Midwifery’s complicated relationship with gender

There are a significant number of men who are midwives globally. This opportunity has been available in the UK since 1982, yet there remain few within the NHS. Dr John Pendleton, Senior Lecturer in Midwifery (University of Northampton) & Honorary Research Fellow (Coventry University) reflects on their history, current attitudes towards gender diversity within midwifery, and whether services are prepared for change. 

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Men have only been fully allowed to work as midwives since 1982 and since that time very few have taken up the opportunity. Figures show that the number of men registered as midwives has remained stubbornly static and we constitute only 0.3% of the professional population (Nursing and Midwifery Council, 2024).  Considering the outcry at ending midwifery as a woman-only profession, there has been remarkably little research about what it feels like for men working in this contested domain, something I decided to correct with my PhD study.  As soon as I mentioned interviewing men who worked as midwives to colleagues, they were very keen to tell me that it would be good to be able to prove once and for all that there really is no issue with men in midwifery.  They said, “What’s the difference between men working as obstetricians and men working as midwives?” or, as one of the participants in my study told me, “Same job, different genitalia!”  So far, so simple – in the 21st century it seems midwifery is not who you are, it is what you do.  This differs very much from the view in 1978 when the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) argued that “the fact that the midwife is a woman is an important part of her function”(McKenna, 1991). My journey exploring this topic showed me that bracketing away gender – the social and cultural identities and behaviours associated with a particular sex – is far from easy.  Even within the men I interviewed there was no consensus, with some arguing they were a midwife who “just happens to be a man” whilst others felt that there were “very few moments when I wasn’t aware of my gender.”  In fact, perhaps the only thing they did agree on was that they hated the term “male midwife.”  As one explained, it was (female) midwives’ way of saying “You’re a midwife, but you’re a ‘Male Midwife,’ so you don’t get the title without this little add-on because that just lets everybody know that we’ve let you in, you’ve got the badge, but you’ve got this other sticker that says you’re not really one of us.”   

To understand this in more detail, it’s helpful to turn to where it all began.  Buried in the archives of the British Library lies a 93-page type-written report from 1982 on the “experimental” schemes in England and Scotland to test the “acceptability” of men working as midwives (Speak and Aitken-Swan, 1982).  The report concerned itself with establishing whether having “male midwives” performing intimate care could ever be “acceptable.”  It makes fascinating reading largely because the choice of words and phrases belong to a bygone era, and in today’s politically charged atmosphere many of the sentiments might not be so openly articulated.  Consider this statement: “Consultant obstetricians… were doubtful about the sort of men who would want to train as midwives and about their motivation.”  Or this: “At an emotional time it would not be difficult for the ministrations of the male midwife to arouse sexual anxieties in the husband.”  These anxieties – that men wanting to be midwives were either perverts or at risk of abusing their power over women at a particular moment of vulnerability – foreshadow conversations about the significance of single-sex spaces that continue to reverberate in the 21st century.  The Royal College of Nursing and the RCOG, along with most NHS Trust guidelines, state that chaperones should be offered for any intimate procedure regardless of the sex/gender of the practitioner to protect them from medico-legal challenges.  The RCM, however, does not offer any guidance on this matter and I have never known a midwife to offer one prior to any episode of care.  In the 1982 report the Scottish study decided not to insist on the use of chaperones for male students as “midwives in Scotland believe that the introduction of another member of staff, especially a nursing auxiliary, merely to act as a chaperone would counter the establishment of the close relationship which needs to be developed between the midwife and mother.”  It was – and likely still is – inconceivable for most within and without the profession that intimate care procedures could ever be opportunities for abuse by women working as midwives on the people they are caring for.   

Conversely, what came across clearly from the men I interviewed was that they were in fact acutely aware of the power dynamics within their interactions with service users and their partners and, in the absence of chaperones, worked hard to find ways to navigate them.  Most commonly this involved giving lots of detail around any examinations and interventions to gain fully informed consent before proceeding, considering where to position themselves in the rooms, attempting to make their sexuality non-threatening by indicating if they were gay or married, and paying close attention to maintaining the dignity of the person they were caring for.  Recent scandals within NHS Maternity services show that abuse of power is not isolated to any one demographic or profession, and there is significant evidence of interventions being delivered without consent both in the UK and globally, including by midwives, contributing to rising levels of obstetric violence and PTSD (Pijl et al., 2024).  Having to repeatedly account for their gender, whilst tiring, is incredibly helpful for men working as midwives and the people they support.  It makes visible the dynamics of power which we all need to acknowledge when building the relationship of trust highlighted by Speak and Aitken-Swann as a hallmark of midwifery, and which seems increasingly difficult to achieve for all with the current pressures and fragmentation of maternity services.  Gender, rather than a barrier, can in fact be a facilitator to effective care when it is accounted for.     

Having to make room for a small number of men does raise a few practical issues beyond chaperonage.  Several men told me about labour ward workloads having to be reallocated when their care was declined and, humiliatingly, another had to wear a female uniform because a midwifery tunic without bust darts simply didn’t exist.  It also raises existential questions such as whether the name should change. The men I interviewed repeatedly get called midhusbands because, unsurprisingly, most people don’t speak 15th century Middle English and therefore don’t understand the original meaning of the word midwife.  It’s easy to see why some – maybe even most – people might feel it would be a lot simpler if things had just stayed the way they were back in the 1970s.  After, all, does the profession even need us?  Wasn’t it doing just fine without us?  As one man was told, “This is a woman only club! There’s plenty of men in obstetrics, there’s anaesthetics and all the rest of it, but this bit is ours!”  Men were allowed into the profession not because we were wanted – far from it – but to bring it in line with EEC legislation on sex discrimination in the workplace.  Speak & Aitken-Swann’s study rather grudgingly concluded that “if male nurses are admitted to the profession, it will not be so much because they are wanted in it but because people can see no very good reason for keeping them out.”  Fortunately for decades very few men wanted to be midwives, probably because the loss of social status for joining a gender-incongruent profession is too high a price to pay for most men.   

