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Midwives

Work abroad as a midwife: UK, Ireland, EU and US (2026)

Every route open to an internationally trained midwife, compared: the regulator, the assessment, the language level and the pay in each country.

Overview

To work as a midwife abroad you register with the midwifery regulator in the country you choose: the NMC in the UK (midwifery CBT and OSCE), NMBI in Ireland (a period of adaptation if gaps are found), the state authority in Germany, the BIG register in the Netherlands (no BI test for midwives), or in the USA a nursing licence and graduate midwifery training before certification.

Midwifery is a protected profession in every country MedicSail covers, and in most of them it is regulated separately from nursing. In the UK the Nursing and Midwifery Council (NMC) registers midwives on their own part of the register. In Ireland the Nursing and Midwifery Board of Ireland (NMBI) keeps a midwives division. In Germany the title Hebamme is protected under the Midwives Act (Hebammengesetz), and in the Netherlands the verloskundige is one of the professions on the BIG register.

The USA is different. Certified nurse midwives are advanced practice registered nurses: the Bureau of Labor Statistics says they need a registered nursing licence, an accredited graduate programme, a national certification exam and an advanced practice licence from the state. A midwife who trained without a nursing qualification therefore has a much longer route to the USA than to the other four countries.

In the UK and Ireland the route is built around English and a competence check. The NMC asks most overseas midwives to pass the midwifery Test of Competence, a computer-based test (CBT) and an OSCE in the UK. NMBI compares your programme with EU Directive and NMBI requirements and, if it finds gaps, asks you to complete a period of adaptation in Ireland; the aptitude test is not offered for midwives.

In Germany and the Netherlands the language is usually the biggest task. German authorities such as the Bavarian State Office for Nursing generally ask midwives to pass a professional language test, and the BIG register sets Dutch at B2 for higher vocational professions such as midwifery. Both countries compare your training with their own and can require an adaptation course or test if they find substantial differences.

Use this page to compare the five routes, then read the country page for full details. Where an official page does not publish a figure, we say so and describe the rule instead.

Qualifications

Minimum

A midwifery qualification that has allowed you, or will allow you, to register as a midwife in the country where you trained, with unrestricted permission to practise there. For the USA, a registered nursing licence is the starting point, because certified nurse midwives are advanced practice nurses.

Preferred

A direct-entry or post-nursing midwifery programme with a detailed transcript showing theory hours, clinical hours and the number of births and other clinical experiences you completed. Regulators compare these with EU and national standards, so full records reduce the chance of an adaptation period.

Experience

No country sets a fixed minimum experience period for registration, but recent midwifery practice counts. Germany's Midwives Act lets authorities offset differences in training with lawful professional experience, and the NMC accepts a year of registered midwifery practice in a majority English-speaking country as evidence of English in some cases.

Country by country

United Kingdom: NMC

Registered midwife (RM)

Requirements
A midwifery qualification that allows registration where you trained, good standing confirmed with your regulator, and health and character declarations. If you trained as a nurse and then in midwifery, check with the NMC how your qualification will be assessed before you pay.
Exams
The midwifery Test of Competence: a CBT with a midwifery clinical part, sat through Pearson VUE in most countries, and a 10-station midwifery OSCE at an approved UK test centre.
English
IELTS Academic 7 in listening, reading and speaking and 6.5 in writing, or OET B in three parts and C+ in writing, no more than two years old. Other evidence routes exist.
Timeline
The NMC aims to assess your qualification within 14 days of your regulator's response and to decide within 30 days of having everything. You have two years from confirmed eligibility.
Good to know
The NMC evaluation fee is £167, the CBT £83, the OSCE £794 and the registration fee £182.
Midwives in the United Kingdom: full guide
About the NMCWorking in the United Kingdom

Ireland: NMBI

Registered midwife in the Midwives division

Requirements
Qualifications recognition, then registration. NMBI assesses whether the clinical and theory content of your programme meets EU Directive and NMBI requirements.
Exams
If NMBI finds gaps, midwives complete a period of adaptation in an approved Irish health care facility. The RCSI aptitude test is offered only for general and psychiatric nurses.
English
IELTS Academic overall 7.0, with 7.0 in any three components and 6.5 in one, or OET B in three components and C+ in one, from one sitting less than two years old. IELTS Online and OET at home are not accepted.
Timeline
The adaptation period's clinical component lasts at least 6 weeks and can extend to 12 weeks or more. You have 12 months from your letter to secure a place.
Good to know
Fees are €350 for qualification recognition, €145 for registration and €100 a year for retention.
Midwives in Ireland: full guide
About the NMBIWorking in Ireland

