved in that field.

Getting into a Midwifery degree is very competitive, however it is becoming less competitive as there are more places on the degree being made each year to help start to fill the gap in how many trained registered Midwives the NHS is down by.

I am going to break this section down into two parts: getting into the degree and getting a job as a Midwife.

For getting onto the course my number one tips that I tell everyone is to get some sort of experience in the healthcare system, whether that’s by having a job as a healthcare assistant or by volunteering in the maternity department.

Along with having some form of experience, knowing of the latest scandal – for lack of a better word – in the maternity system is actually helpful.

It shows that you’ve gone beyond just watching One Born Every Minute and Call the Midwife and have done some form of research on what Midwifery truly consists of.

Having that in your personal statement and being able to reference it in your interview will show your enthusiasm for the degree and Midwifery as a whole.

It will also benefit you to have an understanding of what has gone wrong in the situation and knowing what the next steps are in maternity care as this will be what you will be a part of and hopefully the best practice you will be aiming to achieve once you have qualified.

This section will mostly be fuelled by the information I have been given as I am going through the process of applying for a Midwifery job as a Newly Qualified Midwife.

When writing your CV and personal statements for a Midwifery job it’s great to show your character whilst also keeping it relevant to the job you are applying for.

The basics outline for your CV should/can look like this:

• Personal Contact Details

• Personal/Professional Profile

• Professional Experience

• Student Experience - Just say roughly the areas you worked in/teams worked with.

• Qualifications/Education

• Personal interests

• References

For your personal statement the main things you want to show are:

Why you want to work in that trust and evidence of knowing the trust you are applying to.

So do your research on the trust you are applying to and write it into your personal statement.

Show that you are interested in the trust and the maternity care they offer.

Talk specifics to show you have done your research.

Talk about the specific teams they have and the percentages they have.

Incorporate it into why you want to work for them.

Why do you want the job?

Your interests

Don’t be too long winded here.

However, you can show your passion for a particular field by talking about any study days you went to whilst at university.

Your skills

They know what you can do from your degree and from the skills part of your interview, they want to know what extra stuff you know, i.e. IT skills.

Future aspirations

Don’t talk too much about this part in case you mention something you want to do, which they do not have or do at that trust, as this will show you might be leaving after your first year which is not desirable.

Personal Specification

Remember to read the job description as this will tell you what they are looking for and they will even tell you what skills are desirable to them.

You don’t need to write it all into your personal statement but it would be handy to incorporate the majority of them in your personal statement.

What does a typical day for a Midwife look like?

Here is a rough run down of a typical day in the life of a Midwife for both a hospital based Midwife and a Community Midwife.

A Ward/Hospital Midwife Every hospital has a different start time ranging from 0715 to 0800 for a day shift and 1915 to 2000 for a night shift.

A typical shift will start off with some form of a hand over, whether that is a general overview of the board in a group setting or a short run through of the board and then a more detailed Midwife to Midwife handover once the women or number of beds have been allocated to the new Midwife.

Once handover is finished (around half an hour into the start of your shift) this is when you go and introduce yourself to the woman or women you are looking after.

Some people like to check the woman’s (or women’s) maternity notes either just after hand over or after introducing themselves to the woman or women they are looking after.

With labour care you tend to spend the rest of your day with that one woman or until she delivers and is then either transferred to the postnatal ward or is discharged home after a not complicated natural birth.

On antenatal and postnatal wards, a lot of these women will require either observations/vital signs to be taken or will need medication.

Every day there should be a full examination of the woman, including an emotional well-being check.

Wards tend to be busy as one Midwife can have anywhere from four women and babies to eight women and babies they are looking after all requiring something.

A Community Midwife Community Midwives and hospital clinics generally start at 0800 and finish around 1800.

In hospital clinics antenatal check-ups and postnatal mother and baby assessments can happen within the same clinic or in separate clinics on different days.

There are also opportunities for parent education classes that help prepare mothers and fathers for labour, birth, breastfeed, and sometimes the postnatal period.

In community Midwifery, there may be a clinic all day in a health centre, primary school or GP, where the Midwife stays in her room all day or there are days when a Midwife may have clinic only in the morning, then lunch and then postnatal home visits in the afternoon.

