Falling staff numbers and the increase in birth rates has led to a crises in midwifery staffing, most acutely felt in the Dublin area. However, recognition of these staff shortages is leading to changes in the profession, in the way maternity services are provided and in the professional recognition of midwives.

"Midwifery is a separate profession to nursing," Ursula Byrne, midwifery education officer with An Board Altranais, says. "Historically they became linked, but now a much greater recognition of the separate professional identity is emerging."

The routes into midwifery are expanding, says Byrne. "There are now two possible routes to becoming a midwife, whereas until recently there was just one."

The established path is to complete a three-year diploma to become a registered general nurse and then undertake a further two-year midwife registration education programme. There are seven schools of midwifery based in hospitals in the State, three in Dublin and one each in Cork, Limerick, Galway and Drogheda. The schools in Dublin accept applicants in spring and autumn, while the others have an autumn intake only.

In each hospital the programme is run in partnership with a university. Nurses undertake the midwifery registration education programme as both students with the school of maternity and employees of the hospital. This means they are salaried while in training. To further ease the financial burden of training, the fees for the two-year programme are, since 2000, paid by the Department of Health in return for a two-year work commitment to the public health service.

Since 1959 this was the only route into midwifery, but last year a direct-entry programme was introduced on a pilot basis. This new course is a three-year diploma in midwifery and applicants do not require a nursing qualification. Some 20 students are taking the pilot course, run between the Rotunda Hospital, Dublin, Our Lady of Lourdes Hospital, Drogheda, and TCD. It involves full-time education, so the students are not salaried, but they can apply for a grant.

"The pilot will be evaluated in 2003 and hopefully continued. This will bring us in line with other European countries like Germany and Holland, who already have direct entry courses," Byrne says.

Midwifery is different to nursing, says Byrne, in that midwives are generally working with healthy people and their role is mainly one of education and support.

"A midwife's job starts at the time the woman becomes pregnant and lasts up to six weeks after the birth."

The way the service is provided is also changing and expanding beyond hospitals into the community. "Midwives can be part of an outreach programmes and there are moves towards a more midwife-led service."

The staffing crisis means there are plenty of job opportunities for midwives, the bulk of these are Dublin-based. The midwife promotion structure is very similar to nursing, with clinical, educational and management career routes and a range of further education options. "If you're keen to progress, the opportunities are there and midwives are progressing at a younger age than previously," Byrne says.

The increasing birth rate makes the job very busy. However, Byrne says the vast majority of births are normal and it's a very rewarding job.

There is currently a major focus on recruitment and retention in midwifery, Mary Brosnan, midwifery advisor in the nursing policy division of the Department of Health, says.

"Hopefully when the three year direct-entry pilot is completed, a four-year degree programme will be introduced. CrΦche facilities are being developed in hospitals and flexible working hours and job sharing have been initiated. In the future there will be increased promotional opportunities and more community midwifery, but I think the biggest selling point is that it is health-focused rather than illness-focused."