America’s Maternal Healthcare Crisis Has a Fix — Midwives 

For many, giving birth in America is more dangerous today than it was a generation ago. Other wealthy nations put midwives at the center of care and see far better results. If we want to lead the world in maternal and infant health, it’s time for us to invest in the lifesaving care of midwives. 

Where Deep Medical Knowledge Meets Person-centered Care 

Midwives are highly-skilled medical professionals trained in full-spectrum reproductive healthcare, childbirth, and newborn care. While often associated with pregnancy and birth, midwives also provide essential services like contraception and family planning, routine gynecological exams, and STI treatment. They offer independent care for low-risk pregnancies and partner with OB/GYNs and other clinicians when higher-level support is needed. This ensures integrated care across home, birth center, and hospital-based birth settings.

Rooted in the belief that birth is a normal, physiological event — not a medical emergency — midwifery centers around patient autonomy and informed consent. This philosophy stands in contrast to the obstetric model, which is designed to manage medically complex and high-risk pregnancies through medical and surgical intervention.

In a system that often prioritizes intervention over autonomy, midwives offer a model of care that listens first. Their approach restores trust and choice across an individual’s entire perinatal health journey.

The Marginalization of Midwifery in Modern-day America 

For generations, midwifery was a common practice in the US. It was one of the few professions open to women of all backgrounds, including immigrants and women of color. But, the medicalization of maternity care that began in the 1800s sparked a transition away from midwife-assisted births. This trend accelerated in the early-to-mid-20th century thanks to a coordinated campaign of social, political, and economic efforts — a campaign led by white, male physicians and politicians and influenced by a history of sexism, classism, and racism in American medicine. As a result, by the 1980s, less than two percent of US births were attended by a midwife.

However, over the past several decades, this trend has reversed, and by 2020, nearly 12 percent of US births were attended by a midwife. But while demand for the high-quality, evidence-based reproductive, sexual, and perinatal healthcare that midwives provide is on the rise, the availability of midwives — particularly those who are racially or ethnically diverse — has failed to keep pace.

Supporting an Overburdened Obstetric System 

There are multiple factors contributing to this pervasive shortage of midwives in the United States. For one, prospective midwives face a lack of federal funding to support their training and education, which means fewer people entering the profession. This scarcity of new midwives coincides with a striking shortage of maternal healthcare providers in the US. Over one-third of counties across the country are considered obstetric deserts with no access to birthing centers, hospitals, or obstetric providers. That means less perinatal care and poorer health outcomes for babies and birthing people. While midwives could help provide desperately needed relief in these regions, in most states, they aren’t widely incorporated into hospitals or given professional autonomy.

Outdated laws and regulations require many midwives to work under physician supervision, resulting in duplicative efforts and unnecessary oversight. And their full scope of services is rarely covered by insurance providers, which makes midwife-assisted maternal care even more inaccessible to low-income families. This is in stark contrast to many high-performing maternal health systems around the world — countries like the UK, Netherlands, and New Zealand — where midwives are fully trusted and integrated into the mainstream healthcare systems. In the United States, there are only four midwives per 1,000 births, compared to an average of 57 midwives per 1,000 births in other high-income countries.

Challenges Surrounding Maternal Mortality in the US 

We’re not facing a maternal health crisis — we’re facing a crisis of the maternal healthcare system. The staggering rates of maternal mortality in the US aren’t due to the minds or bodies of women and birthing people but rather failures in the systems meant to care for them.

While the US spends more on healthcare than any other country, our health outcomes are markedly poorer than those of our high-income peers. This troubling trend can also be seen in America’s maternal healthcare. In fact, the US suffers from one of the highest maternal mortality rates among developed countries, a rate that has continued to worsen over the past decade: from 17.4 deaths per 100,000 live births in 2018 to 32.9 deaths per 100,000 live births in 2021. This is nearly 10 times the rate of other high-income nations like Japan, Germany, and Australia. And while these rates have been rising across all ethnicities in the US, Native American and Black women are two and three times more likely to die from a pregnancy-related cause than White women.

The reasons behind the US’s worsening maternal mortality rates are complex and multifaceted, spanning social factors like racial, ethnic, and gender bias in the healthcare system, inequitable access to preventative care, and pre-existing health conditions like cardiovascular disease and mental health disorders. Yet, data from the CDC suggests that over 80 percent of pregnancy-related deaths in the US are preventable.

Midwives Save Lives    

Expanded access to midwives is a practical and proven strategy to improve care and save lives. In addition to administering fewer unnecessary medical interventions, their holistic, interdisciplinary approach is associated with a much higher rate of spontaneous vaginal delivery and a lower rate of cesarean sections. Research indicates more positive birth outcomes and fewer maternal deaths in regions where midwives are well-integrated into the health system. Their contributions result in fewer preterm births, low birth weight infants, and neonatal deaths.

Central to their practice is informed consent and culturally concordant and trauma-informed care — particularly for members of marginalized communities. Integrating midwives into healthcare systems worldwide could provide 80 percent of essential maternal care while reducing maternal deaths by 41 percent, neonatal deaths by 39 percent, and stillbirths by 26 percent.

Midwives’ comprehensive approach, which combines compassion and medical expertise, makes them indispensable in improving maternal and infant health outcomes in the US and globally. Broadening access to midwife-led care in the US would not only help address the need for more maternal healthcare providers but also offer care alternatives and supplements that improve outcomes for birthing people and their babies.

March, 2025