Are Midwives a Dying Profession? The Realistic Future in an Era of Declining Birthrates, and How to Become a 'Chosen Midwife' Now More Than Ever

“I saw a birth and fell in love with the profession of midwifery.”

“I want to be able to support women through the major life events of pregnancy, childbirth, and child-rearing.”

To all the nursing and midwifery students studying hard with such wonderful dreams, or those of you in the workforce wondering if you should aim to become a midwife:

As you see the news about the “declining birthrate” flowing in every day, do you ever have these anxieties cross your mind?

When you search online, you might see heartless words like “Midwifery is a dead-end job,” which might dampen the motivation you worked so hard to build.

Even among active professionals, I sometimes hear the realistic concern that “opportunities for delivery assistance are decreasing compared to before, and I’m feeling anxious about my lack of experience.”

In this modern age where the number of births itself is decreasing, there is no doubt that this is an industry that will shrink.

However, to give you the conclusion first…

I do not think midwifery is a dead-end job at all. On the contrary, I believe it is a “specialized profession” that can provide value precisely because we are in an era of declining birthrates.

However, if you remain just an “ordinary midwife who only holds a qualification,” just like in the past, there is a risk of being swallowed by the waves of the times. I believe the key to surviving in the coming era is to become a “chosen midwife.”

When I thought about “What should I do to become a chosen midwife?” in this coming era, one phrase came to mind.

It is the phrase “Aim to be a one-in-a-million rare character (highly valuable talent),” which appears in the book “Will You Have a Job in 10 Years?” by education reform practitioner Kazuhiro Fujiwara.

Being “chosen” is not just about being chosen by moms (expectant mothers).I feel that you will be required to be chosen by everyone: the “hospitals (management)” that want you when you are looking for a job or changing careers, and the “superiors and colleagues” who want to work with you on the front lines.

In this article, after looking squarely at the “realistic situation of data and schools” surrounding midwives—which is not just all sunshine and rainbows—I will examine the career multiplication needed to become this “one-in-a-million rare character midwife.”

I want to help resolve the anxieties of those of you who are unsure about your career path, so that you can take a step forward with confidence, saying, “I really want to be a midwife!” Please be sure to read until the end.

【The Current Reality】 The Environment Surrounding Midwives Based on Data

To avoid being misled by information online, let’s first look squarely at the current reality based on accurate data from the Ministry of Health, Labour and Welfare and other sources.

The number of births in 10 years will be in the “500,000 range.” The declining birthrate is progressing faster than expected.

The number of births in Japan continues to hit record lows every year.

The most recent number of births in Japan was 671,236. In fact, official government data had predicted that the number of births would reach the 670,000 range around 2040. However, in reality, it has already dropped to the 670,000 range, 15 years earlier than that.

If things continue at this pace, it is predicted that the number of births in Japan will enter the "500,000 range" in 10 years (around 2036). A future where there are nearly 100,000 fewer births than there are now is almost unavoidable.

In fact, just in the last few years, many delivery facilities have been forced to close, and it is a fact that even among young midwives, there are voices saying, "I'm anxious because I can't gain as much experience (number of cases) in delivery assistance as in the past."

Why is the number of midwives increasing despite the declining birthrate?

You might think, "If births are decreasing, the work of midwives should be disappearing." However, strangely enough, according to Ministry of Health, Labour and Welfare statistics, the number of employed midwives has increased from 33,956 in 2014 to 38,721 in 2024, which is an increase of about 5,000 over the past 10 years.

There are three main reasons for this.

Are training schools decreasing? (The realistic current state of schools)

The environment surrounding schools is also changing drastically. The current reality is that the form of education is shifting from "vocational schools" to "universities and graduate schools."

• One-year vocational schools are closing one after another
  To become a midwife, it is necessary to perform "practical training handling 10 or more delivery (childbirth) assistance cases while enrolled." However, because the number of births itself has decreased due to the declining birthrate, there are not enough births for students to gain experience, and vocational schools are closing one after another because they cannot organize practical training. In fact, prestigious schools with long histories, such as the Japanese Red Cross Midwife School (scheduled to close in March 2027) and National Hospital Organization training schools (scheduled to close in March 2029), have announced they will stop accepting new students, and I believe this trend will accelerate over the next 10 years.

• Training routes at universities and graduate schools are becoming the center 🎓
  On the other hand, the number of nursing universities has increased over the past 20 years. Cases of training midwives through "courses that also earn a midwife qualification within the 4 years" of university or "graduate schools (2-year programs)" that students enter after graduating from university are increasing. It is expected that the routes to obtain the qualification will become "more academically demanding (and more exclusive)" than they are now, such as through advancement to graduate school.

