Nurse-Midwives Poised to Fill Rural Health Gaps

Midwives around the world are crucial members of healthcare systems, yet in the United States (U.S), many midwives do not have the opportunity to practice to their full scope and potential. In a national survey of 93 rural hospitals with labor and delivery units, less than half of the facilities reported access to nurse-midwifery services (Sheffield, 2024). One in five Americans live in a rural area and often have decreased access to healthcare when compared to those living in urban settings (Monnat, 2025). Those statistics worsen if maternity care is the needed service, as one in three counties in the U.S. is a maternity care desert. For pregnant and postpartum women, the lack of healthcare services can be life-threatening, and Nurse-Midwives providing rural maternity care can improve outcomes by creating access where little exists (March of Dimes, 2026). 

The word midwife means “with woman”. Nurse-Midwives first entered the American healthcare system around 1930, and most were also public health nurses or community nurses with additional knowledge in pregnancy and childbirth. While midwives are often associated with pregnancy and childbirth, midwives take on various roles throughout different regions of the U.S. There is a nurse-midwife for everyone, as they are trained providers of respectful, inclusive midwifery care across the lifespan. The scope of practice of a Certified Nurse-Midwife (CNM) in the United States includes:

• Pregnancy, childbirth, and the postpartum period

• Newborn Care up to 28 days of life, including inpatient care and ambulatory well-baby visits

• Sexual and Reproductive Health visits, including gynecologic care, family planning and contraceptive care, preconception care, and concurrent partner therapy

• Primary care services, including annual examinations and assessments required for work or school

• Prescription and management of medications, including those used to care for clients with substance use disorder

In addition to these varied care options, nurse-midwives practice in hospitals, birth centers, homes, ambulatory care clinics, community health clinics, public health systems and telehealth services. CNMs are uniquely prepared to extend their work into rural health spaces, often learning and training in lower-resourced areas. While CNMs receive training in both normal and abnormal pregnancy and gynecologic care, most programs also prepare new midwives to care for vulnerable or underserved populations. Wherever you may find nurse-midwives, you will see patient-centered, compassionate clinicians with evidence-based practice at the center of all they do.

In 2025, there were approximately 15,000 licensed CNMs in the U.S. and the states with the highest and lowest utilization of CNMs were California and North Dakota respectively (AMCB, 2025). On average, the United States has around 4 CNMs per 1,000 live births, falling short of the World Health Organization recommendation for at least 6 midwives per1,000 live births. According to the ACNM, only 11 out of 50 states meet this minimum recommendation by the WHO (Vanderlaan, 2023). This means almost 80% of all states in the U.S. do not meet minimum international recommendations for midwifery models of care. 

Ultimately, the design and delivery of maternity care is driven by a complex interplay between historical models, systems of care, workforce structures, funding models and knowledge of options, as well as population expectations and demand. When the overwhelming international evidence supports the integration of nurse-midwives into our systems of care, we owe it to women and their families to develop and sustain interprofessional, collaborative and integrated midwifery models of care to achieve better experiences, outcomes, and health for our communities. For women and families in our rural communities, nurse-midwives are a vital part of the solution to our widening gaps in access to care. This is an important moment to change the rural landscape of maternity care in the U.S. and integrate midwives into the mainstream. 

The theme of this year’s Midwifery Week (October 4-10) is This Is Our Moment, highlighting a national moment for midwifery to gain visibility and acknowledge both the need and demand. “Workforce shortages, maternal health outcomes, and calls for patient-centered care put the midwife-let models at the center of the conversation” this year (ACNM, 2026). Leading into the 71^st Annual Meeting of the American College of Nurse-Midwives (ACNM), more than 600 midwives will gather from across the nation to collectively advocate for their profession, spotlighting midwifery-led innovation and research. Nurse-midwives stand ready to fill the gaps in the healthcare system, especially in rural areas! 

References

ACNM, (2026). National Midwifery Week: 2026 communication & engagement toolkit. https://midwife.org/wp-content/uploads/2026/08/NMW_2026_Toolkit.pdf 

American Midwifery Certification Board (AMCB). (2025, August). Certified Nurse-Midwives/Certified Midwives by state.https://www.amcbmidwife.org/docs/default-source/default-document-library/number-of-cnm-cm-by-state---august-2025.pdf?sfvrsn=f240ecf_0 

March of Dimes. (2026). Nowhere to go: Maternity care deserts across the U.S. https://www.marchofdimes.org/sites/default/files/2026-08/MCDR_2026_Report_English.pdf

Monnat, S. M, (2025). U.S. rural population health and aging in the 2020s. Public Policy & Aging Report, 35(1), 3–9. https://doi.org/10.1093/ppar/prae031

Sheffield, E. C., Fritz, A. H., Interrante, J. D., & Kozhimannil, K. B. (2024). The availability of midwifery care in rural United States communities. Journal of Midwifery & Women's Health, 69(6), 929-936.https://doi.org/10.1111/jmwh.13676

Vanderlaan, J., (2023). Access to midwifery care national chartbook. https://midwife.org/wp-content/uploads/2025/02/Access-to-Midwifery-Care-National_Chartbook_20241024.pdf