Germany: State licensing authorities (Approbation)

Hebamme

Requirements
The recognition authority for your state checks whether your qualification is equivalent to the German qualification under the Hebammengesetz, then checks personal fitness and German. In Bavaria this is the Bavarian State Office for Nursing (LfP), responsible for health professions since 1 July 2025.
Exams
If there are substantial differences, you can choose between an adaptation course (Anpassungslehrgang) and a knowledge test (Kenntnisprüfung), according to the LfP. You can also waive the detailed equivalence check and go straight to an adaptation measure.
Language
German. The LfP says applicants for health professions usually have to pass a professional language test (Fachsprachenprüfung) as part of recognition.
Timeline
The LfP decides within three or four months of a complete application, depending on the legal basis. Under the employer-led accelerated skilled worker procedure, it aims for two months.
Good to know
In Bavaria the fee is €40 to €70 plus €40 for the certificate. Each German state has its own authority and fees.
Midwives in Germany: full guide
State licensing authorities (Approbation)Working in Germany

Netherlands: BIG

Verloskundige (midwife) in the BIG register

Requirements
With a diploma from outside the EU or Switzerland you apply for a certificate of professional competence. The Commission for Foreign Healthcare Graduates (CBGV) compares your education, diploma and experience with the Dutch standard, then you register in the BIG register.
Exams
Midwives do not take the BI test, which is for doctors, dentists and nurses. The CBGV can still require extra training, an adaptation internship or a practical skills test before it recognises your diploma.
Language
Dutch at B2, the level the BIG register sets for higher vocational (hbo) professions such as midwifery, from the NT2 State Examination, plus proof of English reading skills. Certificates must be no more than two years old.
Timeline
For professions without a BI test, you receive the intended decision within 6 weeks of the commission receiving your file. The whole process averages 6 months to 1.5 years.
Good to know
The certificate application is free. BIG registration costs €85, and any extra training is at your cost.
Midwives in the Netherlands: full guide
About the BIG registerWorking in the Netherlands

United States: NCSBN

Certified nurse midwife (CNM), an advanced practice registered nurse

Requirements
A registered nursing licence from a state board of nursing, an accredited graduate-level midwifery programme, a national certification exam and an advanced practice licence. State requirements vary.
Exams
The NCLEX-RN for the RN licence, then the national nurse midwife certification exam after the graduate programme.
English
Set by each state board of nursing. For an occupational visa as an RN, a VisaScreen certificate with an approved English test is usually needed.
Timeline
Long: the RN licence, a master's-level programme and certification. The Bureau of Labor Statistics lists a master's degree as the typical entry education.
Good to know
The NCLEX registration fee is $200, rising to $350 from February 1, 2027.
About the NCSBNWorking in the United States

The route, step by step

  1. Check that your qualification is a midwifery qualification

    Regulators register you on the basis of your midwifery training, not your job title. If you qualified as a nurse and then did a post-registration midwifery course, gather both transcripts. For the USA, confirm you hold, or can obtain, a registered nursing licence first.

  2. Collect training records and good standing

    Ask your school for a transcript with theory hours, clinical hours and your clinical experience record. Ask every regulator you have been registered with for a certificate of good standing. Missing clinical records are the most common reason for an adaptation period.

  3. Meet the language requirement

    Use IELTS Academic or OET for the UK and Ireland, German for Germany and Dutch at B2 for the Netherlands. Check the exact rules on sittings and test versions; NMBI accepts one sitting only and does not accept online or at-home tests.

  4. Apply for recognition or assessment

    Apply to the NMC, NMBI, your German state authority or the BIG register with the fee and documents on its checklist. Have documents certified and translated as required, and keep copies of everything you send.

  5. Complete the test or adaptation

    Pass the NMC midwifery CBT and OSCE, complete NMBI's adaptation period, or the German adaptation course or knowledge test, or any training the CBGV requires. Plan for time in the country for the practical stages, and check whether a visa is needed for them.

  6. Find a maternity post and arrange your visa

    Most midwives are recruited by a public maternity service: an NHS trust, an HSE hospital, or a German or Dutch hospital or practice. Your employer usually sponsors the visa or permit, such as the UK Health and Care Worker visa or Ireland's Critical Skills Employment Permit.

