Midwifery Workforce Study
Midwifery Workforce
PROBLEM:
ACNM conducted a Midwifery Workforce Study that identified policy changes needed to expand the midwifery workforce to optimum capacity.
Midwifery in the United States is underutilized and underfunded (Sakala et al., 2020). Increasing access and integration of midwives throughout the United States can improve equity and outcomes (Vedam et al., 2018). Currently, the United States has approximately 4 midwives employed per 1,000 live births. With over 3.7 million live births a year, at least 22,000 midwives are needed in the midwifery workforce to meet the World Health Organization goal of at minimum 6 midwives per 1,000 live births. Currently, there are about 14,000 midwives in the US including those not in clinical practice, resulting in a gap of at least 8200 midwives. Even at 6/1000 births, we would have a smaller midwifery workforce than other high-income countries with better outcomes.
The Midwifery Workforce Study researchers analyzed publicly available data and data collected by the American Midwifery Certification Board (AMCB) and the Accreditation Commission for Midwifery Education (ACME), to provide the most accurate evaluation of the current midwifery workforce size, capacity, and growth trajectory.
Resources
The Executive Summary provides an overview of the study.
The Access to Midwifery Care and National Chartbook tells the story in maps, tables, and text.
The State-Specific Midwifery Data (ACNM State Fact Sheets) are available to our members via the member portal. Please note access to the State-Specific Midwifery Data is a ACNM Member benefit.
ACNM has created an Advocacy Toolkit for Midwives that provides a road map for developing strategies to increase access to midwives and midwifery-led care models and to grow the midwifery workforce. The national and state data from the Workforce Study inform these initiatives.
Workforce Study Data Briefs
Data Brief No. 3: How long do midwives work as nurses before starting midwifery education?
Download Brief #3: PDF
Data Brief No. 2: Is the proportion of midwives from self-identified Black, Latinx, Asian, and Indigenous groups increasing? (revised)
ACNM – Data Brief No. 2 (Update).pdf
Workforce Study Data Release
The American College of Nurse-Midwives was granted funding from the Johnson & Johnson Foundation to complete an in-depth analysis of the midwifery workforce. This project analyzes and packages data collected by the American Midwifery Certification Board and the Accreditation Commission for Midwifery Education, as well as from public sources, to provide the most accurate evaluation of the current midwifery workforce size, capacity, and growth trajectory based on available data sources. This webpage is a release of data gathered so far. The work of this study continues throughout 2023. By the end of the year, these data will be combined with publicly available data to build a model for an adequate midwifery workforce based on maternal-child health outcomes. Analysis of the data by states will identify which state policies are associated with an adequate midwifery workforce that can work to full capacity. This project will synthesize this information that can be used to advocate for policies that facilitate an adequate midwifery workforce.
Definitions
Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) are educated in graduate-level midwifery programs accredited by the Accreditation Commission for Midwifery Education (ACME). CNMs and CMs pass national certification examination administered by the American Midwifery Certification Board (AMCB) to receive the professional designation of CNM (if they have an active RN at the time of the certification exam) or CM.
Laws and regulations governing the practice of midwifery are rapidly changing. CNMs and CMs are regulated on the state level, thus professional practice and interaction with other health care professionals, such as physicians, can vary from state to state. CNMs are legally recognized to practice in every state in the United States and in the District of Columbia. CMs are currently legally recognized to practice in Delaware, Hawaii, Maine, Maryland, New Jersey, New York, Oklahoma, Rhode Island, Virginia, and the District of Columbia
State licensing is the process by which a state confirms that a health care worker is competent to practice and designates the health care worker as legally able to practice within the state. Requirements for licensing are generally set by state statute, and the licensing process is overseen by a regulatory authority in the state. In “independent” states, midwifery licensure is based on evidence of education and certification. In “restricted” states, midwives are required to provide evidence of a written contract with a physician to be licensed to provide midwifery care.
