How Nurse-Midwives Can Help in Maternity Care Deserts

Lack of access to care is a crucial factor in maternal mortality in the U.S., and a March of Dimes 2022 report found that 2.2 million women of childbearing age live in maternity care deserts. Integrating care from nurse-midwives into those areas can make a difference.

According to the report, Nowhere To Go: Maternity Care Deserts Across the U.S., more than 146,000 babies were born in maternity care deserts. The designation refers to a county with a lack of maternity care resources, no hospitals or birth centers offering obstetric care, and no obstetric providers. One of the actions recommended in the report is expanding access to and improving the integration of the midwifery model of care.

“This can help improve access to equitable and culturally informed maternity care in under-resourced areas, lower costs, reduce unnecessary medical interventions that contribute to risks of maternal mortality and morbidity,” and more, according to the study’s researchers.

Lack of access to quality maternal care

Researchers asserted that obstetricians (OBs), certified nurse-midwives (CNMs), and family physicians can all provide “quality maternal care.” Yet 39.8% of counties lack a single OB or CNM, and “capacity for midwives in rural areas has potentially been underutilized.”

In a press release about the new report, Zsakeba Henderson, MD, March of Dimes Senior Vice President and Interim Chief Medical and Health Officer, said, “Our 2022 report confirms lack of access to care is one of the biggest barriers to safe, healthy pregnancies and is especially impacting rural areas and communities of color where families face economic strains in finding care.”

“We have struggled with a maternal mortality crisis for more than three decades,” observed Lora Sparkman, MHA, BSN, RN, in a blog discussing efforts to improve maternal outcomes. Sparkman, who is Relias’ Vice President and Partner, Clinical Solutions, Patient Safety and Quality, noted that despite advancements, “The U.S. maternal mortality rate remains stubbornly high, at 17.4 deaths per 100,000 live births.”

CNMs can bring life to maternity care deserts

With maternity care deserts making up 36% of all U.S. counties, improving access to care and reducing the maternal mortality rate will require far-reaching efforts including changing policies, educating providers, addressing social determinants of health, providing technological support, and expanding access to midwifery care.

“Having CNMs in these known underserved areas would be a lifeline to these mothers,” Sparkman noted.

“Not only would they provide evidence-based care, but they could direct and coordinate appropriate levels of care for mothers who are at a higher risk for birth-related complications,” she said.

According to the 2022 March of Dimes report, previous research identified the following benefits to using a midwife during pregnancy and postpartum periods: “Midwifery care has been associated with an increased chance of having a low-intervention birth and lower cost of care due to significantly lower odds of medical intervention. Additionally, it has been associated with possible reduction of preterm birth and other adverse birth outcomes.”

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