ACNM Applauds Critical Research that Links Integration of Midwifery into State Health Care Systems to Improved Birth Outcomes
In light of a new state-by-state “report card,”
ACNM President Lisa Kane Low, CNM, PhD, FACNM, FAAN calls for a renewed push for full practice authority and the
passage of other laws supporting midwifery practice.
In a first-of-its-kind study, “Mapping Integration of Midwives across the United States: Impact on Access, Equity, and Outcomes,” a multidisciplinary team of investigators found a strong, positive connection between the role of midwives in the health care system—what the researchers call “midwifery integration”—and birth outcomes.
States with high midwifery integration generally had better results on measures such as premature births, cesarean deliveries and newborn deaths, while states with the least integration, primarily in the Midwest and South, tended to show worse outcomes, according to the research published February 21 in PLOS ONE. As with most population-related health studies, the statistical association between the role of midwives and birth outcomes doesn’t prove a cause-and-effect relationship because of the many complex, intersecting issues that come into play, including structural racism, socio-economic resources, and health care system infrastructure. However, almost 12% of the variation in neonatal death across the United States appears to be solely attributable to the degree to which midwives play in each state’s health care system.
The degree of integration of midwives within the systems of care ranged from a high of 61 in Washington State to a low of 17 in North Carolina (See the complete list, with links to each state’s report card.) “Our results show that families experience better outcomes when midwives can practice to their full capacity and are part of the system,” said Lead Investigator Saraswathi Vedam, an associate professor in the Department of Family Practice at the University of British Columbia, who headed the study’s team of U.S. epidemiology and health policy researchers.
“The results of this important work provide further evidence that the role of midwives is a critical part of the response to the broken maternity and health care system we have in the U.S.” said Lisa Kane Low, CNM, PhD, FACNM, FAAN, president of the American College of Nurse-Midwives. “We need to do more to change state laws to ensure that midwives can practice to the full extent of their education and training. Removal of barriers to practices, such as supervision requirements or lack of prescriptive privileges, and restrictions on hospital credentialing are necessary to support integration of certified nurse-midwives and certified midwives into the fabric of state health care systems.” CNMs/CMs attend 10% of the births occurring nationally, with individual state rates ranging from 3% to 27% of births.
Prior research has linked states laws supporting full practice authority for CNMs and CMs have a higher number of midwives in those states, increasing access to care options. Model legislation for integration and support of midwives is described in another landmark publication developed by the United States Midwifery Education, Regulation, and Affiliation Coalition. Entitled, "United States Model Midwifery Legislation and Regulation: Development of a Consensus Document," the article, whose lead author is Holly Powell Kennedy, CNM, is available in the current issue of the Journal of Midwifery and Women's Health.
“As we look at maternity care provider shortages, rising rates of maternal mortality, and ongoing barriers to access to care and quality health care coverage,” Kane Low added, “it is time to put aside differences and work together to ensure midwives are fully integrated into a system of care that centers those we serve instead.”