Evidence Supports Continuous Labor Support

- A landmark 2017 Cochrane review, which analyzed over 15,000 women across 17 countries, found that continuous support from a person like a doula was associated with a 39% decrease in the risk of Cesarean delivery. This type of support also correlated with a 15% increase in the likelihood of a spontaneous vaginal birth and a 31% decrease in the risk of being dissatisfied with the birth experience. - In Virginia, recent legislative advocacy has led to significant policy changes effective July 1, 2025, including a law requiring insurance reimbursement parity for Licensed Certified Midwives (LCMs) and Licensed Midwives (LMs) at the same rate as Certified Nurse-Midwives (CNMs). Another key change will allow experienced CNMs and LCMs to be recognized as "independent practice midwives" on hospital medical staff, granting them more autonomy. - The Virginia Affiliate of the American College of Nurse-Midwives' 2026 legislative goals include addressing barriers that prevent midwives from contracting with Virginia's Managed Care Organizations (MCOs), which would further integrate midwifery care into the state's healthcare system. - Virginia recognizes several types of midwives, creating a varied landscape for practice. Certified Nurse-Midwives (CNMs) are advanced practice registered nurses with graduate degrees who can practice across the lifespan in all settings, while Certified Professional Midwives (CPMs), also known as Licensed Midwives (LMs), have expertise in out-of-hospital settings for healthy pregnancies. - The demand for midwives is growing amidst a national shortage of obstetricians, which is projected to reach a deficit of 5,170 by 2030. In Virginia, approximately 36% of counties are considered "maternity care deserts," lacking adequate access to obstetric services, a gap that midwives are positioned to help fill. - Digital health platforms and telehealth are becoming increasingly integrated into midwifery practice, offering remote monitoring of vital signs like blood pressure, virtual consultations, and enhanced data sharing between patients and providers to allow for early detection of complications. - Midwifery-led care models have been shown to be an effective strategy for reducing non-medically indicated cesarean sections. Evidence-based practices often emphasized in midwifery care include intermittent fetal monitoring, which has been associated with a lower C-section rate compared to continuous electronic monitoring, and encouraging mobility during labor. - For CNMs in Virginia, the path to autonomous practice involves completing 1,000 hours of practice under a consultation agreement with a physician or an experienced independent practice midwife before being able to practice without a written agreement.