The Regulation of Professional Midwifery in the United States

The World Health Organization (WHO) designated 2020 as the International Year of the Nurse and the Midwife. Part of the WHO campaign focuses on the fact that nurses and midwives comprise more than half of the shortfall in the global health workforce. In the United States, maternity care is critical because half of rural counties have no access to maternity providers and because the rate of maternal morbidity and mortality continues to climb, surpassing rates of countries with similar incomes. Midwives have a proven record for quality, safety, cost-savings, and high patient satisfaction, yet they attend only 10.2% of births in the United States. In many countries with better maternal mortality and morbidity outcomes, midwives attend 50% to 70% of births. This article reviews the history of professional midwifery in the United States, including the development of the certified midwife credential, outlines current challenges in regulation of the profession, and summarizes widely accepted recommendations to improve access to high quality maternal and child health through support of the midwifery workforce. It is intended to assist state boards of nursing in understanding how they might expand their authority to include the licensing and regulation of certified midwives.