Some community Midwives are also on call for home births or born before arrivals (BBA); this is when a woman gives birth before getting to the hospital.

Beyond the obvious, are there other types of roles available in Midwifery?

As a Midwife there are a range of career possibilities and specialisms.

The obvious routes are being a hospital based/ward Midwife, working on either antenatal, labour and delivery, or postnatal ward.

There are also Day Assessment Unit (DAU) Midwives and hospital based antenatal clinic Midwives, who gave different working hours to regular ward Midwives.

Another obvious role is a community Midwife and a home birth Midwife.

Moving on from these roles there are also different teams a Midwife can be in or different specialities/focus a Midwife can have:

• Breech specialists

• Diabetes Midwife/team

• Fetal medicine Midwife

• Public Health Midwife

• Perinatal Mental Health team

• Perineal specialist

• Safeguarding Midwife/team

• Teenage pregnancy team

Side note: these roles may differ or not exist depending on your trust’s size and location.

Moving on from specialising within Midwifery, there is also the possibility of becoming a research Midwife, going into academia or moving up to a management or senior level within the NHS, such as Ward Manager, Consultant Midwife or Director of Midwifery.

What I love about working as a Midwife?

Some of the things I love most about being a Midwifery student is the privilege it entails.

Being able to assist and support women and their families and build a trusting relationship with them in such an emotional and intimate time in their lives is such an incredible honour.

Being able to give women as much support as I can so that they can feel empowered in their body’s ability and also seeing them start to believe in themselves as new parents is such an important thing to be able to do, and I love that I am able to help them figure things out as a new family unit.

It’s amazing to be able to go to work and 95% of the time have the people you see and look after be happy to see you.

I feel particularly lucky to be entering a career where that is possible.

Being able to provide a good experience for a woman and her partner is something I strive for every day as I have seen what having a bad pregnancy or birth can lead to.

Being able to listen to women’s or even their partner’s concerns and being able to reassure them is so rewarding because I know that sometimes it takes just one person listening or being kind to help a woman not have a traumatic experience.

As a student I’m lucky that I have the time to talk to women during an emergency situation and explain to her everything that is happening and who is entering the room.

That simple act can make a usually scary situation for her not so scary.

What attracted me to working as Midwife?

My route into Midwifery has also been a slightly strange one.

I was not a part of the 18 year olds in class who had always wanted to be a Midwife but I also was not part of the mum group who either had a great experience and was inspired to become a Midwife or had a terrible experience and wanted to be the change.

What attracted me to being a Midwife was inspired by God.

It was something I had never fully thought about as a career for myself but it was always in my world in a different way.

What first ever attracted me to be a Midwife started off as a passion for home births and an intrigue in the process of birth and the different ways in which a woman can give birth.

This probably first started when I had my year 5 sex education session, where we got to see a close up of a lady giving birth.

Everyone in class thought it was disgusting except one boy who said his mum had given birth at home and he was there for it.

That intrigued me.

Plus, watching the 1977 Roots miniseries as a young child and seeing the women on that giving birth standing up really spoke to me.

So when YouTube became a thing I would actively search for and watch birth vlogs, especially home birth videos.

My passion for physiological births and God drove me to wanting to be a Midwife.

The knowledge I would go on to learn and be able to share with other people was a driving factor of wanting to become a Midwife.

In addition, the fact that I would also be able to empower the women who would be in my care and their partners really spoke to me.

Also it is a bonus that I can work in another country as a Midwife and even better I would be able to volunteer with a charity like I have always dreamed of.

What are the challenges faced by Midwives in the UK?

With the advances in technology and medicine and the state of our country’s finances, there are a lot of challenges in the maternity services in today’s climate.

The bulk of the challenges come down to the financial strain that is on the NHS and how much money actually ends up going to the maternity services of each trust.

There’s a shortage of Midwives and, therefore, an increase in spending on agency Midwives to fill the gap.

However, this increase in spending means the trusts have spent a huge bit of their budget.

Changes in policy has created an increase demand on the maternity services.

Such as the initiative to reduce stillbirths with the increased awareness of baby’s movements.

This is a great initiative, however, when there has been more than two episodes of reduced fetal movements in a term pregnancy and induction is advised.

