thumb|250px|right|助産婦が助産をしている様子
'''助産師'''（じょさんし、英'''Midwife'''）は、妊娠や出産にかかわり、助産行為を行う者である。

看護師や保健師と異なり、資格は'''女性のみ'''である。

== 歴史 ==
古くは「'''取り上げ婆'''」（とりあげばばあ）と、戦前は「'''産婆'''」（さんば）、戦後は「'''助産婦'''」（じょさんふ、じょさんぷ）と呼んでいたが、2002年3月1日に従来の「保健婦助産婦看護婦法」が「保健師助産師看護師法」に変更された際に、看護師や保健師とともに助産師に名称が改められた。

* 1899年（明治32年） - 産婆規則と産婆名簿登録規則が発布
* 1948年（昭和23年） - 「助産婦」に改称
* 2002年（平成14年） - 「助産師」に改称

== 法規 ==
保健師助産師看護師法第3条に規定され、「助産師とは厚生労働大臣の免許を受けて、助産又は妊婦、じよく婦若しくは新生児の保健指導を行うことを業とする女子」と明記されている。
また、従来は業務独占のみの資格であったが、平成18年に保健師助産師看護師法に第四十二条の三が追加され、助産師・看護師・准看護師にも名称独占規定が設けられた。

== 業務 ==
'''助産行為を行うことができるのは、医師および助産師である。'''助産行為の範囲については、法的には示されていない（分娩介助、臍帯の切断は、保助看法にも記載されている助産行為である）。助産師が単独で行えるのは、正常な経過の妊娠分娩に関しての助産行為である。正常経過ではない、或いは正常分娩ではない・困難な場合は、医師がかかわる事になっている。従って、個人で助産所を設け助産師としての活動を行っている際に異常を確認した場合、提携の産婦人科医に連絡するなりの措置を行う。

助産師は、女性の妊娠、出産、産褥の各時期において必要な監督、ケアおよび助言を行い、自分自身の責任において分娩介助をし、新生児及び乳児のケアを行うことができる。このケアには予防的措置、母子の異常な状態の発見、医学的援助を得ること、医学的援助が欠如している場合の緊急措置の実施が含まれる。

助産師は女性のためだけでなく、家族及び地域社会の中にあっても健康カウンセリングと教育に重要な役割を担っている。その活動には産前教育と親になるための準備が含まれ、さらに婦人科の一部の領域、家族計画及び育児にまで及ぶ。また、助産師は病院、診療所、保健所、家庭、その他のサービスの場で業務を行うことができ、助産師は、「助産所（助産院）」を自ら開業することが可能である。

== 教育 ==
保健師助産師看護師法第20条に規定されている。

看護師免許取得者が、助産師学校などの養成機関で6ヶ月以上の専門教育と実習（規定数がある）を受け、それぞれの国家試験に合格すると、助産師の資格が与えられる。ただし看護大学には、助産師に関する講義や実習を加えて行うことで4年間の大学教育を経て看護師と同時に受験資格をえられる大学も多い。

現在は、4年制大学に選択制の「助産」のコースを設置する大学が増加し、短期大学の助産専攻科や助産師学校は減少傾向にあるが、その大学においても少子化によるお産の減少や看護師養成教育の充実などを背景に、時間的な制約が大きく十分な助産技術が習得できないなどの理由から、近年は助産師教育を担う大学院や専攻科などが設置され始めている。

== 統計 ==
日本国内において平成16年末現在で就業している助産師の総数は25,257人であり、その就業先は病院が約70%、診療所が16%、助産所が7%、養成・研究機関が4%となっており、<ref>[http://www.mhlw.go.jp/toukei/saikin/hw/eisei/04/kekka1.html 平成16年度「保健・衛生行政報告」]</ref>全体としてこの10年に限れば、助産師数は増えてきており、施設内分娩の普及や住宅事情により、助産所よりも病院等の医療施設に勤務する助産師が増えている。

'''Midwifery''' is a expecting birth of the infant, and provide postpartum care to the mother and her infant. Practitioners of midwifery are known as midwives, a term used in reference to both women and men (the etymology of midwife is ''mid'' = with and ''wif'' = woman).

