Introduction
Problem and relevance
In Germany, midwifery training and the profession of midwife is poised to undergo
a deep-seated transformation as heralded by the current proposed amendment to the
German Midwifery Law [1]. The cornerstones for the proposed changes to future midwife training qualifications
were laid down in Directive 2013/55/EU of the European Parliament [2]. As the goal is to ensure freedom of movement within Europe, one of the new entry
requirements for starting midwifery training is 12 years of formal education. The
new German legislation aims for a complete academization of midwifery training by
January 18, 2020 as this will bring training in Germany in line with training in other
EU countries [2], [3]. This aim is rather at odds with the academization goals of the care professions
themselves; the German Science Council has proposed that initially only 20% of current
training places should be academic training places. In Germany, college-based training
will continue to be available in this field for work for some time to come [4]. Complete academization would mean that midwifery training would change from being
a skilled occupation where training is college-based to being an academic profession
with training carried out at university. This implies that in future, both the theoretical
and the practical components of the qualification would become more science-based
with a greater degree of analytical reflection. According to the German Qualifications
Framework, college degrees are classified as level 4 whereas Bachelor degrees are
classified as level 6 [5]. The rationale behind the proposed academization of the midwifery profession and
the switch to university-based training is that this takes account of midwivesʼ increasingly
complex and continually expanding scope of duties [6] and provides them with additional skills [7]. Just one year before the Directive must be completely transposed into national
law, it is still not clear when complete academization can be achieved in Germany.
Midwifery training in Germany continues to be largely college-based.
Objective
This paper presents the current status of the academization of midwifery training
in the context of German national law and the Model Clause. Current developments and
challenges created by the ongoing process of academization and the draft amendment
of the German Midwifery Law are described here.
Overview
Status of academization in 2019
In contrast to other European states where Directive 2013/55/EU has already been implemented
in full, in Germany in 2019 the majority of midwives still train in vocational training
colleges. This means that the professional qualifications of persons currently training
to become a midwife at one of the 62 German schools of midwifery [8] will no longer be recognized throughout the EU and that these persons will therefore
not be able to benefit from the free movement of peoples promoted by the Bologna Process.
Article 43 of the Directive states that EU member states will only recognize the qualifications
of applicants with an entry requirement of 10 years of general education if the applicant
began their midwifery training before 18 January 2016 [2]. As shown in [Table 1], currently there are 16 midwifery degree courses in Germany where students can either
obtain an academic degree (Bachelor of Science) in parallel to their vocational training
or can obtain a Bachelorʼs degree after completing their vocational training. Two further degree courses were identified,
which expected to start in the autumn of 2020, subject to regulatory approval (as
per: March 2019). Thus, one year before Directive 2013/55/EU enters into force, only
about 20% out of a total of just under 2800 midwifery training places in Germany are
based at institutions of higher education. The current versions of the German Midwifery
Law (Hebammengesetz, HebG) and the German Midwifery Training and Examination Regulations (Hebammenausbildungs- und Prüfungsverordnung, HebAPrV) constitute additional barriers to a further academization of midwifery,
as both of these bodies of regulations explicitly consider the job of midwife to be
an occupation that requires vocational rather than academic training. Because this
approach requires trainees to complete 3000 hours of practical training and because
of a number of explicitly formulated requirements which cannot easily be incorporated
into modular training systems, it is more difficult to set up academic degree courses
[9], [10]. This applies even more so to the model degree courses which are attempting to integrate
their training contents into the structures of university-based teaching. The initial
draft of new midwifery training regulations was only completed in March 2019.
Table 1 Type of qualification and college places of the midwifery degree courses which currently
exist in Germany.
|
Type of qualification
|
Location: cooperation partner(s)
|
Degree program, ECTS
|
College places/year, specific features
|
|
* The number of available places on these degree courses depends on the number of
clinical training places.
