Will Pennsylvania Allow Midwives to Save Mothers and Babies?
Many are familiar with the popular British television series “Call the Midwife,” set in post-war London. In the show, nurse midwives are professionals who provide exceptional care to mothers before, during, and after a baby is born. The reality is much the same. Throughout the world, more than 75% of babies are delivered with the help of midwives. The U.S., though, has much lower rates, with Pennsylvania alone ranking at 16%. Nationally, we have higher levels of maternal and infant mortality than other rich countries. We are fifty-first in world rankings.
Unfortunately, infant mortality is the most egregious example of a healthcare system that too often delivers poor results at ever-increasing costs. To some degree, those shortcomings are the result of our state’s public policy, as restrictive licensure rules reduce the number of healthcare professionals and consequently drives up their cost.
A bipartisan bill (Senate Bill 507) is working its way through the state Senate, which would expand the scope of nurse midwives and licensed certified midwives. These midwives have two to three years of graduate training. The bill does not change the status of traditional or lay midwives who operate in many Mennonite and Amish communities. If the bill became law, midwives would be able to write prescriptions for relevant products or services, such as breast pumps, or pelvic floor exercises.
Midwives would likely expand mothers’ access to care throughout the Commonwealth’s maternity care deserts, particularly acute in our rural counties. Sen. Rosemary Brown, the bill’s sponsor, observes that, “Both rural and urban regions in our state lack obstetricians or licensed midwives and face challenges in doctor recruitment and retention.” At present, midwives who graduate from Thomas Jefferson’s Certified Midwife program typically leave for places like New Jersey, where midwives are allowed to operate as SB 507 envisions.
According to the March of Dimes, several rural counties – such as Perry, Snyder, Cameron, Forest, and Fulton – lack any maternity care facilities. The Hospital and Healthcare Alliance of Pennsylvania observed that 100 rural hospitals have closed over the last decade. By their estimate, a third of the state’s 700 rural facilities are in danger of closing, a trend exacerbated by recent changes in federal law and spending.
The statistics on Black and Latino infant and maternal mortality are no less dire. Annetra Taylor, a midwife in Pittsburgh, observes that Black maternal mortality is two and half times the national average. Social media, moreover, creates a perception of hospitals as dangerous, and at times, capricious places. Jatolloa M. Davis, a CM in Philadelphia, observed that one mother came to her because she “didn’t want to die” due to poor care in a hospital.
Of course, the reverse is also true. Many mothers reach out to midwives due to success stories they see on TikTok and other platforms. In Davis’ experience, midwives build trust with mothers, work collaboratively with other healthcare professionals, and ensure that mothers receive the care that they need.
This echoes what state Sen. Brown has argued. “Midwives play a crucial role in promoting maternal health and well-being,” she said. “Their expertise in providing holistic, personalized care throughout the reproductive journey is invaluable…By recognizing and integrating the unique contributions of midwives within the health care system, Pennsylvania can further improve maternal outcomes and promote the well-being of families across the state.”
Moreover, midwives are more cost effective, saving families and the healthcare system about $2,000 on average. Yuliya Labko, a certified midwife in the Philadelphia area, has found that some hospital systems use the expertise of midwives for normal deliveries –where hospitals lose reimbursements – to free up doctors for surgery, which earns lucrative fees and closes the loop for these institutions.
States exercise an important function in regulating licenses, which ensures that only trained professionals can offer services. Of course, the same rules can artificially restrict entry into a market and raise prices for consumers. The number of doctors that medical schools graduate each year are only somewhat above what they were in 1981, when the population was lower, as was the average age. In part due to supply and demand, doctors salaries are twice what they are in other rich countries. Much of that is due to the ways that doctors have successfully used the federal government to restrict competition.
It's also the background for why there is more and more pressure for Pennsylvania to allow greater latitude for physicians assistants, nurse practitioners, and midwives to provide healthcare services.
SB 507 will not fix all that is wrong with our healthcare system. But it would expand the number of healthcare professionals, providing Pennsylvanians with great choice and saving lives. It would not require the state to spend money, raise taxes, or create a new bureaucracy. The proposal to modernize midwifery in the Commonwealth is an example of common-sense legislation in the public interest.
Let’s hope it succeeds.
