The percentage of births midwives attend is on the rise, as is the number of practicing midwives and students in midwifery education programs, according to a U.S. Government Accountability Office report published in April. Midwives attended nearly 12% of U.S. births in 2021, the report found, up from 9.6% in 2016. The vast majority of these births were attended by certified nurse midwives and certified midwives.

Figure. The number and percentage of total births attended by midwives, 2016-2021. Image courtesy of the Government Accountability Office.

In the context of a worsening maternal mortality crisis-in which hundreds of birthing people die each year due to complications, more than half of rural counties don't have hospital-based care for pregnant people, and racial and ethnic disparities persist-ensuring better access to maternal health care providers such as midwives is vital to improving outcomes and reducing disparities. As the report notes, "Research indicates that midwives can help improve the quality of maternal care and improve health outcomes."

Yet barriers to midwifery care remain. Nurse midwives are the only midwives authorized to practice and receive Medicaid reimbursement nationwide, for instance, but their ability to practice independently and to the full extent of their training and education varies by state. As the report highlights, in 2021 midwives attended 26.4% of births in New Hampshire, where they practice independently, but were present at just 3.6% of births in Louisiana, where their scope of practice is limited. The report, which was requested by members of the U.S. House of Representatives, including nurses Lauren Underwood and Cori Bush, also notes that some patients don't have insurance coverage or even a full understanding of what midwifery care entails, whereas others seeking midwifery care can't find an available midwife in their area.

Challenges such as these must be addressed to ensure birthing people have access to culturally congruent care and the care they prefer. In a statement by Oversight Committee and Black Maternal Health Caucus members upon release of the report, Underwood emphasized the need for action. "Evidence shows that midwives provide personalized, high-quality care that leads to great outcomes for moms and babies, and we must advance legislation to ensure every family who wants a midwife can access one," she said. "The Black Maternal Health Momnibus Act makes historic investments to grow and diversify the midwifery and broader perinatal workforce, and Congress must pass this legislation immediately."-Corinne McSpedon, senior editor