  7. Register and start practice

    Pay the registration fee and wait for your name to appear on the register before you practise as a midwife. Until then, follow your employer's pre-registration role and pay arrangements.

Exam preparation

Midwifery assessments test safe practice across pregnancy, birth and the postnatal period at the level of a newly registered midwife. In the UK this is the NMC's midwifery CBT and OSCE; in Ireland, Germany and the Netherlands assessment is mainly through document review and adaptation, with knowledge tests or skills tests where gaps are found. Language tests matter as much as clinical ones: OET or IELTS for the UK and Ireland, and professional language tests in Germany and the Netherlands.

Tips

  • Download the NMC's midwifery Test of Competence materials and blueprint before you study, and follow its structure.
  • Practise the OSCE stations aloud with a timer and a partner, including the assessment, planning, implementation and evaluation sequence.
  • Learn national guidance on antenatal screening, intrapartum care and postnatal checks for the country you are moving to, because local standards are tested.
  • Practise drug calculations, including those for oxytocic drugs, analgesia and neonatal doses, until they are fast and accurate.
  • For Germany and the Netherlands, learn midwifery vocabulary for history taking, handover and documentation, not just general language.
  • Keep your clinical skills current while you prepare; an adaptation period is easier if you are still practising.
  • Book tests early and check attempt limits; the NMC allows three attempts at each part of the Test of Competence per application.

Topics that come up

  • Antenatal care and screening
  • Normal labour and birth
  • Obstetric emergencies: postpartum haemorrhage, shoulder dystocia, pre-eclampsia
  • Fetal monitoring and interpretation
  • Postnatal care of mother and baby
  • Newborn examination and neonatal resuscitation
  • Infant feeding and breastfeeding support
  • Perinatal mental health
  • Safeguarding and consent
  • Medicines and drug calculations in midwifery
  • Professional codes, record keeping and accountability

Pay by country

Midwives in the UK and Ireland are paid on national public sector scales, quoted here from the official tables. Germany and the Netherlands set pay through collective agreements or the employer, and in the USA we give the federal median for nurse midwives. Figures are basic annual pay before allowances.

  • UK£32,073 to £39,043 (band 5); £39,959 to £48,117 (band 6), 2026/27NHS Agenda for Change rates from 1 April 2026. Each employer sets the band for a midwifery post, so check the advert.
  • Ireland€38,166 to €56,592 (registered midwife), from 1 June 2026HSE consolidated pay scales. Staff midwife awaiting registration: €33,370. Senior staff midwife: €59,278. Clinical midwife manager 1: €57,780 to €70,087.
  • GermanySet by collective agreement or employerHospital midwives are paid under the collective agreement their employer applies; self-employed midwives bill for their services. We could not confirm a current official table.
  • NetherlandsSet by collective agreement (CAO)Hospital and practice midwives are paid under the CAO for their sector. Check the scale named in your contract.
  • USA$134,040 median for nurse midwives (May 2025)Bureau of Labor Statistics. This is for certified nurse midwives, who are advanced practice registered nurses.

See your NHS band and annual pay

Career growth

Midwives can build careers in clinical specialism, leadership, education and research. Your first post after registration is usually in a hospital maternity unit, with options to move into community and specialist roles.

  1. Senior and specialist midwife

    Experienced midwives move into senior posts or specialist roles such as fetal medicine, bereavement, perinatal mental health, diabetes or infant feeding. In the HSE, senior staff midwife and clinical midwife specialist are distinct grades.

  2. Community and continuity of care

    Community midwives care for women at home and in clinics through pregnancy and after birth. In the Netherlands, many midwives work in community practices that look after low-risk births.

  3. Leadership and management

    Ward and unit leadership roles, such as clinical midwife manager in Ireland or a band 7 labour ward coordinator in the NHS, combine clinical care with staffing and quality.

  4. Advanced practice

    Some countries have advanced midwife practitioner roles; NMBI registers advanced midwife practitioners. In the USA, certified nurse midwives practise as advanced practice registered nurses.

  5. Education and research

    Practice educators, lecturers and research midwives teach students, support new staff and lead quality projects. Most of these roles expect postgraduate study.

Common mistakes

  1. 1

    Applying with a nursing qualification when the regulator needs a midwifery one, or not explaining a post-nursing midwifery course clearly.

  2. 2

    Missing clinical experience records, which often leads to an adaptation period.

  3. 3

    Using a language test the regulator does not accept, such as IELTS Online or OET at home for NMBI, or combining sittings where only one is allowed.