Midwives are autonomous practitioners who are specialists in normal pregnancy, childbirth and the postpartum. They generally strive to help women have a healthy pregnancy and natural birth experience. Midwives are also primary care givers providing general women's health care. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.<ref>Wagner, Marsden. [http://nsrc.sfsu.edu/MagArticle.cfm?Article=661 Welcoming Baby, or Not: Are men, machines, and hospitals really necessary for a healthy childbirth?] American Sexuality Magazine. Accessed 3-27-07.</ref>

Midwives refer to obstetricians when a woman requires care beyond their area of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that are considered abnormal, including breech birth and posterior position, using non-invasive techniques. In many areas of the world, traditional midwives, renamed "traditional birth attendants" by the World Health Organization (WHO) and other groups, are the only available providers for childbearing women. 

In the 1700s obstetricians were referred to as male midwives and once treated patients for female hysteria.

==Defining midwifery==
According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics): 

<blockquote>
A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures. 

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and childcare. 

A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.[http://www.medicalknowledgeinstitute.com/files/ICM%20Definition%20of%20the%20Midwife%202005.pdf][http://www.who.int/pmnch/media/lives/lives_newsletter_2006_2_english.pdf] 
</blockquote>

This definition is controversial and not everyone agrees with the exclusion of traditional midwives who in developing countries often are the only people available to assist women in birth.'''''

thumb|250px|right|A woman giving birth on a birth chair, from a work by [[Eucharius Rößlin.]]

==Early historical perspective==

It is unknown exactly when midwifery emerged as a profession but it can be assumed that since women have been birthing children since the emergence of the human race, then the need for aid during this challenging life event has been present just as long. Evidence of midwifery exists in records from ancient Egypt and the imperial Roman Empire but no written records of midwifery are known to exist from before these times.

In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.<ref name="TowlerBramall-9">Jean Towler and Joan Bramall, ''Midwives in History and Society'' (London: Croom Helm, 1986), p. 9</ref>

Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians.<ref name="Flemming-359">Rebecca Flemming, ''Medicine and the Making of Roman Women'' (Oxford: Oxford University Press, 2000), p. 359</ref> However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus in the second century. He states in his work, ''Gynecology'', that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses [i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child.<ref name="French-69-84">Valerie French, “Midwives and Maternity Care in the Roman World” (Helios, New Series 12(2), 1986), pp. 69-84</ref> Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife.<ref name="Jackson-97">Ralph Jackson, ''Doctors and Diseases in the Roman Empire'' (Norman: University of Oklahoma Press, 1988), p. 97</ref> A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.<ref name="Jackson-97" />

Midwives were known by many different titles in antiquity, ranging from ''iatrinē'', ''maia'', ''obstetrix'', and ''medica''.<ref name="Flemming-421-424">Rebecca Flemming, Medicine and the Making of Roman Women (Oxford: Oxford University Press, 2000), pp. 421-424</ref> It appears as though midwifery was treated different in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (''maia'') to that of obstetrician (''iatros gynaikeios''), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors.<ref name="French-69-84" /> One example of such a cited midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.<ref name="Jackson-97" />

However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.<ref name="French-69-84" />

The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they could also help in other medical problems relating to women if needed. Often, the midwife would also call in a physician to be on-call with her in case a more difficult procedure was needed during an abnormal delivery; and in most cases she brought along two or three assistants.<ref name="Towler-Bramall-12">Towler and Bramall, p.12</ref> In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the chair was a crescent-shaped hole through which the baby would be delivered. The chair also had armrests for the mother to grasp during the delivery. Most chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant had to stand behind the patient and support her.<ref name="French-69-84" /> The midwife then faced the patient, gently dilating and pulling the fetus forward, all the while instructing the mother on proper breathing and how to push downwards during a contraction. The assistants helped by pushing downwards on the patient’s abdomen. Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord, and cleansed the baby.<ref name="Jackson-97" /> The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.<ref name="French-69-84" />