ECTS = European Credit Transfer and Accumulation System
|
|
Dual education/integrated vocational training (trainees receive vocational training
pay)
(cooperation between tertiary institution and school of midwifery – external partners offering practical training)
|
Berlin:
Evangelische Hochschule Berlin, School for Healthcare Professions Berlin GmbH, St. Joseph
Hospital Berlin Tempelhof and other hospitals in Berlin
|
B. Sc. Midwifery
240 ECTS
|
-
20 places
-
8 semesters for a dual degree (= academic degree + vocational certificate)
-
Part-time degree possible
-
Start in 5th semester as an on-the-job degree possible
|
|
Bremen:
University of Applied Sciences Bremen, cooperation partner(s) unknown
|
No information currently available
|
|
|
Hamburg:
Hochschule 21, Education Center for Healthcare Professions (BZG) of the Asklepios
Clinics Hamburg GmbH; UKE Academy, regional hospitals in the vicinity
|
B. Sc. Midwife
180 ECTS
|
|
|
Heidenheim/Ulm:
DHBW Heidenheim, Academy for Healthcare Professions Ulm, University Hospital Ulm and
teaching hospitals
|
B. Sc. Applied Science of Midwifery
210 ECTS
|
|
|
Jena:
Ernst Abbe University of Applied Sciences Jena, various hospitals in Thuringia
|
B. Sc. Obstetrics/Midwifery
240 ECTS
|
|
|
Karlsruhe:
DHBW Karlsruhe, Karlsruhe School of Midwifery, regional hospitals in the vicinity
|
B. Sc. Applied Science of Midwifery
210 ECTS
|
|
|
Ludwigshafen:
University of Applied Sciences Ludwigshafen am Rhein, midwifery schools in Heidelberg,
Lahr, Saarbrücken, Speyer and their associated hospitals
|
B. Sc. Midwifery
180 ECTS
|
|
|
Lübeck:
Lübeck University, UKSH Academy not-for-profit GmbH (school of midwifery), hospitals
all over Germany (including in Kiel, Lübeck, Husum, Itzehoe)
|
B. Sc. Midwifery Science
|
|
|
Mainz:
Catholic University of Applied Sciences Mainz, various schools of midwifery and hospitals
in the Rhein-Main area
|
B. Sc. Health & Care, main focus Midwifery
210 ECTS
|
|
|
Munich:
Catholic University of Applied Sciences, cooperation partners unknown
|
B. Sc. Midwifery
210 ECTS
|
|
|
Osnabrück:
Osnabrück University of Applied Sciences, midwifery schools all over Germany, partners
offering practical training all over Germany
|
B. Sc. Midwifery
180 ECTS
|
|
|
Stuttgart:
DHBW Stuttgart, midwifery schools in Stuttgart, Winnenden, Heilbronn, hospitals in
the vicinity
|
B. Sc. Applied Science of Midwifery – Midwifery
210 ECTS
|
|
|
On-the-job model (no vocational training pay; tuition fees possible)
(only university-based)
|
Dresden:
DIU Dresden International University
|
B. Sc. Midwifery
180 ECTS
|
|
|
Stuttgart/Horb:
DHBW Stuttgart (Campus Horb)
|
B. Sc. Applied Science of Midwifery – expanded practical midwifery
210 ECTS
|
|
|
Cologne:
Catholic University of Applied Sciences North Rhine-Westphalia
|
B. Sc. Midwifery
180 ECTS
|
|
|
Dual primary qualification (no vocational training pay)
(cooperation between university and external partners offering practical training)
|
Bochum:
Bochum University of Applied Sciences
|
B. Sc. Midwifery
210 ECTS
|
|
|
Fulda:
Fulda University of Applied Sciences, various regional hospitals are partners offering
practical training
|
B. Sc. Midwifery
210 ECTS
|
|
|
Dual primary qualification (no vocational training pay)
(cooperation between university and internal partners offering practical training)
|
Tübingen:
Eberhard Karls University of Tübingen and Tübingen University Hospital
|
B. Sc. Midwifery Science
210 ECTS
|
|
Type of qualification offered by current degree courses
The degree courses currently on offer in Germany range from dual education/integrated
vocational training degrees, on-the-job degrees and dual primary qualification degrees,
although the majority are dual education/integrated vocational training degrees ([Table 1]). The latter are easiest to implement within the framework of existing statutory
regulations.
