Midwifery Care: A Pillar of Maternal Health Facing Systemic Barriers in the United States

Midwifery, one of humanity’s oldest professions, has a rich history spanning tens of thousands of years, with midwives consistently supporting individuals through pregnancy and childbirth, demonstrably improving outcomes for both mothers and their children. Today, this model of care focuses on low-risk pregnancies, offering comprehensive support from conception through pregnancy, birth, and the postpartum period. The foundational principle of the midwifery model of care is the recognition of birth as a normal, physiological process, adopting a holistic approach that acknowledges the intricate connection between mental, emotional, and physical well-being. However, in the United States, a nation grappling with maternal mortality rates nearly double those of other developed countries, a legacy of discrimination and concerted efforts has systematically marginalized midwives from mainstream healthcare systems. As the country confronts a burgeoning shortage of maternal healthcare providers, the imperative to dismantle barriers to midwifery care has become undeniably clear: expanding access to these skilled professionals promises to save lives.

The Enduring Legacy and Holistic Approach of Midwifery

For millennia, midwives have served as the bedrock of maternal health, their expertise honed through generations of practice and observation. This deep-seated understanding of the natural birthing process allows them to anticipate needs, manage deviations with grace, and empower birthing individuals with knowledge and agency. The midwifery model is characterized by its patient-centered philosophy, where the pregnant person is an active participant in their care journey. This collaborative approach fosters trust and ensures that decisions are made with informed consent, respecting the individual’s values and preferences.

The holistic nature of midwifery care extends beyond the purely physical. Midwives are trained to recognize and address the psychological and emotional dimensions of pregnancy and childbirth, understanding that a supportive and empowering environment is crucial for a positive birth experience. This comprehensive care model stands in contrast to more intervention-heavy approaches, often leading to reduced rates of unnecessary medical procedures.

Bodily Autonomy: A Cornerstone of Midwifery Care

A fundamental tenet of midwifery care is the unwavering commitment to a pregnant person’s bodily autonomy. Midwives champion the right of individuals to make informed decisions about their own bodies and healthcare throughout the pregnancy, birth, and postpartum continuum. This is achieved through comprehensive education, clear communication, and a dedication to presenting all available options and potential outcomes. Midwives meticulously identify potential health concerns and provide pregnant individuals with the necessary information to navigate their care choices confidently.

Should health complications arise, midwives possess the expertise to recognize them promptly and are adept at collaborating with or referring to other healthcare specialists, ensuring a seamless transition of care when necessary. This emphasis on empowered decision-making is directly linked to improved patient outcomes. Studies have consistently shown that individuals receiving midwifery care are significantly less likely to undergo cesarean surgeries, episiotomies, epidural anesthesia, and drug-induced labor. These interventions, while sometimes medically necessary, can carry their own risks, contribute to longer recovery times, and escalate healthcare costs. By prioritizing less invasive approaches, midwifery care not only enhances the birth experience but also contributes to greater maternal and infant safety and potentially reduces the financial burden on the healthcare system.

Diverse Settings: Hospitals, Homes, and Birth Centers

Midwives offer their expertise across a spectrum of birth settings, catering to diverse preferences and needs. Whether a pregnant person chooses to give birth at home, in a hospital, or at a freestanding birth center, midwives are equipped to provide care. Their training encompasses the nuances of each environment, allowing them to function independently or in collaboration with physicians and nurses. This flexibility in practice settings is particularly vital in the United States, where a significant portion of the population resides in areas designated as "maternity care deserts." These regions, often rural or underserved urban communities, lack adequate access to obstetric care facilities. In such contexts, midwives can serve as critical providers, bridging the gap in essential maternal health services and ensuring that individuals in these underserved areas have access to skilled birth attendants. The ability for individuals to choose their birth location and attendant is a crucial aspect of reproductive justice, and midwifery care plays a pivotal role in realizing this choice.

A History of Exclusion and Systemic Marginalization

The historical trajectory of midwifery in the United States is marked by a systemic exclusion that has had profound and lasting consequences. Prior to the 19th century, midwives were the primary providers of maternity care in America. However, as the medical profession, largely dominated by white male physicians, began to assert its authority, deliberate efforts were made to marginalize and dismantle the practice of midwifery. This was achieved through the enactment of restrictive laws and the establishment of educational barriers that effectively pushed midwives to the periphery of the healthcare system.

