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Improving Maternity Care Access: The Impact of Midwives and Birth Centers

Updated: Mar 1

Emily Dial courtesy of Wilburn Ervin Birth Photography


In recent years, there has been a growing recognition of the vital role midwives and birth centers play in enhancing access to maternity care services. These alternative care providers and settings offer a unique approach to childbirth that emphasizes personalized care, patient empowerment, and natural birthing options. As a result, they have become increasingly popular choices for expectant parents seeking high-quality, holistic care during pregnancy and childbirth.


There is, however, a concerning trend emerging in recent years. More than half of rural hospitals in the United States no longer offer birthing services. This decline in accessibility has left many expectant mothers in rural areas struggling with limited options and increased travel distances for care during pregnancy and birth. Nothing could be more true than for Kentucky, where nearly half of counties in the commonwealth are maternity care deserts and many counties have low or moderate access to care.


The decrease in birthing services are particularly impactful to Medicaid recipients. Nationally, Medicaid financed 42% of births in 2020 and 45% in Kentucky.

Medicaid pays for a greater share of births for women in rural areas who are more likely to face healthcare disparities.


Marry the rise in interest for midwives and birth centers with the decline in accessibility to comprehensive, quality prenatal care particularly in rural and underserved areas of the country. What emerges is the need for a union which bridges the gap in maternity care access and results in improved outcomes, greater satisfaction, and cost savings.





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Research has shown that access to midwifery care and birth centers can have a positive impact on maternal and infant health outcomes. Studies have found that women who receive care from midwives are less likely to experience medical interventions during childbirth, such as cesarean sections or epidurals, and are more likely to have positive birth experiences overall. Additionally, midwifery-led care has been associated with lower rates of preterm birth, low birth weight, and neonatal mortality compared to standard obstetric care.


Furthermore, midwives and birth centers play a crucial role in improving access to maternity care services  in underserved communities and marginalized populations. By offering culturally sensitive care and providing services in community-based settings, midwives and birth centers help address disparities in maternal health outcomes and ensure that all women have access to the care they need to have a healthy pregnancy and birth.


Although Kentucky is home to the oldest and largest continually operating nurse-midwifery education program in the United States, and Kentucky endorses both Certified Nurse Midwives and Certified Professional Midwives, Kentucky has no freestanding birth centers. In January, 2024, the Mary Carol Akers Birth Centers Act was filed in both the House and Senate. As with previous legislation, these bills will exempt freestanding birth centers from Kentucky's certificate of need requirement and will update existing antiquated administrative regulations for birth centers, paving the way for birth center care to grow.


Despite being one of only eight states in the country with no access to a freestanding birth center, Kentuckians want birth center access. Currently, Kentucky families who desire birth center care must travel out of state to Indiana, West Virginia, and Tennessee to visit a freestanding birth center. Kentuckians also want better outcomes for it's mothers and babies. The 2023 March of Dimes Report Card gave Kentucky a grade of "F" for the rate of preterm births and other indicators reflecting maternal and infant health.


Kentucky recognizes the importance of midwifery care in enhancing access to maternity care services and improving maternal and infant health outcomes, especially during a time of a lack of availability of hospitals offering labor and delivery services. By investing in midwifery care and supporting the expansion of birth centers, we can ensure that all families, regardless of where they live, recieve the high-quality, compassionate care they deserve. This partnership offers a valuable solution and great potential to transform access to care during pregnancy and childbirth, one of life's most significant experiences.




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