Giving birth in America poses safety risks, especially for Black women, who face even greater dangers. The maternal mortality rate for Black women in 2021 was 2.6 times higher than that of white women. This alarming disparity exists despite the fact that the United States has higher maternal mortality rates compared to other affluent countries and the gap is widening. To address this issue, promoting the utilization of midwives is a viable solution.
Midwives, who are certified professionals recognized by the state, offer comprehensive prenatal, birthing, and postpartum care for low-risk pregnancies. They prioritize respectful and person-centered care, ensuring that every birthing person can experience the joy of childbirth. Extensive research consistently demonstrates that midwifery care leads to better outcomes, including lower rates of cesarean sections and preterm births.
However, the integration of midwives into pregnancy care is lacking in New York State. There is a scarcity of state-licensed midwifery-led birth centers, and many hospitals in New York have limited or no midwives on staff. To improve the integration of midwives, several steps should be taken.
Firstly, it is essential to recognize that hospitals should not be the sole option for giving birth. Midwifery-led birth centers should be established as an alternative, specifically catering to low-risk pregnancies. These centers can have different facility standards compared to traditional hospitals. Unfortunately, many state regulators view birth as a medical condition rather than a family-centered experience. The stringent requirements for opening midwifery birth centers create unnecessary barriers, particularly for underfunded rural and urban communities.
In New York, legislation signed by Gov. Kathy Hochul aims to reduce regulatory barriers to licensing midwife-led birth centers. However, the draft regulations proposed by the State Health Department fall short of aligning with the national accreditation standards set by the Commission for the Accreditation of Birth Centers. It is imperative for the Health Department to revise these regulations accordingly, ensuring the highest level of care for childbearing families.
Additionally, freestanding midwifery-led birth centers must establish backup agreements with hospitals for rare instances when transfers are necessary. Unfortunately, many hospitals resist these arrangements. States should require all maternity hospitals to have transfer agreements with birth centers and grant midwives hospital admitting privileges to ensure continuity of care for their patients.
To address the shortage of midwives, New York should follow the lead of other states like New Jersey and allow Certified Professional Midwives, one of the three types of midwives in the U.S., to practice and receive health insurance reimbursement. This change would help bolster the midwife workforce and enable them to staff birth centers and provide care for home births adequately.
Currently, the midwife workforce lacks diversity, with 85% of midwives being white. This stark contrast to the racial diversity of the population they serve is a result of historical factors that marginalized Black, brown, and Indigenous midwives in favor of white male physicians. To expand and diversify the profession, additional training programs with state funding and support for trainees are crucial.
State regulations should also mandate hospitals providing pregnancy care to establish midwifery units. Although developing an adequate midwife workforce will take time, state health departments can expedite the process by requiring hospitals to hire a sufficient number of midwives by 2030.
Furthermore, Medicaid reimbursement rates should ensure parity between obstetricians and midwives offering the same level of care. Reimbursement rates should also match 100% of Medicare rates for pregnancy care for all provider types. New Jersey has already taken these important steps, and New York should follow suit.
In conclusion, Gov. Hochul has emphasized the need to address the high rates of maternal mortality in the United States. Embracing midwives as a central component of pregnancy care is a crucial step towards achieving this objective. Gov. Hochul, along with state Health Commissioner Dr. James V. McDonald, the state Legislature, and their counterparts in other states, should prioritize the integration of midwives to improve maternal health outcomes.
Mary T. Bassett is the director of the FXB Center for Health and Human Rights at Harvard University and former commissioner of the New York State and New York City Departments of Health. Richard N. Gottfried served in the New York State Assembly for over 50 years and chaired its Health Committee. Deborah L. Kaplan is the former assistant commissioner of the Bureau of Maternal, Infant, and Reproductive Health at the New York City Health Department.
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