Midwifery Care and Birth Centers Are Data Driven

Here’s a look at what the research says about midwives and birth centers.

Our nation’s maternal mortality rate has risen, for Native American women by over 180% and that mortality rates in rural areas are more than 50% higher than urban areas. We also know that hospitals continue to shut down their maternity services in the rural communities (Commonwealth Fund Maternal Mortality in the US 2025). Adding home access midwives creates a network of options in these rural communities. Midwives have impressive outcomes. Midwifery-led models-especially community based settings such as home and birth center-tend to provide more continuous, individualized and holistic care. Community-based midwives such as CPMs are associated with lower rates of interventions such as cesarean delivery, episiotomy, and induction, with higher rates of maternal satisfaction.

Birth Settings in America: Outcomes, Quality, Access, and Choice is a 2020 report from the National Academies of Sciences, Engineering, and Medicine that analyzes U.S. childbirth, finding worse outcomes than other high-resource countries, especially for BIPOC women, despite high spending. It examines hospitals, birth centers, and homes, exploring risk factors, social determinants, financing, and access to improve care.

  • Key findings show lower intervention rates for low-risk women in birth centers/homes, but highlight the need for better integration, risk assessment, and addressing systemic issues like racism to improve overall outcomes.

    Centers for Medicare and Medicaid Services (CMS) also supports midwives and birth centers as the solution. 53% of all Ohio births are on Medicaid dollars. Ohio, potential savings to the state would be $1.99 million per year if freestanding birth centers could operate. This number does not include other improved outcomes from birthing centers such as reduction in low birthweight rate and preterm birth rate which would reduce NICU time and required care.

  • One study found that shifting 10% of births to birth centers would result in cost savings of nearly $2 billion yearly nationally (https://oneill.law.georgetown.edu/structural-barriers-regulating-birth-centers-can-harm-maternal-health-outcomes/).

  • Data shows that when midwives are well integrated into the healthcare system it results in improved maternal and infant health outcomes, because midwives have high rates of normal spontaneous vaginal births, and low rates of complications. One study demonstrated that states could cut infant mortality rates by 12% by improving midwifery integration and utilizing midwives for care, specifically, midwifery care results in significantly lower rates of preterm birth (https://www.birthplacelab.org/key-findings/).

References:

Cray, A. (2025, February 18). Structural barriers regulating birth centers can harm maternal health outcomes. O'Neill Institute. https://oneill.law.georgetown.edu/structural-barriers-regulating-birth-centers-can-harm-maternal-health-outcomes/

Declercq, E., & Zephyrin, L. (2025, July 29). Maternal mortality in the United States, 2025. The Commonwealth Fund. https://doi.org/10.26099/kdfd-fc19.

Dubay, L., Hill, I., Garrett, B., Cross-Barnet, C., Masten, A., & Markell, J. (2018). Improving birth outcomes and lowering costs for women on Medicaid: Impacts of “Strong Start for Mothers and Newborns”. Urban Institute. https://www.urban.org/research/publication/strong-start-mothers-and-newborns-evaluation-year-5-project-synthesis

National Academies of Sciences, Engineering, and Medicine. (2020). Birth settings in America: Outcomes, quality, access, and choice. The National Academies Press. https://doi.org/10.17226/25636

Vedam, S., Stoll, K., MacDorman, M., Declercq, E., Cramer, R., Cheyney, M., ... & Fisher, T. J. (2018). Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLOS ONE, 13(2), e0192523. https://doi.org/10.1371/journal.pone.0192523