Japanese Nursing Association (JNA)
Initiatives Designed to Promote
Midwifery in Communities
Survey on opportunities for midwives to harness their expertise (2022)●The survey also showed that, when providing support for women withpsychiatric disorders or lifestyle diseases, midwives coordinate their workwith many other professionals including physicians from otherdepartments and public health nurses from outside the hospital. As such,the data shows that midwives play an important role in improving thequality of care provided to women and babies in communities.

●JNA conducted this survey to understand the current situation andongoing challenges related to opportunities for midwives to harnesses
their expertise, with the aim of helping JNA determine the content of its
assistance and policy proposals, so as to further improve care for births
and women’s health.
●The survey showed that the percentage of midwives responding that “thedecision is made at the discretion and judgment of the midwife” or “thedecision is made at the discretion and judgment of the midwife following
advance consultations with the physician on rules” exceeded 80% for 16of the 17 decisions made from the ﬁrst stage to the fourth stage of anormal birth, indicating the prevalence of midwife-led care.

●89.8% of midwives who responded said they hope to continue working asmidwives.

Occupations that collaborated last year
(own workplace) (multiple answers)

Midwife's discretion and judgment in midwifery diagnosis regarding normal birth (multiple answers)
Even if the progress is normal, conducted at the discretion and judgment of
the midwife following advance consultations with the physician on rules
No answer

Conducted at the discretion and judgmentof the midwife due to the normal progress

1st stageof labor

49.2■ Diagnosis of labor onset

69.6■ Diagnosis of rupture of membranes

48.9■ Diagnosis of process of labor

47.2■ Diagnosis of fetal health41.4■ Judgment of pelvic examination andpelvic examination ﬁndings

54.1■ Starting and evaluation of CTG monitor

46.5

44.6

2.1

■ Nursing※1 staff in otherdepartments※2

2.7 2.0■ Licensed Psychologists/
Clinical Psychologists

4.1
25.7

4.2

44.7
47.0
53.0
40.6

71.6

■ Certiﬁed Social Workers/
Mental Health Social Workers(including medical social workers)

Not determined(n=3469)■ Evaluation of the general conditionof the woman in labor■ Physicians from other departments(psychiatric, endocrinology, andother outpatient practices, etc.)

58.5

43.4

38.5

2.2

3.6

2.1

3.6

2.0

3.2

2.1

■ Certiﬁed Nurses/
Certiﬁed Nurse Specialists

27.3

15.5

■ Others

7.6■ Never collaborated

2.9 2.0

48.6

1.5■ No answer

2nd stageof labor■ Evaluation of the general conditionof the woman in labor

46.6■ Diagnosis of the course of labor

43.9

47.4
50.5

3rd stageof labor■ Diagnosis of fetal health

39.3■ Delivery assistance

51.3■ Evaluation of the general conditionof the woman in labor

43.6

3.7

2.3

3.4

2.2

3.6

54.9

2.2

2.5 2.2

44.0
50.1

3.9

4th stageof labor

6.0

2.5

■ Evaluation of the general conditionof the newborn

48.1

45.9

3.7

2.3

■ Evaluation of the general conditionof the woman in labor

46.3
9.0

■ Evaluation of the general conditionof the newborn

68.7

49.7

44.0

020

40608080100 (%)

regional cooperation departments, etc.
※2 Other than certiﬁed nurses and specialist nurses

88.8■ Administrative organizations
other than public health centersand health centers

2.3

28.7

■ Midwives at maternity homes

12.5■ Certiﬁed Public Psychologists/
Certiﬁed Clinical Psychologists

11.3■ Nursing staff at visiting
nursing stations

10.3

3.3
4.060

※1 Clinical departments such as psychiatry and endocrinology, outpatient departments,

2.4

19.040■ Public Health Nurses at public healthcenters and health centers

41.7■ Perineal lacerations assessment

202.4

49.8

3.40Occupations and facilities that collaborated last year
(other facilities) (multiple answers)■ Placental delivery

47.9(n=3469)

100 (%)

Investigations into the structures required
to support women and their families (2022)●Interviews were conducted to understand the extent to which midwives areable to exercise their expertise through advanced women’s healthcare
initiatives, including preconception care and support for menopausal health.