This increase in inductions of labour causes there to be more work for the Midwife without any extra help.

A lack of flexible working hours can also be a problem for a lot of Midwives that have families.

And with England leaving the EU there is also the threat of a lot of the workforce leaving as they are European Midwives.

In addition, the level of complexity is up.

A lot of women who get pregnant nowadays are women who would not have been able to get pregnant before and, therefore, are resulting in more high risk pregnancies that may need more intervention, which the NHS does not always have the resources for.

A dip in the number of student Midwives, the future of the profession, and the ageing Midwifery profession caused a gap where there is a shortage of Midwives, especially those capable of doing night shifts and working long days.

It also means there is not a lot of solid band 6 and band 7’s who can look out for all of the newly qualified Midwives once the older generation retires, meaning more pressure is put on newly qualified band 5’s.

This can tend to lead to burn out and Midwives leaving the profession.

What is the current state of Midwifery in the UK?

In the UK who access the maternity services has change a lot over the years, with the rising age of mothers as well as women with medical condition that wouldn’t usually allow you to get pregnant now getting pregnant.

This has caused Midwifery in some ways to become more about trying to manage these health conditions enough so that the woman can have a healthy pregnancy.

And as you will see in the section below, the maternity workforce has a higher amount of pressure on them as well as a shortage of staff workforce.

There are a few government initiatives that have slowly been put into effect over the last few years in hopes of being fully implemented by the end of this year.

One of them is by the Department of Health and it is called Midwifery 2020: Delivering Expectations.

The Department of Health want to improve the quality of the maternity services by encouraging Midwives to be more visible in community settings, which can allow women to choose to access them as a first instead of their GP, and having the Midwife be the lead health professional for pregnant women who do not have any complications.

They also want to encourage a safe and positive transition for women and their partners into parenthood, with women and their partners knowing their Midwives and being about to build a trusting relationship with them.

The Better Births initiative which they wanted to achieve by 2020 has been implemented throughout the maternity services in test batch areas.

The main themes involved, which you will be able to see by the creation of new teams within different hospitals, are continuity of carer, better postnatal and perinatal mental health care, and the ability to work across boundaries in multidisciplinary teams to create a smooth and cohesive care plan for women.

Providing safer care for women involves working across departmental boundaries to ensure the appropriate referrals are made and that when are getting all of the care they need in a timely manner.

Continuity of carer has been one of the leading changes to the maternity services in the UK with the creation of numerous continuity teams.

These team will allow women to get the same information about their health and pregnancy, and also allow them to be able to grow a relationship with their Midwife and be able to trust in them.

This has made it so little things are noticed that may not have been noticed by a different Midwife who does not know a woman’s personality.

It also allows for better personalised care plans to be made that are based on her specific needs, that encourages the woman to be more involve in her care and gives her the opportunity to make informed decisions.

There have been quite a few governmental initiatives put into place to increase funding and access to mental health services for pregnant women as it is one of the leading causes of the Maternal Mortality Rate.

With these improvements women now have more support when needed.

What does the future of Midwifery in the UK look like?

Hopefully, Midwifery in the UK continues to grow with more funding being placed in such an important area of the NHS, and the implementation of the aforementioned initiatives and programs.

One of the biggest aims for Midwifery in the UK at this moment is for everyone to have access to continuity of care and for Better Births to become better implemented.

As the data has shown that when women have one (or two) known Midwives there are an increase in better outcomes for women and their babies and the woman has a better experience of pregnancy, birth and the postpartum period.

In summary

Midwifery is an amazing career, with the opportunity and privilege to be a part of someone’s most special but also most vulnerable time in their life.

This is such an important responsibility that has its challenges at times but is also really rewarding at the end of the day.

Further reading for Midwives on Nurses.co.uk

See our careers hub section on Midwifery here.

Useful websites for Midwives

https://www.nmc.org.uk

https://www.midirs.org

https://www.sarawickham.com

https://www.rcm.org.uk/media/2374/the-gathering-storm-england-s-midwifery-workforce-challenges.pdf

https://www.all4maternity.com

https://www.magonlinelibrary.com/journal/bjom

https://www.rcm.org.uk/publications

http://www.practisingmidwife.co.uk