Why Midwives Matter in Maternal Health

Written By Aicha Traore

Midwives have supported women through birth for centuries, yet many of us still don't know what they actually do. Understanding your options is the first step toward a birth experience that feels safe, supported, and yours. Here's what midwifery care is, how it differs from obstetric care, and what the research says about its role in maternal health.

What is a midwife?

A midwife is a trained healthcare professional who supports women during pregnancy, labor, birth, and postpartum. Midwives:

  • Offer education, emotional support, and patient-centered care

  • Work in hospitals, birth centers, clinics, and homes. Certified nurse-midwives (CNMs) are the type most often found in hospitals.

  • See birth as a normal physiological process, while recognizing when medical care is needed

  • Support informed consent and shared decision-making

  • Attend vaginal births. They do not perform cesarean sections; if surgery is needed, care is transferred to or shared with an obstetrician.

The Lancet's landmark Series on Midwifery describes midwifery as a model that improves quality of care by focusing on prevention, support, and the needs of women and newborns.

Midwife vs. OB-GYN

Midwives and OB-GYNs both support pregnancy and birth. Midwives tend to focus on holistic, preventive, low-intervention care, while OB-GYNs specialize in medical and surgical management. Many women benefit from both, especially when midwives and obstetricians work as a team.

Midwives

  • Holistic, relationship-centered model of care

  • Focus on low-risk pregnancy and support physiologic labor when safe

  • Do not perform cesarean sections or surgery

  • Often encourage movement, breathing techniques, water during labor, and doula support

  • Tend to use fewer routine interventions, such as Pitocin or episiotomy, and support pushing when the body is ready

OB-GYNs

  • Medical and surgical model of care

  • Focus on diagnosis, intervention, emergency treatment, and high-risk pregnancy

  • Perform cesarean sections and surgical procedures

  • Often rely more on medical pain relief, such as epidurals

  • More likely to use interventions as part of standard management

These are general patterns, not rules. Practices vary by provider, setting, and each woman's health needs.

The benefits of midwifery care

Research shows that integrating midwives into health systems is associated with better maternal health outcomes.

  • More spontaneous vaginal births. A 2024 Cochrane Review of 17 randomized trials found that women receiving midwife continuity of care (care from the same midwife or small team throughout pregnancy, birth, and postpartum) were more likely to have a spontaneous vaginal birth: 70% compared with 66%.

  • Fewer interventions. The same review found these women were slightly less likely to have a cesarean or an instrumental birth with forceps or vacuum, and may be less likely to have an episiotomy: 19% compared with 23%. Across the millions of births each year, even small shifts mean many fewer procedures.

  • Comfort measures in labor. Midwives often encourage movement, breathing techniques, and laboring in warm water. According to the American College of Obstetricians and Gynecologists (ACOG), laboring in water during the first stage may shorten labor and is associated with less epidural use. ACOG does not currently recommend giving birth underwater, so talk with your provider about what's safe for you.

  • Lower cesarean rates in birth centers. For women who labor in midwife-led birth centers, the cesarean rate averages 6.1%, about half the rate in studies of low-risk hospital births.

Midwifery care and maternal mortality

Midwives can help reduce unnecessary interventions in low-risk pregnancies, and their relationship-centered model can help close gaps in care, especially for women of color, who face the highest risks in the U.S. maternal health system.

  • Most pregnancy-related deaths are preventable. According to the CDC, more than 80% of pregnancy-related deaths in the U.S. were preventable, and more than half happened between one week and one year after birth.

  • More time with each patient. Midwives often schedule 30–60 minute prenatal visits, compared with the 10–15 minutes common in OB-GYN visits. That time goes to physical health, emotional well-being, birth preferences, and postpartum planning.

  • A global impact. A 2021 study in The Lancet Global Health estimated that universal coverage of midwife-delivered care could prevent 67% of maternal deaths, 64% of newborn deaths, and 65% of stillbirths across 88 low- and middle-income countries by 2035.

Why midwives are controversial

Midwives challenge the idea that every birth must be treated as a medical emergency, and that makes their work a point of debate.

  • Different philosophies of care. Some providers are less comfortable with low-intervention birth and prefer medical management for every birthing person.

  • Misunderstanding. Many people assume midwives aren't medically trained. In reality, certified nurse-midwives (CNMs) are advanced practice clinicians with graduate degrees, and certified professional midwives (CPMs) complete specialized training and national exams.

  • Laws vary by state. Some states let CNMs practice independently, while others require physician oversight. Thirteen states, including Georgia, offer no licensing path for CPMs, who specialize in home and birth center births.

  • A live legal fight. In April 2026, three midwives sued Georgia over laws that bar CPMs from practicing and require costly physician agreements for nurse-midwives. They argue these rules worsen the state's maternal health crisis.

  • Safety debates. Home and birth center births continue to raise safety questions within the maternal health system, which is why careful screening and clear plans for hospital transfer matter.

Finding the care that fits you

You deserve care that sees you as a whole person: your body, your history, and your hopes for birth. Whether you choose a midwife, an OB-GYN, or a team of both, the most important thing is knowing your options and feeling supported in your choice.

If you're unsure where to start, Wombline Care can help you explore providers, birth centers, and community resources near you. Wombline Care helps you find and connect with care; it doesn't provide medical advice or replace a licensed healthcare provider.

References

Aicha Traore
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