Reduced Access to Midwives During the COVID-19 Pandemic

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The COVID-19 pandemic brought new pressure on the healthcare workforce, and midwives were no exception. Because maternity care is essential, midwives quickly reorganized their practices to reduce the risk of transmission. Midwives work within regulations that sometimes restrict their control over their own practices, so these changes may look different in different parts of the country or in different types of practices. The effects of these changes may reduce access to midwives, exacerbate existing disparities, and contribute to reduced perinatal quality and safety during the pandemic and beyond.

The results of a recent ACNM survey of midwifery practices showed that most changes in midwifery staffing during the pandemic were made in response to financial challenges. Midwives, and access to midwives, are especially vulnerable to economic downturns in states where midwifery practice has a limited scope or autonomy. When midwives are not permitted to contribute to a practice at their full capacity, the value of midwives to a practice may be reduced. The undervaluing of midwives puts them at risk of being the first members of the team to be let go when a practice is facing financial trouble.

Changes in Midwifery Workforce during COVID-19 Pandemic: Results of the ACNM Midwifery Workforce: Survey of 727 Midwifery Practices

 February 2020August 2020
Number of Midwives Employed33013190
Practices Precepting418168
Births Attended21,98520,059
Antepartum Visit Capacity32,49434,755
Postpartum Visit Capacity6,6776,591
Primary Care Visit Capacity13,55112,604

Access to midwives during the pandemic was also challenged by reduced reimbursement for the work of midwives compared to physicians. Prior to the pandemic, the lack of reimbursement parity was a barrier to midwifery-led care, midwifery-owned practices, and the provision of birth center and home birth care. The pandemic resulted in a decreased demand for some types of care and changes that may have reduced the number of patients a midwife could see during the day. The intersection of pandemic changes and reduced reimbursement for midwives may have brought about the loss of access to midwives or some midwifery services in many areas across the country. 

There was a need to expand the midwifery workforce even prior to the pandemic; in 2017 there were fewer than 12,000 midwives in the United States compared to over 35,000 obstetrician-gynecologists. The scope of the damage to the midwifery workforce from the pandemic is not yet known, but long-term effects are likely. In addition to loss of midwifery services, the US health system experienced a loss of midwife training sites. Loss of training sites can reduce the number of graduating midwives for several years as student midwives must compete for limited placements. If some students delay graduation to finish training, the competition for sites will continue into the next class of midwives.

The ACNM Midwifery Workforce Committee organized a task force to investigate these issues and begin to quantify losses of midwives, access to midwives, and care practices unique to midwifery. We looked at changes in the number of midwives, the number of visits to midwives, and the types of care midwifery practices provided.  You can learn about the changes the task force identified and how midwifery regulation affected these changes by attending “Workforce and Practice Effects of State Midwifery Licensure and Regulation During the Pandemic”, a podium presentation at the 2021 ACNM Annual Meeting.

Authors:

Jennifer Vanderlaan, PhD, MPH, CNM, FNP

Dr. Vanderlaan is faculty at University of Nevada Las Vegas where she is researching maternal health from a health systems perspective, integrating clinical outcomes, health economics, and health policy to identify ways to improve access to quality maternal care. Her recent projects explore regionalization of maternal care, effects of childbirth education, and the use of hydrotherapy for pain management during labor and delivery. 

Mary Ellen Bouchard, CNM, MS, FACNM