News Briefs: Midwifery Profiles and Practice For Consumers, Attorneys, Physicians and More. .

Advancing Health Equity; Issue Briefs/May 5, 2023

Markus Winkler

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How Expanding the Role of Midwives in U.S. Health Care Could Help Address the Maternal Health Crisis

. Midwives incorporated into U.S. maternity care systems could reduce perinatal health disparities and address other provider shortages. Research shows that when midwives play a central role in healthcare, patients are consistently more satisfied, costs come down, and clinical outcomes for parents and infants improve. 1

. Midwifery care is further associated with fewer cesarean sections, lower preterm birth rates, lower episiotomy rates, more breastfeeding, and patients claim a greater sense of respect and autonomy.2 In 2021, the U.S. had 32.9 maternal deaths per 100,000 births, greater than 10 times (!) that of countries like Australia, Japan, Israel , and Spain, where rates are between 2 and 3 per 100,000 births.3

. Maternal and infant mortality rates are increasing across all ethnicities in America. In particular, Black women are dying at nearly triple the rate of White women, and Native American women at double the rate. 4

. Recent analyses have found that an integrated midwifery workforce in healthcare systems would be able to provide 80% of total essential maternal care around the world and might avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths. 5

. Midwives can be the answer for workforce shortages across the United States, where nearly half of U.S. counties are without a single OB/GYN. It is estimated that America requires at least 8,000. more to meet the demand for maternal healthcare. It is estimated that that this need may rise toooo 22,000 by 2050. Unlike other high-income countries such as Australia, Canada, Netherlands, and the UK, the United States has not systematically incorporated midwives into essential care services. This is due to lack of decent insurance coverage for midwives, restrictive male-driven state and federal regulations limiting practice, and the unavailability of public subsidies to support midwifery education.

Markus Winkler

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. Among other archaic barriers to practice, a multitude of social, political, historical, and economic factors include: ignorant and restrictive state and federal regulations limit midwifery practice in the form of medicalized childbirth, regarding childbirth as inherently risk laden, requiring medical and technological intervention for normal childbirth, not the least of which is the history of elitism, sexism, and racism alive and well in the practice of medicine.6

. Due to the overwhelming benefits of midwifery care, and the current care inequities affecting Black and Indigenous families in the U.S., midwifery care should be far better integrated into this country’s health care system. Attitudes of traditional medicine have systematically eroded the profession of midwifery, nearly decimating the community-centered approach utilized by Black midwives in the South and immigrant midwives in the Northeast.7

Authors: P. Mimi Niles and Laurie C. Zephyrin

1. Molly R. Altman et al., “ The Cost of Nurse-Midwifery Care; Use of Interventions, Resources, and Ssociated Costs in the Hospital Setting”. Women’s Health Issues 27, no. 4 (July 2017): 434-40. “March of Dimes Position Statement – Midwifery Care and Birth Outcomes in the United States, “March of Dimes, 2019; Daphne N. McRae et al., “ Is Model of Care Associated with Infant Birth Outcomes Among Vulnerable Women? A Scoping Review of Midwifery-Led Versus Physician -Led Care, “SSM – Population Health 2 (Dec. 2016): 182-93; and Jane Sandall et al., “Midwife-Led Continuity Models Versus Other Models of Care for Childbearing Women”, Cochrane Database of Systematic Reviews 9 no. 4 (Apr. 28, 2016): 1-101.

2. Jill Alliman and Julia C. Phillippi, “Maternal Outcomes in Birth Centers: An Integrative Review of the Literature,” Journal of Midwifery & Women’s Health 61no.1 (Jan-Feb. 2016): 21-51; Nicole S. Carlson et al., “Influence of Midwifery Presence in the United States Centers on Labor Care and Outcomes of Low-Risk Parous Women: A Consortium on Safe Labor Study”, Birth 46, no. 3 (Sept. 2019), 487-99; Sandall et al., “Midwife Led Community Models, “2016; and Saraswathi Vedam et al., “The Giving Voice to Mothers Study: Inequity and Mistreatment During Pregnancy and Childbirth in the United States, “ Reproductive Health 16, no. 1 (June 11, 2019):77.

3. Donna L. Hoyert, Maternal Mortality Rates in the United States, 2021(National Health Statistics, Feb 2022. Organization for Economic Co-operation and Development, (OECD 2022); and Roosa Tikkanen et al. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries (Commonwealth Fund, )Nov 2020).

4. Centers for Disease Control and Prevention, “Four I 5 Pregnancy-Related Deaths in the U.S. Are Preventable”. Press release, Sept. 19, 2022; and National Academies of Sciences, Engineering and Medicine, Birth Settings in America: Outcomes, Quality, Access, and Choice (NASEM, 2020).

5. Sarah Bar-Zeev et al., The State of the World’s Midwifery 2021 (United Nations Population Fund, May 2021); Chitra P. Akileswaran and Margaret S. Hutchison, “Making Room at the Table for Obstetrics, Midwifery, and a Culture of Normalcy Within Maternity Care”, Obstetrics and Gynecology 128, no. 1 (July 2016) . . .

6. Linda Marsa, “Labor Pains: The OB-GYN Shortage,” AAMC News, Nov. 15, 2018.

7. Gertrude J. Fraser, African American Midwifery in the South: Dialogues of Birth, Race, and Memory (Harvard University Press, 1998. Eugene R. Declercq, “The Nature and Style of Practice of Immigrant Midwives in Early Twentieth Century Massachusetts”, Journal of Social History 19 no. 1 (Autumn 1985): 113-29.

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April 1, 2025