  4. 4

    Letting a test result expire before your application is assessed; both the NMC and NMBI need results less than two years old.

  5. 5

    Not securing an adaptation placement within NMBI's 12-month window.

  6. 6

    Assuming the US route is like the others: certified nurse midwives need a nursing licence and a graduate programme.

  7. 7

    Underestimating the German or Dutch language level and starting study too late.

  8. 8

    Practising or using the title of midwife before your registration is granted.

How we help midwives

  • Review of your qualifications, transcripts, experience and current registration

  • Check against the published requirements of the regulators you choose

  • Check of how recent your practice is and whether any gap in practice affects your route

  • English or other language requirement for each route, with any exemption you may qualify for

  • Comparison of routes and countries, with the trade-offs explained

  • List of the exams, aptitude tests or adaptation periods each route is likely to involve

  • Written roadmap: exams, English test, documents, fees and timeline

  • Budget built from the official regulator, exam and verification fees, kept separate from our own fee

  • Flags for slow steps to start first, such as primary source verification and language learning

  • A call to walk you through the plan and answer your questions

What our eligibility assessment includesPackages and fees

Questions

In the UK, Ireland, Germany and the Netherlands, yes: midwives have their own register entry or protected title. In the USA, certified nurse midwives are advanced practice registered nurses, so a nursing licence comes first.

Most do. Unless you hold a European qualification that meets automatic recognition rules, you pass the midwifery Test of Competence: a CBT you can sit in most countries and an OSCE in the UK.

No. NMBI offers the RCSI aptitude test only to general and psychiatric nurses. Midwives who need a compensation measure complete a period of adaptation in Ireland.

NMBI says the clinical component lasts at least 6 weeks and can extend to 12 weeks or more if needed. You must secure a place within 12 months of your letter.

IELTS Academic overall 7.0 with 7.0 in any three components and 6.5 in one, or OET grade B in three components and C+ in one. Results must come from a single sitting less than two years old.

B2, the level set for higher vocational (hbo) professions, shown with an NT2 State Examination certificate no more than two years old. You also need proof of English reading skills.

No. The BIG register says the BI test is for doctors, dentists and nurses. The commission can still ask for extra training or an adaptation internship.

Not directly as a certified nurse midwife. You need a registered nursing licence, an accredited graduate midwifery programme, a national certification exam and a state advanced practice licence.

The HSE scale for a registered midwife runs from €38,166 to €56,592 from 1 June 2026. Midwives awaiting registration are paid €33,370.

The authority in the state where you want to work. In Bavaria it is the Bavarian State Office for Nursing, responsible for health professions since 1 July 2025.

It counts as evidence of good standing and recent practice, and Germany can use experience to offset gaps in training. It does not replace the assessment of your original midwifery qualification or the language requirements.

NHS Employers says a nurse or midwife entering the UK for a nursing role has up to 12 weeks from the employment start date on the certificate of sponsorship to sit a first OSCE attempt, and must pass within eight months of the start of the visa. Until then you can be employed as a pre-registration candidate. If you do not pass within the permitted attempts, the employer must stop sponsoring you and your permission to stay is shortened.

Sources

  1. 1NMC: register as a nurse or midwife if you trained outside the UK
  2. 2NMC: costs
  3. 3NMC: how long is it going to take
  4. 4NMC: Test of Competence for nurses and midwives
  5. 5NMC: recent practice in English
  6. 6NHS Employers: pay scales for 2026/27
Show all 24 sources
  1. 7NMBI: qualified outside the EU
  2. 8NMBI: application assessment
  3. 9NMBI: English language requirements
  4. 10NMBI: compensation measures
  5. 11NMBI: registration fees
  6. 12HSE: consolidated pay scales, 1 June 2026
  7. 13DETE: Critical Skills Employment Permit
  8. 14Hebammengesetz section 54 (recognition)
  9. 15Hebammengesetz section 56 (offsetting differences with experience)
  10. 16Bavarian State Office for Nursing: recognition of a health profession
  11. 17BIG register: certificate of competence
  12. 18BIG register: Dutch language skills and English reading skills
  13. 19BIG register: professional test (BI test)
  14. 20BIG register: processing time and costs
  15. 21BIG register: Commission for Foreign Healthcare Graduates
  16. 22NCLEX: fees and payment
  17. 23BLS Occupational Outlook Handbook: nurse anesthetists, nurse midwives and nurse practitioners
  18. 24NHS Employers: Recruitment of overseas nurses and midwives (reviewed 23 September 2026)

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