Risk Management Tools & Resources


Eight Strategies for Creating a Culture of Safety for Midwives

Marcy A. Metzgar


The United States is facing a maternity healthcare provider shortage. What may reverse this trend is a robust and more diverse workforce of midwives educated through professionally accredited midwifery education programs.1

According to the Bureau of Labor Statistics, the overall employment of nurse-midwives, nurse anesthetists, and nurse practitioners is projected to grow 40 percent between 2021 and 2031, much faster than the average for all occupations.2

Projections of more nurse-midwives entering the field brings the opportunity for them to help reduce maternal mortality/morbidity in the United States.3 However, to help reduce errors and optimize outcomes for their patients, midwives should work within a culture of safety and be valued for their high-quality care and contributions.

Here are eight strategies to instill a culture of safety in which midwives will flourish:

  1. Midwives should remain current in their knowledge of evidence-based practice, professional standards and guidelines, and the identification of best practices to ensure the delivery of safe, timely, effective, efficient, patient-centered, and equitable care.
  2. Midwives should implement strategies that address communication barriers and foster open, effective, and ongoing communication among all team members. Additionally, midwives should adhere to a formal mechanism for transfer of care between providers.4
  3. Midwives should use standard abbreviations and nomenclature to reduce the risk of errors.5
  4. Midwives should educate patients regarding outcomes, benefits and risks of treatments, potential side effects, and alternatives.
  5. Midwives should actively involve patients and their families in decision-making. Care should be holistic, patient-centered, and relationship-based, and it should recognize and value participants in the care process.
  6. Midwives should thoroughly document consultations, informed consent processes, collaborative management, and referrals to other specialists in patients’ health records.
  7. Midwives should participate in quality management programs to increase safety. Measures that improve the quality of care include (but are not limited to) process and outcome measurement and analysis of near misses, sentinel events, and root causes.6
  8. Midwives should become active in quality improvement research and policy development, with the goal of achieving a high-quality, high-value maternity care system.7

For more information, please see MedPro’s Risk Q&A: Scope of Practice for Midwives.


1 Accreditation Commission for Midwifery Education, & American College of Nurse-Midwives. (2019). Midwifery education trends report. www.midwife.org/acnm/files/acnmlibrarydata/uploadfilename/000000000321/Midwifery_Education_Trends_Report_2019_Final.pdf

2 U.S. Bureau of Labor Statistics. (2019). Nurse anesthetists, nurse midwives, and nurse practitioners. Retrieved from www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm

3 Accreditation Commission for Midwifery Education, & American College of Nurse-Midwives. Midwifery education trends report.

4 American College of Obstetrics and Gynecologists. (2007). Communication strategies for patient handoffs. ACOG Committee Opinion No. 367. Obstetrics Gynecology, 1091:1503-1505.

5 American Academy of Family Physicians, American Academy of Pediatrics, American College of Nurse-Midwives, et al. (2012). Quality patient care in labor and delivery: a call to action. Journal of Midwifery & Women's Health, 57(2):112-113. doi:10.1111/j.1542-2011.2011.00163.x

6 American College of Nurse-Midwives. (2016). Position statement: Creating a culture of safety in midwifery care. Retrieved from www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000059/Creating-a-culture-of-safety-in-midwifery-care-MAR2016.pdf

7 Ibid.

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