Every October, National Midwifery Week shines a spotlight on an evidence-based model of care that has been used throughout history. Whether consulted during prenatal care, delivery, or postpartum, midwives are increasingly chosen by couples seeking personalized, relationship-centered care as they grow their families. At Solidarity, we share into the full spectrum of maternity care, from hospital-based obstetrics and delivery to post-natal care, and for Members who choose to deliver at a birth center or plan a home birth, we also share into the cost of using midwifery professionals and birthing centers.

More Families Are Choosing Midwives

Midwifery use is steadily rising in the United States:

• Vaginal births attended by midwives increased from 11.7% to 15.9% between 2012 and 2022.^{1 2}
• Out-of-hospital births (home or birth center) increased during 2019–2021 and remain above pre-pandemic levels.³

This growth reflects a desire for safer, less-interventionist options and more personalized care than can be found in traditional hospital settings without a midwife.

The Value of Midwife-Led Care

Evidence from around the world supports the efficacy of the midwife-led continuity of care (MLCC) model of treatment, where the same midwifery team supports the mother throughout pregnancy, birth, and postpartum.

• MLCC is associated with higher rates of spontaneous vaginal birth (having the baby naturally when it is ready), lower cesarean section rates, and better patient experiences compared to standard care.⁴
• The National Academies of Sciences emphasizes that integrated systems, including hospitals, birth centers, and home settings, achieve the safest outcomes when midwives play a central role.⁵
• States with stronger midwifery integration demonstrate lower rates of preterm birth, cesarean, and neonatal death.⁶

My Concern with Maternal Health in the U.S.

The U.S. maternal health system remains deeply flawed. While maternal mortality rates improved slightly in 2023, they remain higher than most other developed nations. In 2023, the national maternal mortality rate was 18.6 deaths per 100,000 live births, down from 22.3 in 2022, but still far above peer countries.⁷

The disconnect is striking; despite spending the highest per-capita on maternity care, the U.S. lags behind other developed nations in maternal outcomes. Many families are turning to midwifery because it provides more relational care, closer follow-up, and a stronger overall continuity of care, all of which address critical gaps in our current system.

Safety: Hospital, Birth Center, and Home Birth

For low-risk pregnancies under the care of licensed midwives in integrated systems, planned birth center and home births have been shown to be as safe as hospital births, with significantly lower intervention rates.⁸

Key indicators include:

• Planned home births attended by midwives show outcomes comparable to birth center births for low-risk women.⁹
• Women under midwifery care consistently experience lower rates of induction, epidural use, and operative delivery without compromising safety.¹⁰
• Safety is maximized when midwives are well-integrated into the healthcare system, with seamless protocols for transfer when higher-level care is needed.¹¹

Postpartum: More Touchpoints, Better Outcomes

Postpartum is one of the most vulnerable periods for mothers. More than half of U.S. mothers miss recommended postpartum visits, leaving complications like hypertension, depression, and infections undetected.¹²

Midwifery models address this gap:

• In a large Ontario study of 105,000 births, women with midwifery care received a median of 7 postpartum visits, often including home visits, while those under physician-led care received only 0–1 visits. This was associated with fewer postpartum emergency department visits (6.7% vs 8.4%).¹³

Since most maternal deaths in the U.S. occur postpartum and many are preventable, these extra touchpoints may explain why midwifery systems worldwide are associated with lower maternal morbidity and mortality rates. Global modeling suggests that robust midwifery care could avert up to 41% of maternal deaths.¹⁴

A Better Way Forward

Midwifery is not an alternative to modern obstetric care—it is a complementary, evidence-based model that improves outcomes, enhances patient experience, and often reduces costs. Families today are increasingly drawn to midwives because they offer continuity of care, increased presence, and trust, qualities that are sometimes lost in high-volume obstetrics.

At Solidarity, we stand alongside families as they make their birthing decisions, whether that means sharing into an OB-led hospital birth or a midwife-led home or birth center birth. Our goal is to support care models that are safe, relational, and life-affirming, ensuring mothers and babies receive the attention they deserve from pregnancy through the “fourth trimester.”

In Solidarity,

1. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final Data for 2022. National Vital Statistics Reports; 2024. ↩︎
2. American College of Nurse-Midwives. Essential Facts about Midwives. 2022. ↩︎
3. Time. “Home Births Rose During the Pandemic, Study Shows.” Time, November 17, 2022. https://time.com/6234756/home-births-rise-us-covid-19/. ↩︎
4. Sandall J, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016. ↩︎
5. National Academies of Sciences, Engineering, and Medicine. Birth Settings in America: Outcomes, Quality, Access, and Choice. National Academies Press; 2020. ↩︎
6. Vedam S, et al. Mapping Integration of Midwives across the United States: Impact on Access, Equity, and Outcomes. PLoS One. 2018. ↩︎
7. Hoyert DL. Maternal Mortality Rates in the United States, 2023. National Center for Health Statistics; 2025. ↩︎
8. Hutton EK, et al. Perinatal or neonatal mortality among women who intended at the onset of labour to give birth at home versus in hospital: A population-based cohort study. EClinicalMedicine. 2019. ↩︎
9. Cheyney M, et al. Planned Home Birth in the United States and Outcomes: An Integrative Review. J Midwifery Womens Health. 2024. ↩︎
10. Stapleton SR, et al. Outcomes of care in birth centers: Demonstration of a durable model. J Midwifery Womens Health. 2013. ↩︎
11. National Academies of Sciences, Engineering, and Medicine. Birth Settings in America: Outcomes, Quality, Access, and Choice. National Academies Press; 2020. ↩︎
12. American College of Obstetricians and Gynecologists. Optimizing Postpartum Care. Committee Opinion No. 736. Obstet Gynecol. 2018. ↩︎
13. Stoll K, et al. Postpartum Care and Health Service Use Among Women in Midwifery Versus Physician Models of Care: A Retrospective Cohort Study. CMAJ. 2020. ↩︎
14. Homer CS, et al. The projected effect of scaling up midwifery. Lancet. 2014. ↩︎