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12/2024

As of 2019, over one-third of rural U.S. communities had no obstetrician/gynecologists or family physicians trained in obstetrics. In 2022, 60 percent of rural U.S. counties had no hospital-based maternity unit. Despite the current circumstances, there is hope in the projected growth of the midwifery care field and an increasing demand for the midwifery model of care among birthing people. These case studies describe how two hospitals that serve rural U.S. communities incorporate midwifery care into their services.

Highlights:

• Bozeman Health (a mid-size, regional health care hub in rural Montana) and Plumas District Hospital (a small, remote Critical Access Hospital in rural California) recruited midwives in response to community demand for midwifery care.
• At Bozeman Health, four staff midwives provide perinatal care and attend births using a group-based model, in addition to providing primary care and women's health care services across the life course.
• At Plumas District Hospital, one staff midwife provides prenatal and postpartum care, leads childbirth classes, provides primary care and women's health care services, and responds to immediate patient concerns through a 24/7 Mother-Baby phone line.
• Both hospitals emphasized that the success of their midwifery programs is due to the autonomy granted to midwives, including the ability to practice without restrictive supervision agreements, prescribe medications, and make independent clinical decisions. Hospitals attributed this autonomy to the midwifery practice policies in their respective states as well as the support of collaborating physicians.

University of Minnesota Rural Health Research Center

Alyssa Fritz, Maggie Thorsen, Emily Sheffield, Katy Kozhimannil

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