Expanding Access to Midwifery Care

Access to Midwifery Care has Never Been a Top Priority in the US. 

It is perceived to be “less-than” what services the Ob/Gyn can provide. However, with the rising demand of maternity care around the US, it is clear to say that midwives are much needed than before. According to CDC, around 3.66 million babies were born in 2021, representing a 1% increase from 2020. Since 2014, births in the United States have declined 2% every year and dropped 4% during the early stages of the Covid-19 pandemic in 2019 and 2020, the report said. The fertility rate in the United States, which represents an estimate of the average number of babies a woman will have in her lifetime, also increased slightly in 2021 to 1.66, up from 1.64 in 2020, which was the lowest fertility rate the United States has seen since the government started tracking it in the 1930s.

Despite the astronomical sums that the U.S. spends on maternity care, mortality rates for women and infants are significantly higher in America than in other wealthy countries. And because of a shortage of hospitals and ob-gyns, especially in rural areas, many women struggle to access proper care during pregnancy. Moreover, the rate of cesarean sections is exceedingly high at 32 percent—the World Health Organization considers the ideal rate to be around 10 percent—and 13 percent of women report feeling pressured by their providers to have the procedure.

It is indeed with much greater consideration how important expanding the access to midwifery care is. Midwifery care is safe — some say safer than physician care — for women and families at lower risk. People who use midwives report high levels of satisfaction with their care. A 2018 research analysis  found that, in hospital settings, people who have midwives are less likely to have cesarean deliveries, commonly known as C-sections, or episiotomies. Other research  has found that people who birth with nurse midwives are more likely to breastfeed and less likely to experience a perineal laceration during birth. The value that midwives provide to maternity care is enormous. Expanding access to midwifery care will significantly help not just the mothers, but the families, community and the healthcare industry.

To further enhance the access to midwifery care, there must be an emphasis to be put on the quality and quantity of midwifery education, training individuals and informing them, and increasing midwifery human resources through employment. Additionally, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities and providing birth facilities with front-line equipment, promoting and reinforcing the position of midwives in the health care industry. Finally, establishing an efficient and powerful monitoring system to control the practice midwives and other birth professionals, increasing the collaborative practice of midwives and birth practitioners, and promoting teamwork with respect to midwifery care.

Moreover, here are some recommendations to increase access to midwifery care:

1. Federal policymakers should:

• Enact the Midwives for Maximizing Optimal Maternity Services (Midwives for MOMS) Act (H.R. 3352 and S. 1697 in the 117th Congress). This bipartisan bill would increase the supply of midwives with nationally recognized credentials (CNMs, CMs, CPMs) by supporting students, preceptors, and schools and programs. It would give funding preference to programs supporting students who would diversify the profession and who intend to practice in underserved areas.
• Mandate equitable payment for services of CMs and CPMs recognized in their jurisdiction by Medicaid, the Child Health Insurance Program (CHIP), TRICARE (the military health care program), the Veterans Health Administration (VHA), the Indian Health Service (IHS), and Commissioned Corps of the U.S. Public Health Service, and make CMs and CPMs eligible to qualify for federal loan repayment from the National Health Service Corps.
• Mandate that hospitals cannot deny admitting and clinical privileges to midwives as a class.
• Require the collection and public reporting of data related to health inequities, such as racial, ethnic, socioeconomic, sexual orientation, gender identity, language, and disability status in critical indicators of maternal and infant health – including, but not limited to, maternal mortality, severe maternal morbidity, preterm birth, low birth weight, cesarean birth, and breastfeeding.
• In all relevant deliberations, consistently engage early and proactively with community-based midwives bringing a birth justice framework. This involves their meaningful decision-making roles in shaping federal policy priorities and strategies, and diverse representation that reflects the demographic makeup of adversely affected communities.