With dual education/integrated vocational training courses, students attend a regular school of midwifery and complete the mandatory hours of
practical training on the premises of the respective cooperation partner. They are
also enrolled at a university of applied sciences which awards the overall ECTS points
(ECTS = European Credit Transfer and Accumulation System) for the theoretical and
practical components of training and additionally requires the student to attend specific
academical modules with ECTS points and complete a Bachelor thesis [11], [12].
With on-the-job degrees, students have a choice of obtaining a degree either by attending specific college
classes or obtaining their qualifications by distance learning. These courses are
available to students who have already completed their training at a school of midwifery.
While this model offers a good opportunity for midwives who have already qualified
to obtain further qualifications and get a bachelor degree through second-chance education,
the model is less attractive for future high-school graduates. They would first need
to complete 3 yearsʼ training at a school of midwifery followed by a further 6 semesters,
during which they would be required to attend certain weeks in person, and they would
need to do all of this in parallel to their regular work (as well as possibly paying
tuition fees).
Finally, dual primary qualifying degree courses teach all of the professional skills required by the HebG and HebAPrV as well as
the relevant academic (university-based) competences [11], [12]. Universities and colleges can either collaborate with external partners who will
offer the required hours of practical training or with their associated university
hospitals and offer all required modules without an external partner. Offering primary
qualifying training at university is currently made more difficult by the legal requirements
in the existing Midwifery Law which state that theoretical education must be obtained
from a school of midwifery. At present therefore, the three existing degress with
primary qualification (Bochum University of Applied Sciences and Fulda University
of Applied Sciences (who work together with external partners to offer dual practical
training) and Tübingen University (which has its own university hospital) are covered
by the Model Clause which allows federal states in Germany since 2009 to deviate from
the requirement that education offered at state-approved schools must comply with
the state-approved training and education regulations, and permitting them to do so
“for a limited period of time” in order to “test educational and training programs which might help to further develop” a specific profession “while taking account of the professionʼs specific requirements” [9], [13].
When the degree courses are compared with the respective locations where training
is still predominantly provided by colleges it becomes obvious that 9 months before
Directive 2013/55/EU is implemented, training at 77% of all locations is still carried
out in schools of midwifery ([Fig. 1]). 15% of training places are in dual education/integrated vocational training courses
and just 4% of training places are in primary qualifying degree courses.
Fig. 1 Organization of midwifery training in Germany (as per: March 2019).
Amendment of the German Midwifery Law
An amendment of the German Midwifery Law planned for 2020 will transpose the provisions
of Directive 2013/55/EU into national law. The current draft of the amended law dated
March 2019 implements the academization. In future, all students will be required
to complete a tertiary institutionʼs degree course to obtain the professional title
of “midwife” (a previously accepted term “male midwife” will be deleted) and this
will replace vocational training in colleges: “The midwifery university-based degree course teaches the professional and personal
skills required to work independently and comprehensively as a midwife in hospital
and on an outpatient basis”
[14]. In the draft law, the number of required practical hours have been appreciably
reduced from the current figure of 3000 hours to 2100 hours, with more time given
over to curriculum-based teaching. Moreover, the draft envisions module-based theoretical
and practical teaching, although the state examination required to obtain the official
title of midwife may be a module-based exam carried out over the last two semesters.
