Virginia CNM Cites Gaps in Rural Maternal Care
Richmond-based Certified Nurse-Midwife Rachel Allen recently highlighted the impact of provider shortages in Virginia's rural areas. Speaking on the "Midwives Making Change" podcast, Allen noted, "Virginia’s rural regions are hit hardest by provider shortages—collaboration with family practice physicians and telehealth expansion are quickly becoming lifelines for underserved communities."
- In 2022, Virginia's overall pregnancy-associated death rate was 70.1 per 100,000 live births, an increase from 66.9 in 2021. The Southwestern Health Services Area, a largely rural region, had one of the highest rates at 87.1 per 100,000 live births. - The shortage of obstetricians is a critical issue in rural Virginia; in one southern Virginia area, the number of OB-GYNs dropped from approximately 14 to five over 15 years. Statewide, a Virginia Commonwealth University study found that 44% of Virginia's census tracts, primarily in rural areas, lack adequate access to primary care physicians, which includes OB-GYNs. - As of August 2024, only eight of Virginia's 28 rural hospitals still offer obstetrics services, following a trend of labor and delivery unit closures due to declining birth rates, insufficient Medicaid reimbursement, and difficulty recruiting staff. - Recent legislation aims to expand the role of midwives. As of July 1, 2025, Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) with sufficient experience can practice without a written agreement with a physician and will receive 100% reimbursement from private insurance and Medicaid. - A 2025 law, HB 1904, allows nurse-midwives to fulfill the 24-hour on-call duty roster requirements for nursery care when a doctor is unavailable and permits the use of telehealth for physician consultations, though individual hospital bylaws may still need to be updated to fully implement these changes. - The Virginia Rural Health Association received a $4 million federal grant to expand maternal health care in rural communities. The multi-year plan includes establishing new perinatal services, creating mobile clinics, and using a telehealth platform called Project ECHO to connect local providers with maternal-fetal medicine specialists. - Governor Glenn Youngkin's recent initiatives include a proposed $2.5 million investment to create three new perinatal health hubs in underserved areas, including one in a rural community, to provide comprehensive, community-based support services. - While telehealth is a key strategy, its implementation in rural Virginia faces significant barriers due to a lack of broadband access. For example, in Patrick County, only 67% of households have broadband access, compared to 84% statewide.
