San Francisco -- The U.S. is one of the few industrialized countries where midwives do not play a central role in the care of all or most pregnant women, according to a new report from The Pew Health Professions Commission and the University of California San Francisco Center for Health Professions Taskforce on Midwifery. To better mainstream midwifery health care, the report is urging reforms in the way midwives practice and are regulated, credentialed, and educated.

The report, Charting a Course for the 21st Century: The Future of Midwifery, calls for a series of 14 changes for educators, policymakers and professionals to consider. In general, it urges the U.S. health system to "embrace" the midwifery model as an essential component of comprehensive care for women and their families.

In 1996, midwives attended 250,000 births, about 6.5 percent of the total, up from 3.6 percent in 1989. "While midwifery is a well-established profession, it has had difficulty gaining full recognition in the health system to date because it calls for different approaches to the birthing process and for shared authority between physicians and midwives over that process," the report says.

To elevate the status of midwives within the health system, the Taskforceof eight national experts recommends that they be recognized as independent and collaborative practitioners, that laws and regulations permit full access to their services, that reimbursement rates be equitable and non-discriminatory, that private credentialing entities avoid artificially narrowing their scope of practice, and that education programs provide opportunities for inter-professional education and training experiences.

Taskforce Chair and midwife Dr. Lisa L. Paine, who chairs the department of maternal and child health at Boston University's School of Public Health, says there is "a persistent lack of understanding on what the role of midwives can and should be." Paine added that "midwives are underrepresented in policy and service development." Thus, "having a place at the policy table and being recognized for their contributions toward the goals of managed care" would be very important advances in the field, she says. The report points out that the new system of health care "represents some distribution of power that may provide midwives greater opportunity to demonstrate what they can contribute" to patient outcomes and cost-effective care.

Deanne Williams, CNM, executive director of the Washington, DC-based American College of Nurse Midwives, says that lifting practice barriers would be a major help to the profession. "Medicine and midwifery, together, offer women more than either profession can offer alone." says Williams.

The report also is calling on payers to reimburse midwives more equitably. Although Medicaid generally pays midwives 100 percent of what physicians are paid by the program, some states pay 70 to 90 percent of what Medicaid pays physicians for the same care; and, in the private sector, some midwives have faced payment barriers, including not being reimbursed directly by insurers.

To view a copy of the report, please go to Charting a Course for the 21st Century: The Future of Midwifery. To order a hard copy, please see our order form page.
For more information about the taskforce and its work please contact Catherine Dower.