The accurate structure is that "while one-year vocational schools are decreasing due to the declining birthrate, a certain number of midwives continue to be born every year because there are training slots at universities and graduate schools."

I became a midwife through a "course that also earns a midwife qualification within the 4 years" at a nursing university, but my alma mater does not have an affiliated hospital. Even so, I am so grateful that I was able to do my midwifery training... My heart ached when I saw the news that even vocational schools with affiliated hospitals were closing because they could not organize practical training.

[Honest Opinion] Isn't it just sugarcoating to say "midwives aren't in surplus even though births are decreasing"?

Here, one big question arises.

"With the number of deliveries decreasing so dramatically, there is no way midwives aren't in surplus. Isn't the shift to a lifelong support profession for women just sugarcoating?"

Because I love childbirth, I cannot wipe away that sense of discomfort.

This is because if we only explain to students who "aspire to become midwives because they admire the childbirth scene" that "it will be fine because you will support things other than childbirth from now on," I think that is an insincere answer.

To put it bluntly without hiding the reality, "the number of delivery assistance cases a single midwife experiences in their lifetime" will physically decrease drastically. The opportunities to work in a way where you "handle hundreds of births" like in the past will definitely become narrower from now on.

That is precisely why I think it is becoming more significant to think about the value of being a "midwife of choice" from now on.

Thinking about the value of a "midwife of choice"

[Comparative Analysis] The decisive difference between an "ordinary midwife" and a "midwife of choice"

How can you become a "midwife of choice" who is not just surviving, but highly sought after in the coming era?

Solid skills are essential, of course, but skills are something that come later. I believe it is the mindset that makes the difference.

What I consider a midwife of choice is a midwife who can respond to the client's latent needs (problems they haven't even realized yet)...

Furthermore, a midwife who is exceptionally skilled at using words that respond to the desire for recognition (the inner voice) that the other person wants their efforts acknowledged and their anxieties understood.

It's not just about providing medical care; it's about being close to the mother's heart and filling her with a sense of security. I feel every day while working that this "anticipatory power" and "skill in communication" is the boundary line that separates an ordinary midwife from a true professional.

[Survival Strategy] Career multiplication to become a "one in a million" talent, learning from Kazuhiro Fujiwara

If you polish the "anticipatory power" mentioned earlier, you can become a slightly rare talent, one in 10,000.

Being "slightly rare" is a bit subtle, isn't it? (laughs)

But what if you think of an Olympic gold medalist as a "one in a million talent"? And you don't need to aim for "one in a million in a single field."

Based on the "scarcity (rare character) logic" of Kazuhiro Fujiwara, whom I mentioned at the beginning, multiply three "one in 100 skills."

"1/100 x 1/100 x 1/100 = 1/1,000,000"

Let's apply Mr. Fujiwara's career survival strategy to a midwife's career👇

When these three axes are multiplied, you become a "one in a million midwife of choice."

Even in an era where the number of births is decreasing due to the declining birthrate and hospitals are being weeded out, don't you think society would absolutely not want to let go of "you, a one in a million rare character"?

[Survival Strategy] To become a midwife who is not weeded out by the times

So far, I have told you about the "career multiplication" to become a one in a million rare character.

In an era where the number of births is falling into the 500,000 range, how can you become a midwife who won't be weeded out by the times?

【Expectant mothers】【Management】【Colleagues】【Society】 How can you get chosen by these four groups? I will explain the reasons for being chosen.

1. How to be chosen by expectant mothers?

Until now, hospitals were chosen simply because they were close to home. However, in an age where reviews and experiences are shared on social media, expectant mothers are doing a lot of research before choosing a hospital.

What if you were a midwife who could respond to a mother's inner voice (validation) and proactively resolve her anxieties?

Don't you think that would lead to the moving sentiment, 'I'm so glad I gave birth here because that midwife was there'?

As more and more hospitals stop handling births, 'Your presence becomes the reason expectant mothers are drawn to the hospital.' I believe this is what a midwife who stays at the forefront and avoids being weeded out in an era of declining birthrates looks like.

2. How to be chosen by management?

Due to the decline in the number of births, hospital management is now in the midst of intense competition for survival. To survive, they are being forced to shift to new services that meet the needs of the times, such as 'painless delivery' and 'postpartum care'.

What management wants to hold onto most is not simply 'someone who can do routine work as always.'It is talent that can flexibly ride the wave and contribute to organizational growth when the hospital is trying to change.

Also, from a management perspective, someone who has a high awareness of medical safety and prevents accidents (medical malpractice) that could shake the hospital's reputation can be considered a chosen individual.

I believe that a midwife who reduces risks that threaten the organization's survival and can create new value together is the one who will be the first to be chosen as someone they 'want to keep' even when waves of restructuring or downsizing come.

