HHS Committee Discusses Midwifery Expansion
A U.S. Department of Health and Human Services committee worksession addressed maternal health disparities and workforce shortages. The February 19 session included discussion of expanding the role of certified nurse-midwives in federally qualified health centers and potentially increasing loan repayment programs.
- Research consistently shows that midwife-led care is associated with better birth outcomes, including lower rates of cesarean sections, reduced use of epidurals, and higher rates of spontaneous vaginal births. Studies have also linked midwifery care to a 24% reduction in preterm births and an overall decrease in fetal and neonatal death. - In Virginia, recent legislation reflects a growing recognition of the role midwives can play in addressing maternal health. As of July 1, 2025, House Bill 1904 allows certified nurse-midwives to be part of the 24-hour on-call roster for nursery care when a physician is unavailable, a key step in tackling care shortages in the state's 36% of counties considered "maternity care deserts." - Another legislative victory in Virginia, House Bill 1923, mandates insurance reimbursement parity for Licensed Certified Midwives and Licensed Midwives, ensuring they are paid at the same rate as Certified Nurse-Midwives for the same services by private insurers and Medicaid. This addresses long-standing pay disparities that made it difficult for some midwifery practices to remain financially sustainable, particularly those serving a high percentage of Medicaid recipients. - Nationally, severe maternal morbidity is twice as high for Black mothers (139.0 per 10,000 births) compared to white mothers (69.9 per 10,000). Expanding the role of a more diverse midwifery workforce is seen as a crucial strategy to address these disparities. - For aspiring nurse-midwives, several federal loan repayment programs are available to incentivize practice in underserved areas. The National Health Service Corps (NHSC) Loan Repayment Program offers up to $75,000 for a two-year commitment in a Health Professional Shortage Area, while the Nurse Corps Loan Repayment Program can pay up to 85% of unpaid nursing education debt. - Technological innovation is rapidly changing maternal care, with new tools like remote fetal monitoring systems, AI-enhanced ultrasounds, and cuffless blood pressure monitors becoming more common. These technologies support midwives by enabling continuous monitoring and early detection of complications, particularly in remote or underserved settings. - The Virginia Affiliate of the American College of Nurse-Midwives is actively involved in state-level advocacy. Current priorities for the 2026 General Assembly include addressing barriers that prevent midwives from contracting with Virginia's Managed Care Organizations and promoting widespread adoption of the new laws enacted in 2025. - Under federal regulations for Federally Qualified Health Centers (FQHCs), certified nurse-midwives can provide professional services as long as they are legally permitted to do so by the state and are under the medical supervision of a physician. This framework allows FQHCs, which serve nearly 20 million people, to integrate midwives into their primary care teams to serve low-income and uninsured patients.
