The number of nurse-midwife-attended births more than doubled between 1990 and 2008 in Massachusetts, according to a new report from the Center for Women in Politics & Public Policy (CWPPP) at the University of Massachusetts Boston taking an in-depth look at the state’s midwifery workforce. There has also been an uptick in out-of-hospital births in the Commonwealth.
Despite the growth, the report indicates that many midwives face obstacles to their preferred style of practice, and many indicated that legislative change could address practice constraints.
The report, “Caring for Women: A Profile of the Midwifery Workforce in Massachusetts,” is coauthored by Christa Kelleher, research director at CWPPP, and Dorothy Brewin, assistant professor of nursing at the University of Massachusetts Lowell.
The report finds that while midwives are more commonly known for the care they provide to childbearing women, they serve women at all stages of life. Further, a significant segment of nurse-midwives in Massachusetts deliver primary care, especially to vulnerable and underserved populations of women. Nearly four out of ten CNMs (38.5%) indicated that primary care is one of their areas of practice
“The Commonwealth faces a rising cesarean rate, rapidly increasing health care costs, and stark and persistent racial/ethnic disparities in infant and maternal health outcomes,” Kelleher said. “Policymakers and health care stakeholders should consider the significant contributions of midwives to the Massachusetts health care system when engaged in efforts to increase quality of care, reduce costs, and ensure access to essential services, particularly for vulnerable populations of women.”
Released at the State House today, the report is based on a survey administered to midwives living and/or working in the state, supplemented by in-depth interviews. This report uniquely analyzes data collected from both certified nurse-midwives (CNMs) and direct-entry midwives (DEMs), including certified professional midwives (CPMs).
Among the findings:
- Access to midwifery services varies across the Commonwealth.
- Many of the hospitals that have a 20% or higher rate of CNM-provided care are safety net hospitals.
- About one-third of CNMs indicated that at least 31% of their patients are Hispanic or Latina.
- A majority of CNMs noted that a significant proportion of their service reimbursement comes through government-assisted health care.
- The majority of CNMs (61.7%) currently practice in either a hospital clinic or medical center. About one quarter of CNMs work in community health centers.
“The capacity to deliver primary care services across the Commonwealth may be enhanced with further integration of nurse-midwives into the primary care delivery system and appropriate reimbursement to such providers,” Brewin said. “In addition, given current efforts to increase consumer participation in health care decision-making, the midwifery model of personalized patient/client-centered care is a significant strength of midwives.”
The report finds that one of the most pressing concerns for midwives is that they collectively represent an aging workforce. Over 30% of CNMs indicated possible retirement by 2020. A midwifery workforce shortage would pose challenges in meeting women’s reproductive and maternal health needs, particularly for the vulnerable populations served by CNMs.
The report was funded through a grant from the Creative Economy Initiatives Fund of the University of Massachusetts President’s Office. The Center for Women in Politics & Public Policy is part of the McCormack Graduate School of Policy and Global Studies.
About the University of Massachusetts Boston
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