This paper discusses the professional issues currently facing midwives and maternity services in Australia and the Pacific region, which are influenced by midwifery being predominantly a women's profession and by working in health systems that are dominated by medicine and nurses. In Australia, the educational preparation of midwives has recently shifted from hospitals to universities, and only nurses can train to be midwives, even though urban midwives rarely work as nurses during their careers. This situation is different in rural Australia and the Pacific islands, where nurse-midwives maybe the only health workers for whole villages and towns, yet the need for a dual system of traininghas notbeen accepted anywhere in Australia. This paper argues for the incorporation of research into practice; the use of high quality, research-based materials to guide the provision of safe, women-centred, midwifery care; and improvements in the profile, quality and contribution of midwifery to maternal and child health services throughout the region.