Midwives may help fill a growing need for maternal care in Iowa

It’s no secret that maternal care in the state of Iowa is struggling, especially in rural areas. Maternal care deserts are popping up across the state leaving thousands without access to care. Iowa’s lone freestanding birth center has closed. There is a midwife shortage, and Iowa women are seeking out more natural birthing options.

“To me, this is a war on women’s rights,” said Claire Solis, who is from Eldridge, Iowa, and had a home birth in June 2022. Solis believes that the current climate of maternal care in Iowa is preventing women from getting the care they are entitled to, whatever their preference may be.

The current state of maternal care in Iowa

Maternal care encompasses every stage of a woman's pregnancy—from prenatal, to birth, and then postpartum. “Typically, a pregnant woman has maternal care appointments every four weeks for the first 28 weeks of pregnancy, every two weeks until 36 weeks of pregnancy, and every week thereafter until birth,” said Bethany Gates, a certified professional midwife at Shiphrah Birth Services.

While maternal care has advanced, where you can receive this necessary care has dwindled. About 50 labor and delivery units have closed in the state of Iowa in the last 15 years, said Gates. That is leading to maternal care deserts: one-third of counties in Iowa are without a hospital or birth center that provides prenatal, birth and postpartum care, according to a 2022 report by the March of Dimes, a nonprofit that focuses on ending preventable maternal and fetal risk and death.

These maternal care deserts force expecting women to frequently take off work, drive long distances for a short appointment, pay more for gas, find and pay babysitters—all of which are not feasible for many women.

It is no surprise then that Iowa is ranked 49th in the nation for maternal care providers per capita, according to Gates. She explains that the closures across the state are multifaceted: there is an overall lack of funding in rural areas, insurance reimbursement complications, women wanting more natural birthing options, and rural Iowa providers often struggle to hire and retain medical staff.

A growing need for midwives

One solution for improving maternal care is including midwives on the front lines of maternal care. Lastascia Coleman, the program director of University of Iowa Hospitals & Clinics Nurse-Midwifery Education Program, says midwives are underutilized. Midwives attend to 89 percent of reproductive health needs of women yet are absent from many providers’ care teams.

MercyOne in Waterloo and UIHC both have midwives working in collaboration with obstetrics providers to assist in maternal care. Coleman says that at UIHC, midwives and obstetrics providers have a great working relationship.

Gates hopes more providers will start including midwives in their care teams. “Studies show that [midwifery is good for women,” Gates said. “It gives them more options, it lowers health care costs and improves outcomes.”

What is a midwife?

OB-GYNs are medical doctors with specialized training in obstetrics and gynecology. They are able to provide medical and surgical care, such as a C-section, when necessary.

Like OB-GYNs, midwives have extensive training in pregnancy care and can deliver babies, though they are not able to perform surgeries. In cases where that is necessary, care may need to be transferred to an OB-GYN.

There are several different types of midwives. A certified nurse-midwife is a registered nurse with specialized training in reproductive care, including childbirth. In Iowa, certified nurse-midwives are licensed as nurse practitioners and primarily work in hospitals. A certified midwife is a non-nurse with an advanced degree in midwifery. Both of these types are certified by the American Midwifery Certification Board.

Certified professional midwives, or direct-entry midwives, are not required to have nursing degrees but have advanced training in midwifery care and primarily work in homes and free-standing birth centers.

Earlier this year, Gov. Kim Reynolds signed into law legislation that created a licensing process for certified professional midwives.

Increase in home births

Since the COVID-19 pandemic, more women have been electing for home births and natural birthing methods. There was a 20 percent increase in home births from 2019 to 2020 and another 20 percent increase the following year, said Gates.

Solis said younger women in Iowa can be more open to natural birthing methods. She decided on a home birth to keep medical intervention as minimal as possible, resulting in a positive birthing experience with the support of her midwife, doula and pelvic floor physical therapist.

“I’ve never heard my friends say they loved their hospital birthing experience,” Solis said.

Solis felt judgment from medical professionals for her decision. Upon the closure of the one freestanding birth center in Iowa, women like Solis are left with few options. Gates echoes Solis’s sentiment—women should have the right to whatever birth experience feels most comfortable for them without judgment.

The future of maternal care in Iowa

Solis, Gates and Coleman agree that utilizing midwives is an important part of improving maternal care in Iowa. Coleman says that the state is making progress, as more midwives are attending births than in years past. Gates agrees that the Iowa legislature is trying.

“The state of Iowa received a grant from the Health Resources & Services Administration and through that program we’ve done a lot of work focusing on quality of care that is being delivered through the creation of Iowa Maternal Quality Care Collaborative,” said Coleman. “Lots of hospitals are participating in this voluntary effort to improve the quality of care and address common problems we see with maternal mortality and morbidity.”

The Nurse-Midwifery Education Program at UIHC travels to communities to deliver outpatient care, filling maternal care voids in Washington and Muscatine counties, where birthing units have closed.

Coleman hopes other providers follow suit and get more creative with their care delivery model to address the growing maternal care deserts.

In Solis’s experience, sharing her story has opened the eyes of others. She believes continuing conversation around the topic of maternal care is how women can advocate for themselves and their reproductive rights.

“Overall, we need to have better working relationships between midwives, practices, hospitals and the state. With limited resources we need to be strategic and work together on initiatives to improve the care we can give in Iowa,” said Coleman.