In the Netherlands, clinical midwives provide comprehensive care to high-risk patients during pregnancy and labor. The obstetric system in the Netherlands is based on the principle that pregnancy and childbirth are physiological processes. Community midwives work autonomously to supervise low-risk pregnancies and childbirths, but patients with potential risks are referred to hospitals, where they are taken care of by clinical midwives or gynecologists. Clinical midwives usually work under the indirect supervision of a gynecologist and their tasks and responsibilities vary widely between hospitals. Although clinical midwives work in a hospital setting with high-risk patients, their educational background is similar to community midwives assisting uncomplicated pregnancies and births. As a consequence, their education might not be sufficient for their current tasks, responsibilities and position. In response to a growing demand for healthcare providers who can work collaboratively with physicians and other healthcare professionals, the first physician assistant (PA) education program in the Netherlands started in 2001. This program was designed to provide students with a broad range of medical knowledge and clinical skills. Since then, the field has grown rapidly. The Rotterdam University of Applied Sciences was the first institution in the Netherlands to offer a PA track specially aimed at clinical midwives. The program is a 30-month (150 EC) education program that combines on-the-job training and a teaching program at the University. Clinical midwives receive specialized training in obstetrics, gynecology, neonatology, general medicine and clinical skills. In addition the program focuses on understanding and performing scientific research, developing critical thinking, communication, project management, education skills, and leadership skills. All of these are essential for midwives to function effectively in a complex healthcare environment. The program was evaluated in 2016 and 2017. The evaluation involved analyzing 119 end assessment reports and administering a digital questionnaire to 156 PA clinical midwives. The findings demonstrated that PA clinical midwives make a significant contribution to the quality of care on multiple levels within the integral birth care system. They demonstrate independence and initiative in complex care situations, and they are able to take a broad view of the situation. In addition, PA clinical midwives contribute significantly to quality-improving committees¹. Looking to the future, the PA education program for clinical midwives will need to continue to evolve to keep pace with changes in the healthcare system. This may include incorporating new technologies, addressing disparities in care, and adapting to new models of care delivery. For example, a new project called “making big data meaningful for the first 1000 days” has recently started, and we believe that it might be crucial for the future PA to cope with big data and know how to translate information from big data to clinical practice. Furthermore, we intent to place significant emphasis on the enhancement of personal development and leadership skills among students. Our aim is to equip them with the competencies required to effect changes in their daily practice, and to ensure that clinical midwives are adept at delivering the highest quality of care to their patients in the present and future.