2. State and territorial policymakers should:

• In jurisdictions that currently fail to recognize them, enact CM and CPM licensure. For CMs, these include all of the territories, the District of Columbia, and all states except Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, and Virginia. Jurisdictions that have yet to recognize CPMs through licensure are: Connecticut, Georgia, Iowa, Illinois, Kansas, Massachusetts, Missouri, Mississippi, North Dakota, Nebraska, North Carolina, New York, Nevada, Ohio, Pennsylvania, West Virginia, and all U.S. territories.
• Amend unnecessarily restrictive midwifery practice acts to enable full-scope midwifery practice, in line with their full competencies and education as independent providers who collaborate with others according to the health needs of their clients.
• Mandate reimbursement of midwives with nationally recognized credentials at 100 percent of physician payment levels for the same service in states without payment parity.
• In states where Medicaid agencies do not currently pay for services of CMs and CPMs licensed in their jurisdiction, mandate payment at 100 percent of physician payment levels for the same services. Currently, Delaware, Hawaii, New Jersey, Oklahoma, and Virginia recognize CMs but do not pay for their services through Medicaid. States that regulate CPMs yet fail to pay for their services through Medicaid are: Alabama, Arkansas, Colorado, Delaware, Hawaii, Kentucky, Louisiana, Maryland, Maine, Michigan, Minnesota (does not pay for home birth services), Montana, New Jersey, Oklahoma, Rhode Island, South Dakota, Tennessee, Texas (does not pay for home birth services), Utah, and Wyoming.
• In all relevant deliberations, consistently engage early and proactively with community-based midwives bringing a birth justice framework. This involves their meaningful decision-making roles in shaping state and local policy priorities and strategies, and diverse representation that reflects the demographic makeup of adversely affected communities.

3. Private sector decisionmakers, including purchasers and health plans, should:

• Incorporate clear expectations into service contracts about access to, and sustainable payment for, midwifery services offered by providers with nationally recognized credentials.
• Educate employees and beneficiaries about the benefits of maternity care provided by midwives with nationally recognized credentials.
• Mandate that plans directories maintain up-to-date listings for available midwives.
• In relevant policy deliberations, consistently engage early and proactively with community-based midwives bringing a birth justice framework. This involves their meaningful decision-making roles in shaping private sector policy priorities and strategies, and diverse representation that reflects the demographic makeup of adversely affected communities.

The greatest dream of every midwife is to achieve and to expand midwifery care services all over the world. Given enough resources and opportunities, this little dream will come into reality.

References:

Editors, T. (2019, February 1). The U.S. needs more midwives for Better Maternity Care. Scientific American. Retrieved July 9, 2022, from https://www.scientificamerican.com/article/the-u-s-needs-more-midwives-for-better-maternity-care/

Johantgen M;Fountain L;Zangaro G;Newhouse R;Stanik-Hutt J;White K; (n.d.). Comparison of labor and delivery care provided by Certified Nurse-Midwives and Physicians: A systematic review, 1990 to 2008. Women’s health issues : official publication of the Jacobs Institute of Women’s Health. Retrieved July 9, 2022, from https://pubmed.ncbi.nlm.nih.gov/21865056/

KB;, A. L. K. (n.d.). Relationship between hospital-level percentage of midwife-attended births and obstetric procedure utilization. Journal of midwifery & women’s health. Retrieved July 9, 2022, from https://pubmed.ncbi.nlm.nih.gov/29144586/

Person. (2022, April 4). Charted: US birth rate increases for the first time in 7 years. Advisory Board. Retrieved July 9, 2022, from https://www.advisory.com/daily-briefing/2022/05/24/us-birth-rate

SW;, W. J. T. M. (n.d.). Association between breastfeeding duration and type of birth attendant. Journal of pregnancy. Retrieved July 9, 2022, from https://pubmed.ncbi.nlm.nih.gov/29686904/

Recommendations to increase access to midwifery care. (n.d.). Retrieved July 13, 2022, from https://www.nationalpartnership.org/our-work/resources/health-care/maternity/midwifery-recommendations.pdf