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Which countries use both direct-entry midwives and nurse-midwives?

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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*).

Worldwide, there are two primary approaches to licensed midwifery practice: nurse-midwifery, which requires prior nursing education, and direct-entry midwifery, where individuals enter the profession through specialized training that is not based in nursing.1

Several countries maintain training and licensure for both of these approaches, including:

Canada1
Ghana1
Kenya1
The United Kingdom1
The United States1

In these nations, the two types of midwives often coexist to provide care across various settings, including homes, birth centers, and hospitals. While nurse-midwives typically complete postgraduate education after becoming nurses, direct-entry midwives receive formal training specifically for midwifery practice.1