As the Maternal Health Crisis Deepens, Midwives Offer a Proven Path Forward

For a lot of pregnant people in this country, the question isn't just "who will deliver my baby," but "will anyone be available at all." Rural hospitals are closing their labor and delivery units at an alarming pace. Fewer medical students are choosing obstetrics. And the people caught in the middle are often the ones with the fewest options to begin with.

Amanda Shafton has spent her career trying to close that gap. She's a certified nurse midwife and the national director of midwifery at Ob Hospitalist Group, the largest employer of obstetricians and midwives in the country. In a recent conversation on MedCity News' FemFwd podcast, she made a case that sounds simple but carries real weight: pairing physicians with midwives, rather than relying on doctors alone, produces better outcomes for patients.

Think of it like a relay team instead of a solo runner. A physician brings deep training in managing medical complications. A midwife brings expertise in what Shafton calls "normal," the natural physiological process of labor and birth that doesn't always need intervention. Put them on the same team, and patients get the benefit of both without having to choose.

"There is something really magical about that collaborative care of bringing obstetrics and midwifery together to care for people," Shafton said. It's not a throwaway line. She points to internal data at OBHG showing that teams pairing a doctor with a midwife actually outperform teams made up of two physicians. That's a striking claim, and one that challenges the assumption that more specialized medical training always means better outcomes.

How the Collaborative Model Works in Practice

At OBHG, no patient is labeled as belonging exclusively to a midwife or a doctor. Everyone is treated as a shared patient, cared for by a team that typically includes both. The hospitalist model means someone is always on hand, filling in for private practitioners who can't be everywhere at once, and catching patients who show up without any prenatal care at all, including travelers who go into labor far from home.

Doulas fit into this picture too, though differently. Patients hire doulas directly, building a relationship over the course of pregnancy. When labor begins, that doula works alongside the clinical team, offering physical and emotional support while the medical side handles the clinical decisions. Shafton describes it as surrounding the patient with a community that shares one goal: a good outcome for that family.

The benefits show up in the numbers Shafton cites. Midwife-involved care is associated with higher rates of successful vaginal birth, including vaginal births after cesarean, often called VBACs. Fewer interventions happen overall, not because midwives avoid necessary medical tools like Pitocin or epidurals, but because they lean on the body's natural process first and use intervention when it's actually needed. Shafton is quick to note that many hospitalist midwives, including much of her own team, care for medically complex, higher-risk patients every day. Midwifery isn't a lower tier of care reserved for simple cases. It's a different lens applied across the full spectrum of pregnancy risk.

Central to Shafton's philosophy is patient autonomy. "It's not my baby and it's not my birth," she said. The goal, as she frames it, is making sure patients have had every question answered so they can make the decisions that feel right for them and their families.

Scale matters here too. OBHG currently employs more than 350 full-time midwives across the country, a number that climbs closer to 500 when part-time and per diem staff are included. That's a meaningful workforce, but Shafton is candid that it's still not enough given the scope of the problem. Rural hospitals are closing. OBGYN training pipelines are shrinking. She'd like to see at least one midwife at every hospital where babies are born, and ideally more.

Insurance, for the most part, has caught up with this model. When a pregnant patient walks into a hospital's labor and delivery triage unit, insurance doesn't distinguish between a midwife and a physician for reimbursement purposes, whether the coverage is private or public. The gap shows up elsewhere: community-based births, in freestanding birth centers or at home, face more complicated coverage questions. OBHG doesn't provide that kind of care directly, but Shafton says the organization is focused on making sure hospitals are a safe landing point when those births need to escalate to a higher level of care. A midwife-to-midwife handoff during a transfer, she notes, can be a genuine comfort to a patient whose birth plan just changed unexpectedly.

Rural and underserved communities stand to gain the most from expanding this model, according to Shafton. Many hospitalist midwives started as nurses working in their own communities before returning to school for a master's or doctoral degree in midwifery, a shorter training pathway than the years required for a physician to complete medical school, residency, and possibly fellowship. That local connection, combined with a faster route to practice, makes midwives well positioned to fill provider gaps in places physicians are increasingly scarce.

Why It Matters

The maternal health crisis in the United States isn't an abstract policy debate. It's measured in hospitals that no longer deliver babies, in patients driving hours for prenatal visits, and in families forced to make decisions about where and how to give birth without enough qualified providers nearby. Shafton's argument is that midwives, working alongside physicians rather than in competition with them, are a proven and underused tool for closing that gap.

Getting there requires more than good data. It means patients asking their providers whether midwives are part of the care team, hospitals building the infrastructure to credential and support midwifery practice, and organizations willing to do the unglamorous work of building trust between disciplines. Shafton's message is straightforward: the workforce solution to America's maternal health crisis may already exist. It just needs the support to grow.