A second-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the cervix, as encouraged by Soranus.<ref name="Jackson-97" />

A more elegantly carved ivory relief from Pompeii depicts a similar scene. There are four women present: the parturient in the birthing chair; an attendant standing behind the chair providing support; the midwife seated in a low stool in front of the mother; and a fourth woman standing behind the midwife, waiting to take the infant or possibly offer a blessing. This minimal visual evidence confirms the verbal descriptions of childbirth present in the works of Pliny and Soranus.<ref name="French-69-84" />

The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives, either highly trained or possessing a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition.<ref name="French-69-84" /> Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.

During the Christian era in Europe Midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law.<ref></ref>
In Medieval times, childbirth was considered so deadly that the Christian Church told pregnant women to prepare their shrouds and confess their sins in case of death. The Church had a biblical explanation for the dangers of childbirth. They put the blame firmly on Eve and her misdemeanours in the Garden of Eden. The church decreed that women were the sisters of Eve, and the rigours of labour were God's punishment for Eve's sins.
Any effort to relieve women's pain in childbirth was looked at suspiciously. "The better the witch; the better the midwife" was a popular Medieval saying. To guard against witchcraft the church decided who could give maternity care. Midwives had to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.<ref> Barlow,Y: "Quick, Boil Some Water", p3, Bookline and Thinker Ltd., 2007</ref>

==Later historical perspective==

In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives. 
Whether this was a valid claim or not can be seen in the entry for Justine Siegemund, a renowned seventeenth century German midwife, whose ''Court Midwife'' (1690) was the first female-authored German medical text.

At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written. 

German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion.<ref>Gunnar Heinsohn/Otto Steiger: "Witchcraft, Population Catastrophe and Economic Crisis in Renaissance Europe: An Alternative Macroeconomic Explnanation.", University of Bremen 2004 [http://www.iksf.uni-bremen.de/publikationen/discussion/papers/dp31/31iksf-6heins-steiger.witchcraft.pdf (download)]; Gunnar Heinsohn/Otto Steiger: "The Elimination of Medieval Birth Control and the Witch Trials of Modern Times", ''International Journal of Women's Studies'', 3, May 1982, 193-214; Gunnar Heinsohn/Otto Steiger: "Birth Control: The Political-Economic Rationale Behind Jean Bodin's "Démonomanie"", in: ''History of Political Economy'', 31, No. 3, 423-448</ref> According to Heinsohn and Steiger's theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.

They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.

While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.<ref>see John M. Riddle: "The Great Witch-Hunt and the Suppression of Birth Control: Heinsohn and Steiger's Theory from the Perspective of an Historian", Appendix to: Gunnar Heinsohn/Otto Steiger: "Witchcraft, Population Catastrophe and Economic Crisis in Renaissance Europe: An Alternative Macroeconomic Explanation.", University of Bremen 2004[http://www.iksf.uni-bremen.de/publikationen/discussion/papers/dp31/31iksf-6heins-steiger.witchcraft.pdf (download)]; also see John M. Riddle: ''Eve's Herbs: A History of Contraception and Abortion in the West'', Princeton: Harvard University Press 1999, ISBN-10: 0674270266, esp. Chapters 5-7</ref>

==Midwifery in the United States==

There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.  

=== Nurse-midwives ===
Nurse-midwives were introduced in the United States in 1925 by nurse-midwives are variably licenced depending on the state as advanced practice pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board. At present approximately 5500 Certified Nurse-Midwives are practicing in the U.S.

=== Direct-entry midwives ===

A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not also require her to become educated as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the [http://www.cfmidwifery.org/mmoc/define.aspx Midwives Model of Care] to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.

Under the umbrella of "direct-entry midwife" are several types of midwives:

A '''Certified Professional Midwife''' (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the [http://www.narm.org/ North American Registry of Midwives] (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US. 

A '''Licensed Midwife''' is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.

The term '''"Lay Midwife"''' has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.  