US Maternal Health Crisis: Midwifery Care Faces Access and Education Barriers
Table of Contents
The United States faces a stark reality: it is the only high-income nation with a rising maternal mortality rate. As of 2022, the US recorded 22 maternal deaths for every 100,000 live births, a figure significantly higher than any other comparable country, according to the Centers for Disease Control and Prevention. While midwifery care is gaining recognition as a potential solution, systemic obstacles are preventing many patients from accessing this vital service.
The Growing Interest in Midwifery Care
Despite the challenges, demand for midwifery care is substantial. A recent survey revealed that 66% of respondents with employer-sponsored insurance expressed interest in utilizing midwifery services for future pregnancies. However, current utilization rates remain low, with only one in five patients having a midwife involved in their care during their last pregnancy. This disparity highlights a critical gap between patient desire and actual access.
Barriers to Access: Knowledge and Coverage
The primary hurdles preventing wider adoption of midwifery care are a “lack of knowledge” and “insurance coverage,” according to those interested but not currently utilizing the service. “People want access to midwifery care,” stated a VP of healthcare innovation at Morgan Health, “But there are some gaps that we can fill there.” Many patients are unclear about the full scope of a certified nurse midwife’s practice – which includes prenatal care, childbirth, and postpartum support – and how they collaborate with other healthcare providers.
A certified nurse midwife is a registered nurse who provides comprehensive reproductive health services in hospitals, private practices, and birthing centers. Research consistently demonstrates that midwifery care is associated with improved clinical outcomes, including fewer cesarean sections and lower rates of preterm birth. However, a shortage of providers limits access across the US.
Insurance Coverage Lags Behind Demand
Current insurance coverage for certified nurse midwives is limited. Data from Mercer’s 2025 health and benefit strategies survey indicates that only 25% of employers with 500 or more workers currently cover these services. This lack of widespread coverage contributes significantly to the access problem.
Employers Can Play a Key Role
Fortunately, employers may be able to expand access without significant additional investment. Unlike some specialized services like doula or fertility support, midwifery care can often be integrated into existing health plans, allowing employees to see midwives as they would any other provider, such as an OBGYN. Employers can collaborate with their insurance carriers to connect employees with in-network midwife providers.
Focusing on both “educating patients” and “clarifying access” is crucial, according to healthcare experts. However, addressing access can be particularly challenging in states with restrictive regulations for midwives or lower reimbursement rates, which impact wages and provider availability.
The Potential for Return on Investment
Despite these systemic challenges, there is growing optimism that increased access to midwifery care could yield a positive return on investment for employers. Deliveries involving midwives tend to have lower rates of costly interventions like C-sections and neonatal intensive care unit (NICU) admissions.
“What our employers want from us is the best possible outcomes, and also they want to be able to manage costs across the board,” explained the chief medical officer with Maven Clinic, a reproductive healthcare benefits firm. “They can get more efficiency out of their spending, and they can produce better health by having solutions that incorporate midwives.” Ultimately, expanding access to midwifery care represents a critical step towards improving maternal health outcomes and controlling healthcare costs in the United States.