The necessary revision of the state study and examination regulations is still being
drafted by the Federal Ministry of Health [14]. Important is that the law draft considers dual degree courses on universities as
well as on universities of applied sciences. At the same time, the draft emphasizes
that all theoretical classes are the responsibility of tertiary institutions and that
from 2030 the cooperating hospitals will be responsible for organizing the practical
guidance and training. But the faculty offering the degree course will also bear the
overall responsibility for both the theoretical and the practical training. The schools
of midwifery have been offered the opportunity to cooperate in the area of practical
training until 2030 as this should allow their existing staff sufficient time to obtain
additional qualifications themselves. Not every tertiary institution has an affiliated
university hospital, which is why “dual degrees” may require some colleges to look
for one or more external partners to provide the practical modules [14], [15]. But there will no longer be a legal basis for the dual education/integrated vocational training model, which currently makes up the majority of existing degree courses (cf. [Table 1]), as with this type of training (in accordance with the still valid Midwifery Law
without having recourse to the Model Clause) the schools of midwifery are also responsible
for part of the theoretical training. The planned change in the legislation means
that this will no longer be possible [14]. According to the draft law, persons applying to study midwifery must either have
completed high school or completed a three-year nursing training course at a technical
college, which currently does not require students to have completed 12 years of general
education [14]. Although it is possible that this is an attempt to mitigate against the lack of
trained midwives by offering the option of an alternative entry to the profession
of midwife, it directly contradicts the regulations of Directive 2013/55/EU which
state that the only eligibility criterion for starting midwifery training is 12 years
of general education [2]. Moreover, this points to the creation of an incipiently dualistic academic system
with a parallel system of regular universities and universities of applied sciences,
as a general school-leaving certificate obtained after twelve years of education or
a qualification recognized as its equivalent is required to be admitted to study at
any university. The draft legislation also requires improvement in other areas; thus,
it suggests that students could be paid a vocational training allowance. This would
run counter to specific provisions in the state laws on universities and colleges
of numerous federal states which assert a different legal status for students compared
to apprentices or employees. Representatives of the umbrella organizations united
in the National Association of Health Insurance Companies (GKV) have indicated that
they would classify vocational training pay offered in the context of degree courses
(which are regulated by the individual federal states) as an extraneous non-system
benefit and would currently refuse to finance such payments. The proposals can only
be implemented in the context of dual education/integrated vocational training degrees.
However, once the new training regulations have been implemented, there will be no
legal basis for such degrees as in future, the existing schools of midwifery will
no longer be permitted to contribute to curriculum teaching [14].
Primary qualification as the silver bullet
The long overdue amendment of the Midwifery Law will make it easier to push the concept
of primary qualifying degree courses (with or without an external partner for practical
training). This model is already in widespread use in the EU [16], [17]. The reform will phase out dual education/integrated vocational training degrees.
Part of the theoretical training in dual education/integrated vocational training
degrees is provided by schools of midwifery, and it has been found that they largely
only offer additional academic skills, meaning that students are less likely to be required to consistently
consider the theoretical and scientific implications of their professional actions.
But this is precisely one of the important goals of academic midwifery training in
many of the countries bordering Germany, where this approach has been implemented
for several years [16], [17], [18], [19], [20]. The German Science Council has recommended that midwifery degree courses should
be designed as primary qualifying degrees, not least because in addition to fostering
their practical skills it will also encourage the development of academic skills.
