Mapping integration of midwives across the United States: Impact on access, equity, and outcomes

Our multidisciplinary team of legal, clinician, and perinatal epidemiology experts designed a study to assess the effects of state regulation of midwives on patient access to high quality maternity care in the US. We developed a novel, weighted scoring system that ranks all 50 states and DC on level of midwifery integration, and then linked state scores to maternal and newborn outcomes. <p>In our study we demonstrate that greater integration of midwives is associated with significantly higher rates of physiologic birth outcomes, lower rates of obstetric interventions, and fewer adverse neonatal outcomes. Our new Midwifery Integration Scoring System provides an evidenced-informed tool that can identify barriers to effective health human resource allocation in maternity care, based on population-level health outcomes data. In the current context of the Sustainable Development Goals to facilitate equitable access to skilled maternity providers, we believe that our findings will be of great interest to your readers. <p>We uploaded the 1) Midwifery Integration Scoring System and 2) the data set that includes all data points needed to replicate the results presented in our paper. Most of the data is for the year 2014 and comes from the CDC. Other data sources are detailed in the publication and a short data dictionary will be uploaded soon.