US Policy Focus Turns to Midwifery
The U.S. maternal health policy landscape is showing increased focus on midwifery-led solutions amid workforce shortages. A recent news brief highlighted an increase in legislative hearings on maternal mortality, ongoing debates on reimbursement parity for nurse-midwives, and the growth of pilot programs pairing midwives with community health workers.
- A worldwide shortage of nearly one million midwives is currently impacting maternal health care, with the Americas having only 15% of the necessary midwifery workforce. This global deficit is projected to persist, with an estimated shortage of 690,000 to 830,000 midwives by 2030. - Research consistently shows that midwife-led care is associated with positive birth outcomes, including lower rates of cesarean sections, reduced medical interventions, and higher instances of spontaneous vaginal births. Studies have also indicated that this model of care can lead to fewer preterm births and NICU admissions. - In Virginia, new legislation (HB1923), effective July 1, 2025, mandates insurance reimbursement parity for Licensed Certified Midwives (LCMs) and Licensed Midwives (LMs) at the same rate as Certified Nurse-Midwives (CNMs) for the same services. This policy aims to address the state's maternity care provider shortage and improve the sustainability of midwifery practices. - Another recent Virginia law, HB 1904, which took effect on July 1, 2025, allows nurse-midwives to be included on the 24-hour duty roster for nursery care when a physician is not available and permits the use of telehealth for physician consultations. - The federal government is also taking steps to address the maternal health crisis, with the Further Consolidated Appropriations Act of 2024 directing the Health Resources and Services Administration (HRSA) to develop a plan for expanding birth centers in maternity care deserts. The act also allocates funds for grants to educate more midwives. - As of May 2023, about half of U.S. states reimburse Certified Nurse-Midwives (CNMs) at 100% of the physician rate for the same services under Medicaid, a factor shown to be associated with an increase in midwife-attended births. However, reimbursement for other types of midwives, such as Certified Professional Midwives (CPMs), is less common, with only 19 states offering it as of April 2023. - The Centers for Medicare & Medicaid Services (CMS) has established new maternal health and safety standards for hospitals, effective as of their 2025 final rule. These standards address the organization, staffing, and delivery of care in obstetrical units. - Digital health is playing an increasing role in maternal care, with CMS expanding reimbursement for Remote Patient Monitoring (RPM) for Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) in January 2025. Additionally, the American Medical Association has advocated for broader Medicaid coverage of virtual maternal health services.