The Science Council therefore suggests that midwifery degree courses should primarily
be set up at universities (if they have a medical faculty) as this will facilitate
interprofessional training in medicine and ensure that the degrees will have high
academic standards [4]. The German Science Council is of the opinion that medical faculties are therefore
best suited to comply with the regulations of Directive 2013/55/EU, as the Directive
also requires students to be given extensive evidence-based teaching in general medicine,
pharmacology and perinatal medicine and how they affect obstetric issues [2]. Given that issues of pregnancy, parturition, puerperium and neonatal care are becoming
ever more complex, it is becoming increasingly important that midwives working in
Germany have far-ranging, specialized, practical and scientific knowledge and skills
[21]. The impact of the new skill levels of academically trained midwives on neonatal
mortality and method of delivery, to name just two examples, will need to be investigated
in detail. To date, there has been no significant reduction in the rate of cesarean
sections following the complete academization of the midwifery profession in individual
EU member states, which is why the relevant statements in the draft legislation are
only hypotheses and should be understood and identified as such. This once again demonstrates
the fundamental importance of scientific evidence in the process of academization
as it provides the basis for practical action and teaching. In future, there will
be an increased emphasis on the quality of both medical training and university-based
midwifery training, with comparative indicators used to monitor the quality of midwifery
and obstetric medicine [22].
Both the regulations of Directive 2013/55/EU and the recommendations of the German
Science Council highlight the necessity of developing evidence-based concepts for
midwife-led obstetric care [14]. They can be taught at university centers combining midwifery research with medical
research in the fields of obstetrics and perinatology, as such centers foster the
teaching and development of the requisite competences [4]. Moreover, medical faculties can ensure that students of medicine and students of
midwifery are made aware early on that in future, the two professions must work together
across the disciplines to overcome the challenges they may face when caring for women
and their infants during pregnancy and parturition and in puerperium. While (academically
trained) midwives bear the responsibility for the physiological processes, physicians
are responsible for dealing with pathological events. But both professions need to
have an extensive knowledge of the other specialty, particularly as theoretical differentiation
is extremely challenging in practice and may be the subject of controversial disputes.
Allowing physicians to provide medical care without a good understanding of physiological
pregnancy, birth and puerperium would be as inexpedient as midwives offering care
without a good understanding of pathological events and their prognoses, the importance
of intercurrent illnesses, and psychosocial factors and their impact. Both professions
must be allowed to train in those areas of the other discipline which focus on pregnancy
and birth. A science-based decision when the course of pregnancy is expected to be
physiological and when it is expected to be pathological can and must be made by practitioners
of both professions working together and using comparable evidence-based knowledge.
This already needs to be taken into account as part of interprofessional skills training
during academic training and amounts to a paradigm shift [23], [24], [25], [26].
In October 2018, Tübingen University and Tübingen University Hospital rose to the
challenges described above and established the first university-based bachelor degree
on midwifery science in Germany, created as a primary qualifying degree. Already in
the first semester students are taught to continually consider the scientific implications
of their actions (also with regard to their practical skills) and develop the relevant
skills using a longitudinal approach. [Table 2] shows the key elements of the path taken in Tübingen to transform the discipline
of midwifery/science of midwifery into an evidence-based specialist discipline and
profession [27]. The degree course is taught by the faculty of medicine and aims to deal with the
increased challenges in obstetrics by offering interprofessional teaching as recommended
by the German Science Council to ensure that midwifery training will be strongly linked
to the medical training given to students wanting to become physicians [28], [29]. The practical study phases are entirely modular and have been incorporated into
the study area “Midwifery duties in theory and practice”.
Table 2 Curriculum of the primary qualifying B. Sc. Science of Midwifery degree course in
Tübingen.
|
Module
|
1st sem.
|
2nd sem.
|
3rd sem.
|
4th sem.
|
5th. sem.
|
6th sem.
|
7th sem.
