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How did trained and regulated midwifery affect maternal mortality rates?

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Midwives assisting a birth while astrologers consult sky charts; woodcut relief print from Jakob Rueff's De conceptu et generatione hominis (1554; The Expert Midwife). — midwifery Midwives assisting a birth while astrologers consult sky charts; woodcut relief print from Jakob Rueff's *De conceptu et generatione hominis* (1554; *The Expert Midwife*).

Historically, the presence of trained and regulated midwifery has been associated with improved health outcomes for mothers and infants. Even prior to the 20th century, regions that utilized trained and regulated midwives experienced comparatively lower rates of maternal mortality than areas where women relied on untrained helpers or delivered without assistance.1

In contrast, the lack of formal training in emergency techniques among lay or informally trained midwives has been associated with increased maternal and infant mortality. Consequently, the World Health Organization (WHO) classifies such practitioners as unskilled birth attendants and emphasizes that the training of midwives is essential to reducing infant mortality and improving maternal health.2

Modern professionalization, which includes standardized education and licensure, serves as a critical component of health care systems globally. By ensuring that midwives are equipped to manage normal births and recognize when to transfer care to a physician for complicated cases, regulated midwifery helps mitigate risks such as hemorrhage and infection, thereby supporting safer childbirth outcomes.3