News and Analysis

It’s no secret that the United States is facing a worsening maternal health care crisis. We have the highest maternal and mortality rates of any other developed country. Black mothers are at even greater risk of dying or facing serious complications. Hospitals are closing around the country due to staffing shortages, leaving women to face a harrowing gap in care, with rural and underserved communities at greatest risk. To address these issues, hospitals and health systems must look towards all measures to improve maternal health care, including elevating the role of certified nurse-midwives (CNMs) on maternal care teams.

While there is extensive data supporting the use of midwifery care – births guided by midwives have less complications, interventions, inductions, and cesarean sections, as well as higher rates of VBACs (vaginal birth after cesarean) and general patient satisfaction – the vast majority of U.S. births do not involve CNMs. In the U.S., there are only 4 midwives for every 1,000 live births, while other countries see between 30-70 midwives per 1,000 births. Not only do these countries have lower maternal mortality rates, but also lower costs of maternal care.

Why CNMs matter – and how hospitals in the U.S. can benefit

So, despite the clear benefits, why haven’t hospitals in the United States followed suit? To start, there is a fundamental misunderstanding of the role of CNMs on the maternal care team. Although many first think of home or birth center births when they hear the term “midwife,” 87% of midwife-attended births in 2020 were in hospital settings in collaboration with nurses and physicians. Furthermore, 95% of midwives work exclusively in hospital settings. Nurse-midwives play an essential role in all aspects of maternal care, extending from prenatal support to labor and delivery. With midwives specializing in managing low-risk pregnancies, obstetricians and other specialists can focus on higher-risk cases that require more intensive medical intervention.

This is especially important as the United States faces access issues, with nearly half of United States counties lacking a single OB-GYN, alienating pregnant individuals and putting both their lives, and the lives of their babies, in jeopardy due to lack of prenatal and birth care. Midwives who are able to practice at the top of their scope would help expand the reach of health care services to communities that might otherwise lack access to maternal care.

The benefits of the midwifery model extend past patients and their infants as well – hospital systems are more efficient and cost effective when nurse-midwives are front and center care leaders. Increasing reliance on midwives doesn’t eliminate the need for OB-GYNs, instead allowing physicians and midwives to achieve their own respective scopes of practice. When midwives and physicians work in tandem, doctors and specialists can focus on patients that require their expertise, such as surgical, emergency, or high-risk cases. Some estimates place the cost savings around $4 billion when midwives take on just 20% of births in the next 10 years.

How hospitals and health systems can better integrate midwifery care

At our Ob Hospitalist Group programs across the country, we’ve seen that when hospitals and health systems have strong OB/GYN and CNM partnerships, outcomes improve and patients thrive. In fact, our data indicates that programs with midwife hospitalists consistently outperform sites without CNMs on key quality metrics, including C-section rates. When hospitals prioritize a collaborative model between physicians and midwives, physicians are able to address high complexity or emergency cases, while the rest of the patients are still able to receive attentive care from nurse-midwives.

For hospitals in rural or other underserved areas, finding OB providers in general can be a challenge, but nurse-midwives can help close the gaps and reduce costs while still providing high-quality care. Hospitals can utilize programs such as Maternal Health Access Solutions to help find customizable solutions for their staffing needs, including bringing in CNMs as influential members of the maternal care team.

It is our responsibility, as those passionate about improving women’s health care, to demonstrate how a collaborative, shared model championed by both nurse-midwives and physicians is ultimately in the best interest of everyone – patients, midwives, physicians, and hospital administrators. It’s time for hospitals to embrace these opportunities to create a more sustainable, patient-centered model of care.

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Mark Simon, MD, MMM is the Chief Medical Officer of Ob Hospitalist Group (OBHG), the nation’s largest and only dedicated OB hospitalist provider. OBHG partners with hospitals and health systems nationwide to employ over 1,800 OB/GYNs and Certified Nurse-Midwives, who work exclusively in hospital settings to implement patient safety initiatives, manage labors, provide emergency obstetrical services, and implement evidence-based best practices.
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