By NextBestFitExpand midwives and birth centers
License and pay certified midwives and freestanding birth centers, with transfer agreements.
Adds capacity in maternity deserts.
Review ledgerHow this path connects
Addresses
Maternity care desertsThis path
Expand midwives and birth centers
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- License certified midwives in all states
- Cover birth centers
- Require transfer agreements
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Maternity care deserts
Licensing and paying certified midwives and freestanding birth centers adds capacity in maternity deserts at lower cost per birth.
What it creates or worsens
- Adds paperwork, coordination, or complexity
Midwives and freestanding birth centers need fast hospital transfers when complications occur.
- Quality concerns when non-physicians practice independently
Expanding certified midwives and freestanding birth centers raises safety concerns among physician groups.
Who's affected
Who gains
- Pregnant and postpartum people and infants
- Maternity care deserts: Obstetric unit closures leave pregnant people and newborns without local maternity care.
- Rural residents
- Maternity care deserts: Obstetric unit closures leave pregnant people and newborns without local maternity care.
- Doctors, nurses, and other clinicians
- Maternity care deserts: Licensing and paying certified midwives and freestanding birth centers adds capacity in maternity deserts at lower cost per birth.
Who loses
- Doctors, nurses, and other clinicians
- Adds paperwork, coordination, or complexity: Midwives and freestanding birth centers need fast hospital transfers when complications occur.
- People with ongoing or specialist care needs
- Quality concerns when non-physicians practice independently: Expanded independent practice may expose them to missed diagnoses or over-prescribing.
Other ways to soften the losses
- Require collaboration agreements and fast transfer to hospital care
Where it has been tried
- UK, Netherlands: Midwives lead most low-risk births.
- United Kingdom and four other countries: A 2024 review of trials in five countries, including the UK, found midwife continuity care likely reduced caesarean births from 16% to 15%.Sources: Cochrane (2024)