■ Others

4.2■ Never collaborated

5.81.8■ No answer(n=3469)●These investigations showed that, particularly in the best practice examples,projects that provide health support for women and allow midwives toconsistently and effectively exercise the specialist knowledge, include thefollowing eight functions:(1) Planning/management (2) division of responsibility (3) evaluation systems(4) ﬁnancial resources (5) facilities and equipment(6) securing human resources(7) thoroughly inform the service to potential users(8) human resource development / ensuring the quality of projects●Systems for securing human resources and smooth matching are required ifmidwives employed in hospitals are to make full use of their expertise inserving communities.

0JNA is the largest nursing
professional organization in Japan,
consisting of and operated byvoluntary individual members who
are licensed nurses.

Improving nursing quality
based on nursing
expertise rooted in educationand self-learning

4060

80

100 (%)

Future JNA initiatives●JNA is strengthening efforts to build the systems that enable women to get
access to midwife-led care in communities, while also taking further steps tomake the public aware of these efforts.
●To enable midwives to exercise their midwife-led care and serve the needs ofsociety, JNA is working to increase the adoption of CLoCMiP®(Clinical Ladderof Competencies for Midwifery Practice), to provide further educational
opportunities for midwives, and to deepen the involvement of midwives in theprofession of women’s healthcare.

Introduction to the JNA
Summary20Mission
Promoting the creationof an environment in which
nurses are able to continue
working peacefully throughout
their life

Developing and expanding
nursing areasto meet people's needs

Key activities of midwifery
Policy proposals♥ Summarizes the issues and opinions on maternal and infant, and make political
proposals to the national government and competent authorities.

Quality improvement of midwives♥ JNA developed the CLoCMiP® (2012).
♥ Midwives who have passed the CLoCMiP ® level Ⅲ certiﬁcation may work as
Midwifery in Japan Overview

Advanced Midwives.

♥ JNA also conducts various training programs designed to improve theJapanese Nursing Day Mascot
Kango-chancompetencies for midwifery practice.

Basic Information on Japanese Midwives
Acquire the midwife license
Passthe National Midwifery
Examination

Passthe National
NursingExamination
andthe National
Midwifery
Examination• Graduate schools with midwifery
courses (2 years)• Training schools, college advanced/
short-term courses, and junior college
advanced courses (1 year)

Pass
the National Nursing
Examination

Universities(4 years)**Obtain eligibility to take both national exams in the 4 years university course

Regulations● Currently, the job of a midwife in Japan is deﬁned under the Act on Public
Health Nurses, Midwives and Nurses, which was enacted in 1948.
● A midwife is “a woman who has acquired a midwife license from theMinister of Health, Labour and Welfare to practice midwifery or provides
health guidance for pregnant women, puerperal women, or newborn
babies, as a profession”.
● Midwives have exclusive rights to perform their duties and exclusive rights
to their title.

The road to becoming a midwife● A person intending to become a midwife must pass the National Nursing
Examination and the National Midwifery Examination and acquire a licensefrom the Minister of Health, Labour and Welfare.
● Over the past 20 years, an increasing number of midwives have completed
graduate schools.

Scope

The work of midwives● Currently, most babies were delivered at hospitals and clinics.

Sexuallytransmitted
diseases● The number of births has been falling since the 1970s. However, the numberof high-risk births, including births to mothers aged 35 or over, is increasing.
● The work of a midwife includes not only birth but also various aspects ofSRMNAH (sexual, reproductive, maternal, newborn and adolescent health).

Maternity
homes

5.6%

Menopause

Variouscomplications

AdultMiddle age

Elderly

UnwantedpregnancyPreconception• Woman• Family• Community

AdolescenceInducedabortion

OthersLifestyle-relateddiseases

PregnancyChildbirthInfertility

9.0%

Fetus

Puberty

Placesof work
• Hospitals• Clinics• Maternityhomes• Government• Others

School age

Infancy

Postpartum- Schools- Ofﬁces

Clinics

24.5%

40,632
Midwives

Hospitals

60.9%(In 2019)

Unanticipated accidents,
Developmental delays- Visiting
nursing● Midwives work together with public health nurses to provide support forvarious clinical treatments and preventative measures designed toensure that everyone in the community can live a healthy life, with each
respective profession exercising their expertise to support the health ofwomen, babies and their families.