HJNO Jan/Feb 2025

HEALTHCARE JOURNAL OF NEW ORLEANS I  JAN / FEB 2025 37 “Midwifery is a standard of care in many countries that have maternal child outcomes far superior to those of the U.S. They are a solution to the shortage of OB- GYN providers, particularly in rural and underserved areas.” are no capped limits on what physicians may charge APRNs for this. Additionally, if unable to find a collaborating physician, the APRN is unable to practice, further exacerbating provider shortages, particu- larly in rural and underserved areas. The American Nurses Association (ANA) is ful- ly supportive of FPA for APRNs as it facili- tates the APRN’s ability to practice to the fullest extent of their education and skills. 12 Another barrier to a fully implemented midwifery workforce — and a barrier for all APRNs — is the lack of subsidized gradu- ate nursing education to produce addi- tional midwives, such as exists in medical education. Health systems are remuner- ated with federal funds to underwrite the costs of educating medical students and of resident’s training, whereas there is nothing parallel in the nursing world. Health systems that allow graduate nurs- ing students to complete their clinical practicum courses within their systems do so largely from an ethical framework of knowing it is the right thing to do to grow the APRN workforce. Without any financial or little other incentive, gradu- ate nursing preceptors are in short supply. PROVEN QUALITY OF MIDWIFERY CARE There is myriad evidence support- ing the knowledge that midwifery care produces excellent outcomes. In addi- tion to the evidence already presented, a systematic review published in 2023 from Fikre, et al., noted a significantly positive impact on various maternal and neonatal outcomes in low- and middle- income countries amongst women re- ceiving care from midwives. 13 These out- comes included significantly lower rates of postpartum hemorrhage and birth as- phyxia. Further, the analysis noted lower cesarean section rates, increased odds of vaginal birth, and decreased use of epi- siotomy amongst midwifery patients. The 2014 The Lancet series on mid- wifery is considered to be the most com- prehensive body of evidence to date on the promise for midwifery to radically change the landscape of women’s health in the U.S. The series’ key findings included: • Women’s experiences and per- spectives are essential to planning health services in all countries. • The key to forward movement in maternal and newborn health is a system-wide shift from pathology to skilled care with multidisciplinary teamwork and integration across hospital and community settings. • Evidence demonstrates that midwife- ry is cost effective with a return on in- vestmentsimilartothatofvaccination. • Midwivesaremosteffectivewhenedu- cated, licensed, trained, regulated, and integrated into the healthcare system. • The world cannot achieve universal accesstoperinatalcarewithoutdrastic increases in the number of midwives. • Systematic barriers to high quality midwifery must be addressed, includ- ing lack of awareness of midwifery, the low status of women, inter-pro- fessional rivalries, and unregulated commercialization of childbirth. 5 THE UNIQUE NATURE OF MIDWIFERY CARE The way that we regard and treat wom- en during pregnancy, childbirth, and post- partum, as well as the institutional options (or more so the lack thereof) provided to them by healthcare settings, directly re- flect the way we value women in our soci- ety. All too often, the positive outcomes of midwifery models of care are disregarded, citing non-existent safety concerns. 14 Mid- wives deliver care within the framework of the midwifery model of care, which em- phasizes a holistic approach with relation- ship-based care at the center. The model is also rooted in the knowledge that the processes in a woman’s reproductive life — menarche, pregnancy, birth, and meno-