A spiral of change in Czech midwifery: turning full circle but one step higher: Zuzana Stromerova describes new legislation for midwives in the Czech Republic, the current challenges and an innovative educational course to help them fulfil their roles.

• Auteur: Stromerova, Zuzana

For midwives in the Czech Republic, 2004 has been a memorable year and maybe a turning point. In April a new law was adopted, which concerns the achievement of professional status for nonmedical healthcare providers. This law sets the conditions under which a midwife is allowed to work without medical supervision.

In May 2004, the Czech Republic became a member of the European Union (EU). This move will influence the life of many people in many directions. The practice of midwifery, will be influenced fundamentally. The EU respects midwives as autonomous care providers, experts in healthy childbirth. In contrast, in the Czech Republic, midwives have had quite a different role: for long years they have been perceived as doctors' assistants, or as nurses in deliver- theatres, who work under the guidance of the doctors. And in those long years midwives have accepted this role, although many of them felt it should be different. Because of this, we greatly appreciate the efforts of all those who participated in setting up the new regulation. Not only ministerial staff worked hard, but also consumers' and midwifery associations. This regulation specifies the activities and competencies of midwives and is very clear about the autonomous work of a midwife. With this regulation we have reached, in written form, the level of democratic EU countries.

But it is not always possible to harmonise theory and practice together immediately. Among those who were caught unawares were some of the midwives themselves: it seemed as if they did not know what to do with all the freedom! Now, according to the law, a midwife may provide care to healthy pregnant women; she is allowed to conduct a normal birth, in a setting the woman chooses. She can work as an independent care provider or be employed in a hospital or gynaecologist's office. Her activities and possibilities are broad.

This is all the good news. But what about the midwives themselves? Do they meet the women's needs and demands? The answer is: not yet. We still have a shortage of midwives who will work as community midwives, and will take complete responsibility for what they do or do not do. In the past few years, the situation for midwives has been dismal, with poor recognition in society, and poor co-operation between hospitals and community midwives. Can anything be done to bring midwives together again, to make them more self-confident and raise their self-esteem?

'A Midwife in the EU'--an...