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07/2024

This infographic provides a snapshot of rural-urban differences in midwife-attended births, including changes over time as access to rural obstetric care declined and severe maternal morbidity and mortality rose across the United States. Researchers used publicly available natality data from CDC WONDER (2007-2022) to document rural-urban differences in the percentage of births attended by midwives (by Certified Nurse Midwives (CNM)/Certified Midwives (CM) or by other midwives), generally and by location of childbirth (hospital, freestanding birth center, home, or other) over time.

Key Findings:

• The overall percentage of births from 2007-2022 that were midwife-attended was higher for rural (9.7%) compared to urban (9.4%) residents.
• Among midwife-attended births, most were attended by CNMs or CMs, but rural residents had a lower proportion of births supported by CNMs and CMs (87.7%) and a higher proportion supported by other midwives (12.3%) compared with urban residents (92.6% and 7.4%, respectively).
• There were rural-urban differences in midwife-attended births in different settings. A higher proportion of midwife-attended births occurred at home for rural residents (10.7%) compared with urban residents (6.2%), and a lower proportion of midwife-attended births occurred in hospitals for rural residents (84.2%) compared to urban residents (89.4%).
• Midwife-attended births increased over time for both rural and urban residents. The proportions of births that were midwife-attended increased from 8.3% and 7.8% in 2007 to 12.7% and 12.0% in 2022 for rural and urban residents, respectively.

University of Minnesota Rural Health Research Center

Katy Kozhimannil, Emily Sheffield, Alyssa Fritz, Julia Interrante

Health disparities and health equity, Healthcare access, Hospitals and clinics, Maternal health, Women