How midwives can help reduce maternal death in the U.S.

When my first child was born, I did everything “right”: I chose a top-rated OB-GYN at a highly acclaimed hospital. But my labor was twelve excruciating hours of feeling alone and abandoned. That experience shook me—and sent me searching for a better way.

For my second birth, I hired a doula. For my third, I worked with a doula and midwife team. By my fourth and fifth babies, I knew: for me, midwives weren’t a luxury, they were essential. Their care wasn’t rushed. They stayed with me through every contraction. They focused on my mind, body, and spirit—not just delivering a baby but supporting me as a whole person.

That’s the power of midwifery care. And it’s why, when we talk about solutions to America’s maternal health crisis, midwives aren’t just nice to have. They’re critical.

If navigating pregnancy care in America has ever felt confusing, fragmented, or unsupported—you’re not imagining it. The U.S. has the highest maternal mortality rate among wealthy nations—and it’s getting worse in places like Alabama, where access to maternity care is so limited that over half the state qualifies as a “maternity care desert.”

But new data spotlights a solution we’re still underusing: midwives.

According to research from the CDC and the Commonwealth Fund, when midwives are fully integrated into health systems—able to prescribe medication, admit patients to hospitals, and work without burdensome oversight—maternal and infant outcomes improve dramatically. We’re talking 41% fewer maternal deaths, 39% fewer newborn deaths, and 26% fewer stillbirths.

So why are midwives attending just 2% of births in Alabama? Let’s break it down.

Related: The U.S. maternal mortality rate is shockingly high—can improved midwife accessibility help?

A system that leaves many moms behind—especially in the South

In 2021, the U.S. maternal mortality rate hit 32.9 deaths per 100,000 live births, according to the CDC. For Black women, the rate was more than double that of white women—a shocking 69.9 per 100,000. And while that number improved slightly in 2022, southern states like Alabama continue to report some of the highest mortality rates in the country.

Alabama’s data reveals a deeper problem: more than 50% of counties lack any obstetric care, and just 2% of births involve a midwife. The result? Pregnant people are traveling hours for routine appointments or laboring without the support they need.

What exactly is a midwife—and why does it matter?

Let’s demystify the titles:

• Certified Nurse-Midwives (CNMs): Registered nurses with additional midwifery training. They can practice in all 50 states, mostly in hospitals.
• Certified Midwives (CMs): Similar to CNMs but without a nursing degree.
• Certified Professional Midwives (CPMs): Often work in homes or birth centers. Only about 30 states license them.

Studies show that when midwives are fully supported and integrated into maternity care, moms experience fewer complications, lower C-section rates, and better postpartum outcomes.

The barriers keeping midwives out

Here’s what’s standing in the way of safer, more supported births:

1. Legal limitations. Some states make it nearly impossible for midwives to practice independently. CPMs, in particular, face patchy licensing laws and are barred from Medicaid reimbursement in many places.

2. Insurance and hospital gatekeeping. Without formal hospital privileges, midwives can’t admit patients—leaving moms caught between systems.

3. Not enough midwives. The U.S. has about 4 midwives per 1,000 births—well below the WHO’s recommendation of 6 per 1,000. We need thousands more midwives, especially in rural areas.

4. Racism and health inequity. Black and Indigenous families are more likely to live in maternity care deserts, and research shows their concerns are more likely to be dismissed by providers.

As Black Mamas Matter Alliance (BMMA) co-steering committee member Elizabeth Dawes Gay explained at a public session, “We envision a world where Black mamas have the rights, respect and resources to thrive before, during and after pregnancy.” 

That’s why midwifery care—which centers relationship-building, continuous support, and cultural attunement—can play a pivotal role in closing the care gap, ensuring birthing people receive the attention and dignity they deserve.

Related: I’m a midwife, and I can’t be silent about our broken birthing system

What we need to fix this

Too many maternal deaths could be prevented—and the tools to change that already exist:

• Expand Medicaid to cover midwives and doulas in every state.
• Standardize licensure so CPMs and CMs can practice legally and fully across the U.S.
• Fund midwifery education and rural incentives, just like we do for OB-GYN residencies.
• Invest in community birth centers, especially in underserved counties.

A recent federal program—the $16.5 million Transforming Maternal Health (TMaH) Model grant—will require Alabama to expand midwifery access, train more providers, and rethink how Medicaid supports community-based care.

According to a January 2025 press release from the Alabama Medicaid Agency, the state “is eligible for up to $16.5 million in funding over the next decade” as part of this initiative through CMS and HHS. It’s one of the clearest signs yet that systemic change is coming—but only if states follow through.

Organizations like NACPM, MANA, and March for Moms are leading the charge. They’re working to make midwifery care more accessible, equitable, and respected.are leading the charge. They’re working to make midwifery care more accessible, equitable, and respected.

A care model that puts moms first

Too often, maternity care in the U.S. emphasizes efficiency and liability management over outcomes that truly center the health and wellbeing of birthing people and their babies. Midwifery care brings a holistic, evidence-based approach that prioritizes the birthing person’s voice and wellbeing. It means listening more. Rushing less. And building trust where it’s long been missing.

Systemic change takes time—but families deserve better support now. Expanding Medicaid, standardizing licensure, and investing in birth centers are critical steps to ensuring all birthing people get the care they need and deserve.

Sources:

1. Study shows states that utilize midwives have better maternal outcome. June 23, 2025. WBRC. Study shows states that utilize midwives have better maternal outcome.
2. Insights into the U.S. maternal mortality crisis: An international comparison. June 2024. The Commonwealth Fund. Insights into the U.S. maternal mortality crisis: An international comparison.
3. Maternity care deserts are making the maternal sepsis crisis worse. (No date). Sepsis Alliance. Maternity care deserts are making the maternal sepsis crisis worse.
4. Improving maternal outcomes through perinatal quality collaboratives. (No date). CDC. Improving maternal outcomes through perinatal quality collaboratives.
5. Expanding the role of midwives to address the maternal health crisis. May 2023. The Commonwealth Fund. Expanding the role of midwives to address the maternal health crisis.
6. Maternal mortality rates in 2021. (No date). CDC. Maternal mortality rates in 2021.
7. Midwife licensing laws by state. (No date). Midwife Schooling. Midwife licensing laws by state.
8. Black Mamas Matter. October 8, 2019. American Public Health Association. Black Mamas Matter.
9. Alabama Medicaid TMaH Grant. January 6, 2025. Alabama Medicaid Agency. Alabama Medicaid TMaH Grant.
10. National Association of Certified Professional Midwives (NACPM). (No date). NACPM. National Association of Certified Professional Midwives.
11. Midwives Alliance of North America (MANA). (No date). MANA. Midwives Alliance of North America.
12. March for Moms. (No date). March for Moms. March for Moms.