|
Σ (ECTS)
|
|
1 Study area “Midwifery science skills”
2 Study area “Theoretical medicine and the natural sciences”
3 Study area “Health and social sciences”
4 Study area “Midwifery duties in theory and practice”
ECTS = European Credit Transfer and Accumulation System
|
|
Healthcare and welfare systems in the context of the practice and science of midwifery1
|
3
|
|
|
|
|
|
|
3
|
|
Health science/midwifery science thinking and methodological skills1
|
3
|
|
|
|
|
3
|
6
|
12
|
|
Social, conversational, communication and observational skills3
|
3
|
|
|
|
|
|
3
|
6
|
|
Basic principles of physiology and anatomy2
|
3
|
|
|
|
|
|
|
3
|
|
Microbiology and hygiene2
|
3
|
|
|
|
|
|
|
3
|
|
Midwifery duties and care: self-perception and basics4
|
15
|
|
|
|
|
|
|
15
|
|
General medical competences, emergency medicine, vital functions2
|
|
6
|
|
|
|
|
|
6
|
|
Scientific basics2
|
|
3
|
|
|
|
|
|
3
|
|
Prevention and health promotion1
|
|
3
|
|
|
|
|
|
3
|
|
Care and management during puerperium and lactation4
|
|
18
|
|
|
|
|
|
18
|
|
Obstetric skills, gynecology and female health2
|
|
|
6
|
|
6
|
|
|
12
|
|
Management of pregnancy4
|
|
|
12
|
|
|
|
|
12
|
|
Birth attendance and care4
|
|
|
12
|
|
|
|
|
12
|
|
Psychosocial, ethical and legal aspects of midwifery3
|
|
|
|
6
|
|
|
|
6
|
|
The neonate4
|
|
|
|
12
|
|
|
|
12
|
|
Care of women in puerperium4
|
|
|
|
12
|
|
|
|
12
|
|
Relationships/family, bonding, female health, health literacy3
|
|
|
|
|
3
|
|
|
3
|
|
Monitoring pathological/abnormal birth4
|
|
|
|
|
6
|
|
|
6
|
|
Surgical care of pregnant women and of women giving birth4
|
|
|
|
|
9
|
|
|
9
|
|
Pathological and abnormal course of pregnancy4
|
|
|
|
|
9
|
|
|
9
|
|
Child development disorders and diseases4
|
|
|
|
|
|
6
|
|
6
|
|
Interventions in standard and complex situations4
|
|
|
|
|
|
18
|
|
18
|
|
Professional skill colloquium1
|
|
|
|
|
|
3
|
|
3
|
|
Midwifery in the German healthcare system, quality concepts, economics1
|
|
|
|
|
|
|
3
|
3
|
|
Evidence and clinical decision-making1
|
|
|
|
|
|
|
3
|
3
|
|
Applied science of midwifery (1 out of 4 choice of modules)1
|
|
|
|
|
|
|
3
|
3
|
|
Bachelor thesis1
|
|
|
|
|
|
|
12
|
12
|
|
Total
|
30
|
30
|
30
|
30
|
30
|
30
|
30
|
210
|
|
Practical study phases
|
|
|
|
|
|
|
|
|
|
Conservative and surgical care4
|
+
|
+
|
|
|
|
|
|
|
|
Puerperium4
|
|
+
|
|
+
|
|
|
|
|
|
Neonatal unit4
|
|
+
|
|
+
|
|
|
|
|
|
Delivery room4
|
+
|
|
+
|
+
|
+
|
+
|
|
|
|
Pediatric hospital4
|
|
|
|
|
|
+
|
|
|
|
Outpatient care/external4
|
|
|
|
|
|
+
|
+
|
|
|
Delivery room and surgery4
|
|
|
|
|
+
|
|
|
|
|
Peripartum care4
|
|
|
+
|
+
|
+
|
+
|
|
|
As the aim is the full academization of midwifery training, this degree course can
help to train specialist midwives who will be taught scientific skills to allow them
to deal with the challenges of midwifery work in general practice and ensure that
medical interventions will be science-based. The degree course aims to meet the need
for well-qualified experts, scientists and leaders with excellent practical skills
who are able to work both in hospitals and in an outpatient setting. The degree course
covers the full range of typical midwifery work and additionally offers comprehensive
scientific and practical training at a university level while also teaching the necessary
basic skills to enable students to work as a midwife as well as carrying out academic
work in the field of midwifery and the health sciences [30].
