Elizabeth G. Muñoz, DNP, CNM, FACNM & 

Allison Shorten, PhD, RN, FACM, FNAP, FAAN

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 (Tucker & Baumstark, 2026). 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). If maternity care is needed, many women face significant challenges in accessing care, as one in three counties in the U.S. is classified as a maternity care desert (March of Dimes, 2026). For pregnant and postpartum women, the lack of healthcare services can be life-threatening. However, when nurse-midwives are positioned to provide rural maternity care and bridge access gaps, health outcomes improve (March of Dimes, 2026). 

For those not familiar with the origins of the midwifery profession, the word midwife means “with woman” (Bradfield et al., 2018). 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 (Holley et al., 2024). While midwives are often associated with pregnancy and childbirth, midwives take on a variety of roles throughout different regions across the country (American College of Nurse-Midwives [ACNM], 2023). 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 a wide variety of areas:

• 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 can be found practicing in a variety of settings depending on the state—hospitals, birth centers, homes, ambulatory care clinics, community health clinics, public health systems and telehealth services (ACNM, 2023). Prepared through either Master’s or Doctor of Nursing Practice programs, 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 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 (American Midwifery Certification Board [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 per 1,000 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 care. This is an important moment to change the rural landscape of maternity care in the U.S. and integrate midwives into the mainstream. Strategies for rural nurses, policymakers and stakeholders include expanding midwifery practice authority, incorporating midwives into various rural practice arenas as a part of the interdisciplinary team (e.g., hospitals, clinics, community maternal health programs, etc.), and expanding their use in telehealth care with concomitant reimbursement expertise (Busse et al., 2026; Centers for Medicare & Medicaid Services, n.d.; Rural Health Information Hub, 2026). 

The theme of this year’s Midwifery Week (October 4-10), This Is Our Moment, was chosen to highlight 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-led models at the center of the conversation” this year (ACNM, 2026). At the 71^st Annual Meeting of the American College of Nurse-Midwives (ACNM), more than 600 midwives gathered from across the nation to collectively advocate for their profession, spotlighting midwifery-led innovation and research. Expanding access to midwives in rural areas of the United States is one solution to solving the maternal health crisis. Nurses from all specialties can collectively advocate for increasing access to midwifery services in rural areas. Nurses can play a vital role in sharing information about CNMs, and raising awareness within the community, especially if midwives are not yet working within their care systems. Nurse-midwives stand ready to team up and collaborate, to help bridge the widening access gaps in our healthcare system, especially in rural areas! 

References

American College of Nurse-Midwives. (2023, May 31). What is a midwife? Journal of Midwifery Women’s Health. 68(3), 411-412. https://doi.org/10.1111/jmwh.13523

American College of Nurse-Midwives. (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). 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

Bradfield, Z., Duggan, R., Hauck, Y., & Kelly, M. (2018). Midwives being ‘with woman’: An integrative review, Women and Birth, 31(2), 143-152. https://doi.org/10.1016/j.wombi.2017.07.011

Busse, C. E., Sheffield, E. C., Carroll, C., Jefferson, K., Vanderlaan, J., Backes Kozhimannil, K., & Interrante, J. D. (2026). State midwifery full practice authority policies and midwife-attended births among rural and urban U.S. residents. Women's Health Issues: Official publication of the Jacobs Institute of Women's Health, 36(5), 436–443. https://doi.org/10.1016/j.whi.2026.06.002

Centers for Medicare & Medicaid Services. (n. d.). Improving access to maternal health care in rural communities: An issue brief. https://www.cms.gov/about-cms/agency-information/omh/downloads/improving-access-to-maternal-health-care-in-rural-communities-an-issue-brief.pdf

Holley, S.L., Mitchell, S., Muñoz, E.G. & Cockerham, A.Z. (2024). History of midwifery at Tuskegee: Vanguards of midwifery education. Journal of Midwifery Women’s Health, 69, 672-680. https://doi.org/10.1111/jmwh.13667

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

Rural Health Information Hub. (2026). Rural maternal health. https://www.ruralhealthinfo.org/topics/maternal-health

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/https://doi.org/10.1111/jmwh.13676 

Tucker, C.M., & Baumstark, J. (2026), Certified nurse-midwife practice authority as a structural determinant of maternal health. Milbank Quarterly. https://doi.org/10.1111/1468-0009.70131

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