Historically midwifery had no reason to actively seek them as it was seen as a prestige healthcare profession oversubscribed with applicants, and so a status quo has been quietly maintained with men constituting only a token presence.  However, in response to an escalating staffing crisis and decrease in the number of applicants to midwifery degrees, international recruitment of midwives has become a key part of the NHS’s strategic vision when previously it had only actively recruited nurses from overseas.  Given that the highest numbers of men with a midwifery qualification are found in sub-Saharan Africa, it is foreseeable that more men could be brought into the profession once again by socio-economic and political necessity.  It remains to be seen whether this will swell the male midwifery workforce beyond its current marginal status, nor how midwifery will grapple with the twin issues of race and gender combined if it does, given that midwifery is significantly less diverse in most matrices than other allied professions within the NHS (Pendleton et al, 2022).  What this does show is that the conversation around men in midwifery has often focused at the level of the individual, described by one participant as ensuring that only the “right kind of man” is allowed in.  This risks diverting attention away from seeing gender as an integral part of a web of political, legal, and economic systems of power which affect all of us in complex ways which need to be continually reevaluated.    

It seems that gender has a habit of cropping up even when it is not anticipated to be part of the conversation, and this is never truer than in the past five years.  In 2020 midwifery was specifically excluded from recruitment drives to actively increase the number of men working in the healthcare (Research Works Ltd. for the Office for Students, 2020) with no explanation offered as to why this might be.  For most professions increasing the number of men might be important to reflect the diversity of the people accessing their care and this doesn’t apply to midwifery because, after all, only women get pregnant, don’t they?  Back in 1982 Speak & Aitken-Swann’s report was grappling with the acceptability – or not – of men within an all-female profession without questioning who or what a man or woman was, or the possibility that people could sit outside of these binary categories.  The number of pregnant trans masculine and non-binary service users accessing midwifery care is not known but the experiences are emerging in the literature (Pezaro et al., 2023) and they are likely to become increasingly visible. Furthermore, there are more midwives who do not identify with the sex that they were assigned at birth than those who identify as male (NMC, 2020).   

Midwifery’s relationship with gender has taken a new turn unimaginable to Speak and Aitken-Swan 40 years ago.  It’s likely, therefore, that midwifery can no longer afford to hope that people will quietly slot into the existing systems or sidestep opportunities to have difficult conversations about, for example, how to accommodate trans men and non-binary people in language, changing rooms, and policies.  Fortunately, what I have also learned through my work teaching student midwives is that they in fact desire inclusivity, even if it’s not always clear how to achieve it.  Centring gender along with conversations on race, class, sexuality, and disabilities within the curriculum has helped shift people from having to choose a side (“This bit is ours!” versus “Same job, different genitalia!”) to asking, “How can we be more inclusive to everybody?” And that feels like positive progress. 

References 

McKenna, H., 1991. The developments and trends in relation to men practising midwifery: a review of the literature. J. Adv. Nurs. 16, 480–489. https://doi.org/10.1111/j.1365-2648.1991.tb03439.x 

Nursing and Midwifery Council, 2020. Nursing and Midwifery Council response to the Women and Equalities Committee’s inquiry into Reform of the Gender Recognition Act. https://www.nmc.org.uk/globalassets/sitedocuments/consultations/2021/nmc-submission-to-women-and-equalities-committee-inquiry-into-reform-of-the-gender-recognition-act.pdf 

Nursing and Midwifery Council, 2024. Equality and diversity reports [WWW Document]. Equal. Divers. Rep. URL https://www.nmc.org.uk/about-us/reports-and-accounts/equality-and-diversity-reports/ 

Pendleton, J., Clews, C., Cecile, A., 2022. The experiences of black, Asian and minority ethnic student midwives at a UK university. Br. J. Midwifery 30, 270–281. https://doi.org/10.12968/bjom.2022.30.5.270 

Pezaro, S., Crowther, R., Pearce, G., et al  2023. Perinatal care for trans and non-binary people birthing in heteronormative “maternity” services: Experiences and educational needs of professionals. Gend. Soc. 37, 124–151. https://doi.org/10.1177/08912432221138086 

Pijl, M.S.G. van der, Essink, M.K., Linden, T. et al., 2024. Consent and refusal of procedures during labour and birth: a survey among 11 418 women in the Netherlands. BMJ Qual. Saf. 33, 511–522. https://doi.org/10.1136/bmjqs-2022-015538 

Research Works Ltd. for the Office for Students, 2020. Male participation in nursing and allied health higher education courses. https://www.officeforstudents.org.uk/publications/male-participation-in-nursing-and-allied-health-higher-education-courses/ 

Speak, M., Aitken-Swan, J., 1982. Male midwives: A report of two studies. DHSS, London 

Dr John Pendleton 

Senior Lecturer in Midwifery (University of Northampton) & Honorary Research Fellow (Coventry University) 

March 2025