Hinson, state lawmakers look to midwives to fill Iowa’s maternity care deserts

Thousands of Iowans are losing access to maternal care.

One-third of Iowa counties are considered “maternity care deserts” without a hospital or birth center offering obstetric care and without any obstetric providers, according to a 2022 report by the March of Dimes, a nonprofit focused on maternal and infant health.

Access to maternity care is decreasing across parts of the U.S., affecting nearly 7 million women of childbearing age and some 500,000 babies, according to the report.

The report found 36 percent of counties nationwide constitute maternity care deserts. In Iowa, more than 35 percent of counties are maternity care deserts. Another 29 percent of counties have low or moderate access to appropriate preventive, prenatal and postpartum care.

One area both state and federal lawmakers have turned to improve maternal health care in Iowa is expanded access to midwifery services.

Iowa Gov. Kim Reynolds last week signed into law legislation creating a licensing process for midwives for the first time in Iowa.

And Iowa Republican U.S. Rep. Ashley Hinson, of Marion, is also working with New Jersey Democratic Rep. Bonnie Watson Coleman to expand access to midwifery services for pregnant people.

"With many women in rural communities having to drive an hour or more to get to an OBGYN, it is critical that we are looking to innovative solutions to expand maternal health care options,“ Hinson told reporters last week. ”Increasing that access to midwifery services will ensure that we have more healthy moms and babies here in Iowa, and also help families continue to grow and prosper here.“

With the signing of House File 265 by Gov. Reynolds, Iowa became the 38th state to license certified professional midwives.

What the new law does

The law, which passed both the Iowa House and Senate with near-unanimous support, provides licensure for certified professional midwives, also referred to as direct-entry midwives, who provide care in homes and free-standing birth centers.

Unlike certified nurse midwives, which are already licensed by the state as nurse practitioners and practice primarily in hospital settings, CPMs are not required to have a nursing degree.

Iowa has approximately a dozen certified professional midwives practicing in the state, said Bethany Gates, a certified professional midwife at Shiphrah Birth Services in Vinton.

Gates praised passage of the new law, which she said will open the doors for certified professional midwives from neighboring states to practice in Iowa.

“Increasing the number of CPMs practicing in Iowa will improve access to desperately needed maternity care providers, especially in more rural areas,” Gates said.

A 2018 study suggests that integrating midwives into regional health care systems could result in better newborn and maternal health outcomes.

“Having the license provides protections for practicing midwives and ensures they are practicing with full legal allowance,” Gates said, noting midwives have been charged in Iowa in the past for practicing without a license.

The new licensure will be managed by the Iowa Board of Nursing, which will establish a midwifery advisory council to advise on education requirements, standards of practice, professional ethics, disciplinary actions, medications and other relevant issues.

A person practicing midwifery in Iowa will be able to obtain a license to practice beginning July 1, 2024, with exemptions for those practicing in Native American, Mennonite and Amish communities or other religious communities with “traditional” midwifery practices.

The bill also limits the liability of a health care provider that accepts clients transferred from a licensed midwife, and requires insurance providers to extend maternity benefits to cover services provided by licensed midwives on the same terms as similar services provided by other health care providers.

Gates said the bill will help facilitate a smoother working relationship with hospital-based providers, who can “confirm we are qualified providers” who are duly licensed.

“Licensure makes birth a lot safer … and means quicker access to collaborative care when we need it,” she said.

More people want to give birth outside a hospital

During the height of the pandemic, home births in the United States increased 22 percent in 2020 and 2021, according to the Centers for Disease Control and Prevention. And demand continues to increase, said Gates, whose practice has doubled the number of home births she has attended since the start of the pandemic, because mothers were concerned about exposure and hospital restrictions.

“We have a pretty significant demand and not enough midwives,” Gates said. “We’re having to turn people away.”

Supporters — including the bill’s floor manager, Rep. Bobby Kaufmann, R-Wilton — say midwives can play a critical role in maternity care as Iowa struggles with a provider shortage.

State Rep. Monica Kurth, D-Davenport, during floor debate on the bill, said the new law ensures pregnant people receive quality care, by requiring practicing midwives in the state to undergo the proper training and holding them to high professional standards as regulated care providers.

Iowa ranks 49th in the country for the ratio of OBGYNs to the general population, “which makes it difficult for women to get proper care in all of Iowa,” Kurth said.

Maternal mortality rate spikes in Iowa, U.S.

Iowa’s maternal mortality rate — the total number of deaths due to pregnancy, childbirth and during postpartum period per 100,000 live births — has steadily risen over the past two decades.

Maternal deaths in the United States spiked in 2021 to 32.9 maternal deaths per 100,000 live birth — a 40 percent increase from the previous year, according to data from the Centers for Disease Control and Prevention.

Iowa saw 43.4 maternal deaths per 100,000 live births in 2021, according to CDC data.

Maternal mortality is higher in the United States compared to any other developed nations. And racial disparities persist in the U.S., where maternal mortality rates for non-Hispanic Black women are three to four times higher than the rates for white women, according to a 2021 Iowa Maternal Mortality Review Committee report, which found 63 percent of pregnancy-related deaths were preventable.

“I truly believe it’s because we are underutilizing midwives” as a front line in maternity care, Gates said.

Studies have shown that among women with low-risk pregnancies, midwifery care was associated with substantially fewer preterm births and labor interventions.

Hinson introduces Midwives for MOMS Act

Hinson last week reintroduced the Midwives for MOMS Act to increase the number of trained midwives in the United States to help fill gaps in maternity care and improve birth outcomes.

This bill provides grant funding for the education of more credentialed midwives to provide services in areas with limited access to professional health care.

Hinson also introduced legislation that allows newborns to be covered under their mother's insurance for 30 days after birth. It establishes a 60-day enrollment period for all plans and insurers after the first 30 days of birth for newborns, and requires that all health plans and insurers immediately notify parents if they receive a bill for an uncovered newborn.

“New parents have enough on their plates without having to worry about getting a surprise medical bill for the cost of an unexpected medical visit in the first few weeks of their babies’ lives,” Hinson said. “This bipartisan provides parents the certainty so they can focus on keeping newborns healthy and happy.”

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