Conclusions
The draft of the new Midwifery Law strongly promotes the full academization of the
midwifery profession. However, the specifications and modifications of the draft legislation
need to be more clear-cut to ensure that they comply with Directive 2013/55/EU and
for new study courses to be implemented quickly. This step was taken very late, and
the suggested timeline for implementing the EU directive is very short. Moreover,
the overall financing proposed in the draft legislation has not yet been settled at
either the federal or the Länder level. The current draft law is not yet capable of
dealing with the many challenges in obstetrics by offering a coherent approach because,
although the recommendations of the German Science Council with regard to quality
and excellence have been implicitly referenced, no quality criteria and (it should
be noted) no effective measures for quality control have yet been explicitly defined.
Even though the new draft Midwifery Law promises that the profession of midwife will
become entirely academized, the law remains vague with regard to how this will be
realized concretely. This has made it more difficult for universities and universities
of applied sciences to develop and establish skills-based degree courses. What is
needed both at the level of curriculum concepts and for the organization of practical
training is the creation of operationalized guidelines for Germany, which would support
the development and implementation of midwifery science degrees. If the draft legislation
is introduced, the majority of the degree courses currently available in Germany will
lose their accreditation because they are dual education/integrated vocational training
courses. The curriculum teaching currently provided by schools of midwifery will have
to be entirely taken on by universities and universities of applied sciences. Because
of the provisions of the currently effective Midwifery Law, primary qualifying midwifery science degree courses are extremely
rare in Germany in contrast to other European countries. The delayed implementation
of academization coupled with weaknesses in the current legislation and the deficiencies
of the proposed draft legislation suggest that we need to think about the lasting
threat posed to the high quality of obstetrics in Germany. Numerous schools of midwifery
are already no longer able to fill vacant teaching staff posts, as interested teachers
– insofar as their qualifications permit it – tend to want to work in academic-based
degree courses. The German Society of Gynecology and Obstetrics and the Professional
Association of Gynecologists fear that this may intensify the already appreciable
lack of midwives, quite apart from any discussion on suitable conditions of work.
An assessment report by the federal government before the final amendment of the law
would be very useful. The development of degree courses by individual federal states
needs to be coordinated across all of Germany. The regulations of the federal states
suggest that, here too, the process of academization is likely to be delayed.
The current draft of the Midwifery Law promotes the academization of midwives – a
small group of professionals – at differing academic levels. A discussion is needed
about whether such a development is desirable. It would be inconceivable if this were
medical training provided to nascent physicians. Because of the limited links to medical
research centers, hospitals and medical faculties which would be needed to promote
a science-based capacity for reflection and interprofessional competence in obstetrics
and obstetric medicine, universities of applied science are not well suited to adequately
address the challenges arising from the regulations on quality and excellence. In
contrast to other groups of health professionals, midwives are expected to be able
to carry out their defined duties to support physiological pregnancies, assist at
physiological births and support mother and child during puerperium independently, i.e. without medical advice from a physician. Because of the overlap in medical
competences, it is important to remember that a 7-semester bachelor degree cannot
be equated one-to-one with a 12-semester medical degree and a further 5 years of medical
specialist training. The academization of the profession of midwife does not just
highlight the need to set up more primary qualifying bachelor degree courses but suggests
that designing Masterʼs degree courses should also be considered in the context of
the Bologna system as this could offer additional professional perspectives [31]. High-quality science-based obstetrical training which also covers other areas of
high-performance medicine must enable future midwives to make evidence-based and analytically
reflected decisions and develop further in their field. The legislature will need
to make more concrete proposals, and professional organizations and advocacy groups
will need to come off the fence and clearly state their positions if they wish to
encourage the redevelopment of the profession in such a way that it reflects the guiding
principles on which the EU directive is based. This is the only way to achieve the
overall objective of creating a new academic midwifery training system and thereby
continuing to improve the care offered to mothers, infants and their families.