This historical discrimination continues to cast a long shadow. In 2022, despite a substantial proportion of births being classified as low-risk (65%), midwives attended only 13% of them in the U.S. This stark contrast is illuminated when compared to other developed nations with superior maternal and infant health outcomes, where midwives are the primary caregivers for low-risk pregnancies. For instance, in countries like the Netherlands and the United Kingdom, midwifery-led care is the norm for the vast majority of low-risk births, contributing to significantly lower rates of interventions and improved health statistics.

Despite a growing demand for midwifery services, particularly in communities lacking adequate access to maternal care, restrictive state laws continue to impede the full integration and practice of midwives. This creates a paradoxical situation where a proven model of care that could alleviate maternal health disparities is hampered by outdated and discriminatory regulations. The demand for midwives is on the rise, as evidenced by the increasing number of birth centers and the growing interest in home birth options, yet the legal and regulatory landscape often fails to keep pace with this evolving need.

The Link Between Supportive Laws and Improved Health Outcomes

The correlation between supportive legislative frameworks for midwifery and enhanced maternal and infant health outcomes is increasingly evident. States that have actively integrated midwifery care into their healthcare systems consistently demonstrate lower rates of premature births, cesarean surgeries, and newborn deaths compared to states with more restrictive policies. This suggests that fostering an environment where midwives can practice to the full extent of their training yields tangible public health benefits.

Despite this evidence, many states continue to enforce "misguided, prejudiced laws" that restrict the ability of thousands of qualified midwives to practice. These restrictions disproportionately affect midwives in the Deep South and other regions where maternal mortality rates are particularly high, often exacerbating existing racial disparities in care. Pregnant people of color, who already face significant systemic barriers to equitable healthcare, are often further disadvantaged by the limited availability of midwifery services.

The international community has taken note of these disparities. In 2022 and 2023, two United Nations human rights bodies specifically called upon the United States to improve access to midwifery care, particularly within Black and Indigenous communities, highlighting the critical role of culturally competent and accessible maternal health services in addressing racial inequities. This international scrutiny underscores the urgent need for policy reform and a broader recognition of midwifery’s vital contribution to public health.

Midwives as Global Advocates for Human Rights and Public Health

Globally, the World Health Organization (WHO) strongly advocates for the widespread adoption of midwifery models of care as a strategic imperative for saving lives, reducing healthcare costs, and elevating the overall healthcare experience for pregnant individuals and newborns. The WHO, in partnership with the United Nations Population Fund (UNFPA), is actively working to increase the number of trained midwives worldwide, recognizing them as indispensable providers of quality healthcare.

Internationally, midwifery is not a niche service but a fundamental component of comprehensive reproductive and maternal health systems. The WHO’s recommendation to "transition to midwifery models of care" is a testament to the profession’s proven efficacy in improving birth outcomes on a large scale. This global endorsement underscores the potential for midwifery to address the current maternal health crisis in the United States and beyond.

Ensuring Access: A Path Forward

Midwives are indisputably experts in the intricate process of birth, and their comprehensive approach to care has been demonstrably linked to improved health outcomes for low-risk pregnant individuals and their infants. As the United States grapples with an ongoing maternal health crisis, one that disproportionately impacts Black and Indigenous populations, expanding access to midwifery care is not merely a matter of preference but an essential step towards advancing reproductive rights and achieving health equity.

The Center for Reproductive Rights has been at the forefront of legal challenges aimed at dismantling restrictive midwifery laws. In April 2026, the Center filed a significant lawsuit against the state of Georgia, challenging two laws that severely 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. These legal battles are crucial in challenging outdated regulations and advocating for policies that recognize and support the vital role of midwives.

The Center for Reproductive Rights continues its unwavering advocacy for midwives and against discriminatory midwifery restrictions. Their work is instrumental in striving to ensure that all pregnant individuals, regardless of their background or geographic location, have equitable access to high-quality, respectful, and comprehensive maternal healthcare, with midwifery care playing a central role. The ongoing efforts to reform laws, increase funding for midwifery education and practice, and integrate midwives fully into healthcare systems are critical for transforming maternal health outcomes in the United States.