Midwives provide care during pregnancy and birth, and may attend births in hospitals, birth centers, or homes. In 2021, midwives attended 12% of births in the U.S.
We found that the number of midwives and midwifery students in the U.S. has increased—although the extent of care they can provide varies by state. Also, some students may have trouble with the cost of education and the limited number of clinical training opportunities available.
The number of births attended by midwives increased in recent years. But some insurance policies don't cover their services—leaving some people interested in having a midwife unable to afford one.
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What GAO Found
Among other services, midwives attend births and provide care during pregnancy and the postpartum period. According to a National Partnership for Women and Families report, midwives can help improve the quality of maternal care and improve outcomes associated with pregnancy and birth. There are three types of midwives with certification in the U.S. Among other differences, certified nurse-midwives and certified midwives primarily attend births in hospitals, while certified professional midwives primarily attend births in birth centers and homes.
Number of Midwives and Midwifery Students by Type of Midwife in 2021
Data show that in 2021, 12 percent of all births were attended by a midwife, and the number of births attended by midwives and the number of practicing midwives have increased in recent years. However, stakeholders GAO interviewed and research reports GAO reviewed identified various challenges to obtaining and providing midwifery care. For example:
- Pregnant people may face challenges obtaining midwifery care, such as insurance policies that do not cover midwives or do not list midwives in their provider directories.
- Midwives may face challenges providing care, including variations by state in limitations on their scope of practice, such as whether their work needs to be supervised by physicians.
Data from accrediting organizations show the number of students enrolled in midwifery education programs generally increased in recent years. According to stakeholders GAO interviewed, students may face challenges accessing midwifery education, including educational costs and limited availability of clinical training placements. Agencies within the Department of Health and Human Services have scholarship and loan repayment programs for nurse-midwifery students and certified nurse-midwives, but these students and midwives make up a small percentage of those supported by these programs.
According to researchers and agency officials GAO interviewed, challenges to measuring the quality of maternal care include the difficulty attributing the quality of care to a specific provider because care is provided in teams and occurs over the course of pregnancy and delivery.
Why GAO Did This Study
Each year in the U.S., hundreds of individuals die from complications related to pregnancy or childbirth, and tens of thousands experience unexpected outcomes such as heart failure. In 2022, GAO reported that research showed more than half of rural counties lacked hospital-based services for pregnant people. GAO also reported on persistent racial and ethnic disparities in maternal death and severe maternal morbidity. Maternal health care providers, such as midwives, can play a critical role in improving maternal health outcomes. GAO was asked to examine midwifery education and access to midwifery care.
This report describes information on midwife-attended births, the midwifery workforce, and any challenges to obtaining midwifery care; information on students of midwifery education programs, any midwifery educational challenges, and available federal financial support; and any challenges to measuring the quality of maternal health care, including midwifery care.
GAO analyzed data from federal agencies and midwifery education and provider organizations, and reviewed research on midwifery care and education. GAO also interviewed a non-generalizable selection of 15 stakeholders knowledgeable about midwifery care and education, and eight researchers and officials from federal agencies about maternal care quality measures.
The Department of Health and Human Services provided technical comments, which GAO incorporated as appropriate.
For more information, contact Jessica Farb at (202) 512-7114 or email@example.com.