The Critical Role of Midwifery in Maternal Health: Navigating Centuries of Exclusion and Championing Access

Midwifery, a practice with roots stretching back tens of thousands of years, stands as a cornerstone of human history, offering vital support through the profound experiences of pregnancy and childbirth. For millennia, midwives have been the trusted guides, ensuring healthier outcomes for both mothers and their newborns. Today, this ancient profession continues to provide comprehensive care for low-risk pregnancies, encompassing prenatal, intrapartum, and postpartum periods. The midwifery model of care fundamentally views birth as a natural, physiological event, adopting a holistic approach that recognizes the intricate connection between a person’s mental, emotional, and physical well-being. However, in the United States, a nation grappling with maternal death rates nearly double those of other developed countries, a legacy of discrimination and concerted efforts has marginalized midwives within the healthcare system. As the country confronts a burgeoning shortage of maternal healthcare providers, the imperative to dismantle barriers to midwifery care has never been more evident—it is a critical step toward saving lives. Understanding the multifaceted contributions and persistent challenges faced by midwives is essential to appreciating their indispensable role in modern healthcare.

The Midwifery Model: Empowering Bodily Autonomy and Holistic Care

At the heart of midwifery care lies a profound respect for pregnant individuals’ inherent right to bodily autonomy. Midwives are dedicated to empowering their clients by providing comprehensive information and facilitating informed decision-making at every stage of pregnancy, birth, and the postpartum journey. This collaborative approach ensures that individuals are active participants in their care, making choices aligned with their values and circumstances. When health complications arise, midwives are expertly trained to identify and manage them, with a clear protocol for collaborating with or referring to physicians and other specialized healthcare professionals.

This emphasis on empowered decision-making demonstrably translates into improved patient outcomes. Research consistently indicates that individuals receiving midwifery care are significantly less likely to undergo interventions such as cesarean sections, episiotomies, epidural anesthesia, and induced labor. These interventions, while sometimes medically necessary, carry inherent risks, can lead to complications, and often increase healthcare costs. By prioritizing physiological birth and minimizing unnecessary interventions, midwifery care not only enhances maternal and infant well-being but also contributes to a more efficient and patient-centered healthcare system.

Diverse Settings of Care: From Homes to Hospitals and Birth Centers

Midwives provide essential care across a spectrum of birth settings, accommodating individual preferences and needs. Whether a pregnant person chooses the comfort of their home, the familiarity of a hospital, or the specialized environment of a freestanding birth center, midwives are equipped to offer expert support. They are trained to function effectively in all these settings, working autonomously or collaboratively with physicians and nurses.

The flexibility of midwifery care is particularly crucial in addressing the persistent issue of maternity care deserts in the United States. According to the March of Dimes, approximately one-third of U.S. counties are classified as maternity care deserts, meaning they lack adequate access to obstetric care services. In these underserved areas, midwives play a pivotal role in bridging critical gaps, extending essential maternal healthcare to communities that would otherwise be left without it. Their ability to practice in diverse locations ensures that more individuals, regardless of their geographic location or socioeconomic status, can access the quality care they deserve.

A Legacy of Exclusion: The Systematic Marginalization of Midwives in the U.S.

The history of midwifery in the United States is marked by a significant and detrimental shift. Prior to the 19th century, midwifery was the primary mode of maternity care, with midwives serving as the trusted experts in childbirth. However, as the medical profession, dominated by white, male physicians, began to focus on obstetrics, concerted efforts were made to professionalize and institutionalize birth, often at the expense of established midwifery practices. Laws were enacted, and educational requirements were imposed, effectively dismantling the widespread practice of midwifery and pushing it to the margins of the healthcare system.

This historical exclusion has had profound and lasting consequences. In 2022, an estimated 65% of births in the U.S. were considered low-risk. Yet, remarkably, midwives attended only 13% of these births. This statistic stands in stark contrast to many other developed nations with superior maternal and infant health outcomes, where midwives are the primary providers of maternity care for low-risk pregnancies. For instance, in countries like the Netherlands, midwives attend a significantly higher percentage of births, contributing to their robust maternal health statistics. While the demand for midwifery care and birth centers in the U.S. is steadily growing, restrictive state laws and systemic barriers continue to impede its widespread integration, particularly in areas with limited access to obstetric facilities.

Demonstrable Impact: States Supporting Midwifery See Improved Health Outcomes

A growing body of evidence highlights a direct correlation between states that foster supportive legal and regulatory environments for midwives and improved maternal and infant health outcomes. States that have successfully integrated midwifery care into their healthcare systems consistently report lower rates of premature births, fewer cesarean surgeries, and reduced newborn mortality compared to states with more restrictive policies.

Despite these clear benefits, many states continue to enforce outdated, discriminatory laws that significantly limit the ability of qualified midwives to practice. These restrictions disproportionately affect marginalized communities, particularly pregnant people of color, who already face significant disparities in maternal healthcare access. The persistent challenges in states like Georgia, where restrictive laws have been actively challenged, underscore the deeply entrenched nature of these barriers. In a significant international recognition of these disparities, two United Nations human rights bodies, in 2022 and 2023, formally called upon the United States to address the critical lack of access to midwifery care, especially within Black and Indigenous communities, emphasizing its connection to racial discrimination and human rights.

Global Recognition: Midwives as Pillars of Public Health and Human Rights

The World Health Organization (WHO) and other international bodies have repeatedly championed the expansion of midwifery models of care as a vital strategy for improving global maternal and child health. The WHO strongly advocates for countries to transition towards midwifery-led care, recognizing its profound potential to save lives, reduce healthcare costs, and enhance the overall healthcare experience for individuals. This commitment is further exemplified by the WHO’s partnership with the United Nations Population Fund (UNFPA) to bolster the global midwifery workforce.

Internationally, midwifery care is not merely an alternative; it is considered an integral component of quality healthcare for pregnant individuals. By prioritizing physiological birth, continuous support, and informed choice, midwives contribute significantly to achieving Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all at all ages, with a specific focus on reducing maternal and child mortality. Their work is intrinsically linked to advancing human rights, particularly the right to health and reproductive autonomy, for individuals worldwide.

The Path Forward: Ensuring Universal Access to Midwifery Care

Midwives are recognized experts in the intricate process of birth, and their care has been empirically shown to yield superior health outcomes for low-risk pregnancies and their infants. In the context of the ongoing maternal health crisis in the United States, which disproportionately impacts Black and Indigenous populations, expanding access to midwifery care is not just a matter of healthcare improvement but a crucial step in advancing reproductive justice and equity.

The Center for Reproductive Rights has been at the forefront of legal challenges aimed at dismantling harmful barriers to midwifery practice. In April 2026, the Center filed a landmark lawsuit against the state of Georgia, challenging two specific laws that critically restrict the practice of midwives. This legal action follows a successful lawsuit in Hawaii in 2024, which led to the state’s expansion of access to midwifery care. Through such persistent advocacy and legal action, the Center for Reproductive Rights is working to ensure that all pregnant individuals, regardless of their background or location, have equitable access to high-quality, evidence-based healthcare, with midwifery care playing a central and vital role. The continued fight against midwifery restrictions is essential for building a healthcare system that truly serves the needs of all birthing people and their families.