3. How to be chosen by colleagues you work with?

As mentioned earlier, with the trend toward later marriage, there is an increase in 'high-risk expectant mothers' who require advanced medical management and geriatric pregnancy care.

In such a tense team, just having someone who is honest, sincere, can report, communicate, and consult accurately, and can do the obvious things as a matter of course, completely changes the atmosphere of the workplace.

Being thought of by colleagues and superiors as 'it's really easy to work with this person and I feel at ease when I'm on a shift with them' is the strongest weapon for surviving in an organization.

4. How to be chosen by society (communities and companies)?

In conclusion, it is 'to aim for solving social issues without being tied to a hospital.'

When you talk about social issues, the scale suddenly feels large... but if you just wait inside a hospital, the 'subjects of care' you can meet are limited. However, if you step outside the hospital and look at 'society,' you will realize that it is overflowing with countless deep worries that hospitals cannot reach.

Modern local communities and private companies are full of issues related to women's health and ways of living, such as the increase in fertility treatment, postpartum depression, menstrual pain and PMS, menopausal disorders, and the delicate balance between working women's careers and childbirth (the Femtech field, etc.).

By turning your attention to 'issues outside the hospital' and communicating your own strengths, you will become chosen as an expert sought after by society.

If you can establish a firm 'unique place' for yourself in society, it won't matter if a hospital's management falters or the number of births decreases. You will be able to work independently or work with mothers across the country online.

A midwife who can survive 10 or even 100 years from now—could you become that kind of midwife, with the ability to solve social issues without being tied to a hospital, regardless of your reasons for becoming one or your working style?

I cannot help but think so.

The reason I don't want you to give up on being a midwife

Seeing the reality of birth numbers in the 500,000 range and the closure of schools might make you hesitate to pursue midwifery, thinking, 'It really is scary, isn't it?'

However, here is the reason why I still don't want you to give up on your dream of becoming a midwife, no matter what the era brings.

It is not just empty words; it is because I personally feel an indescribable sense of fulfillment and pride in this job as a midwife, and I love this work from the bottom of my heart.

It is true that in the coming era, the number of births will decrease, and the hurdles you are expected to clear will likely become higher.

But, the joy of feeling that you were able to help the expectant mother in front of you, and the joy of being present at the miraculous moment when a new, precious life is born, have a 'priceless' value that cannot be replaced by anything else.

What a mother enduring anxiety and labor pains is looking for is not the latest robot or AI. Isn't it your presence, gently looking her in the eye and saying, 'You're doing fine,' or 'Everything is going well'?

Isn't it the warmth of your hands rubbing her back?

Isn't it the warmth of your heart as you shed tears with her, saying, 'You worked so hard'?

At the moment life is born, and during the anxiety-filled days after childbirth, what is needed is not manuals or data, but the 'sense of security' that humans create. It can be said that midwifery is the ultimate profession whose value will never diminish, no matter how much technology and AI evolve.

Ten years from now, having 500,000 births a year means that over 1,300 miracles are happening across the country every single day. Just because the number of births has decreased does not mean the value of life or the value of a midwife's work has decreased.

Do not let the numbers of a declining birthrate steal your wonderful dream.
Many mothers and babies of the future are sincerely waiting for 'those hands of yours' that are studying so hard right now.

Finally—

No matter how the times change, as long as there is new life being born, your strength will absolutely be needed.

'What kind of midwife do I want to be?' 'What kind of unique combination of skills can I offer?'

Why not start by writing down your thoughts in a notebook?

In an era where the birthrate is declining and you must become a 'chosen midwife' to survive, the first and most important turning point is 'job hunting'.

Are you losing sleep over job hunting anxiety while busy with clinical practice and national exam studies?

Actually, I once had the same anxieties as you all. When I aimed for a perinatal center in the city from a rural area, I had no information from those around me and was just anxious about job hunting. I remember enduring strong pressure and loneliness during the job hunting period, thinking, "What if I'm not hired..."

However, after being successfully hired and working in the field for over 10 years, while experiencing clinical instruction and handling hospital tours and internships for recruitment, I realized one important fact.

That is,"what the hiring side (hospitals) looks at when deciding whether to accept or reject a student" has clear, common evaluation criteria.

Students who correctly understand this "hiring side perspective" and prepare in advance are winning job offers one after another from highly competitive hospitals.

Therefore, based on my experience so far, I decided to write a single note so that all midwifery students can practice this without hesitation.

That is this"Job Hunting Roadmap for Midwifery Students".

If you want to be freed from job hunting anxiety and focus 100% on your clinical practice and national exam preparation starting tomorrow, please read this article as well 🙇‍♀️