Scope of practice defines the patient population and types of care midwives can provide. Scope of practice is defined by the American College of Nurse-Midwives. The Accreditation Commission for Midwifery Education (ACME) ensures that midwifery education programs prepare midwives for full scope of practice. The American Midwifery Certification Board (AMCB) administers certification examinations and recertification exams and modules to ensure competence among all practicing midwives. This scope of practice is defined by ACNM as:
Midwifery as practiced by certified nurse-midwives (CNMs) and certified midwives (CMs) encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care. Midwives also provide primary care for individuals from adolescence throughout the lifespan as well as care for the healthy newborn during the first 28 days of life. Midwives provide care for all individuals who seek midwifery care, inclusive of all gender identities and sexual orientations. Midwives provide initial and ongoing comprehensive assessment, diagnosis, and treatment. They conduct physical examinations; independently prescribe medications including but not limited to controlled substances, treatment of substance use disorder, and expedited partner therapy; admit, manage, and discharge patients; order and interpret laboratory and diagnostic tests; and order medical devices, durable medical equipment, and home health services. Midwifery care includes health promotion, disease prevention, risk assessment and management, and individualized wellness education and counseling. These services are provided in partnership with individuals and families in diverse settings such as ambulatory care clinics, private offices, telehealth and other methods of remote care delivery, community and public health systems, homes, hospitals, and birth centers.??
Despite standardized scope of practice for education and certification, states may restrict midwives’ scope of practice as part of licensure. For the purposes of these tables, states were identified as full scope if the laws and regulations were consistent with the ACNM definition regarding 1) populations served, 2) diagnosis and treatment, and 3) prescribing medications. This determination of full scope of practice was made separate from the determination of independence (need for physician collaboration or supervision).
Prescriptive authority means a midwife can independently prescribe medications for their patients. By design, states which require a physician contract for licensure restrict independent prescribing.
The Medical Staff is a body of healthcare providers who are authorized by the hospital and state law to provide health care within a specific hospital. Midwives who are part of the Medical Staff can independently admit and discharge patients.
Medicaid parity means midwives receive the same rate of reimbursement as a physician when they are providing the same service.
Data Sources
CNM and CM state level licensure, prescriptive authority, medical staff privileges, and Medicaid parity was gathered from publicly available state government sources by ACNM staff and researchers. The links will be made available to ACNM members soon.
The American Midwifery Certification Board (AMCB) is the accredited certifying body for advanced practice midwives (certified midwives and certified nurse-midwives). Certification through AMCB occurs prior to licensing, and recertification of practicing midwives occurs every five years. AMCB collects basic demographic and education data on all midwives at certification and at each recertification cycle.
For these tables, we used de-identified data for initial certifications and recertifications occurring from 2016- 2020. Initial certification data included self-reported midwife age, race and ethnicity, state of practice, type of midwife educational program, all educational degrees earned, and the number of years of practice as a nurse prior to starting midwifery education. Recertification data included midwife age, race and ethnicity, state of practice, all educational degrees, and whether the midwife was still in clinical practice.
The National Center for Vital Statistics provides online access to aggregate birth certificate data through the CDC Wonder. The CDC Wonder system allows researchers to access state summary counts of live births based on characteristics included on the birth certificate. Data used for this report represent live births during 2020, the most recent year available.
The American Association of Birth Centers (AABC)is a membership organization that includes freestanding birth centers, alongside midwifery units, individuals, and organizations that support the birth center model. Among other activities, AABC creates national standards for birth centers and midwifery alongside units. The organization supports its member with state regulations and insurance reimbursement.
AABC Position Statement
The Accreditation Commission for Midwifery Education (ACME) is an agency established to advance and promote excellence in midwifery education. The aim of ACME is to ensure that programs are performing at the highest level of quality and providing learning experiences that will lead to optimal outcomes for students. ACME is a reliable authority regarding midwifery education. Since 1982, ACME has been recognized by the U.S. Department of Education (USED) as a nationally recognized programmatic accrediting agency for midwifery education programs.
ACME Homepage
Maps and Tables
State Variation in Midwife Regulation
Click below to view the full table
Midwife Density and Distribution of Midwife-attended Births
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Other Tables
Published December, 2022
