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HHS Releases Action Plan to Reduce US Pregnancy-Related Deaths and Improve Maternal Health

ACNM Played Key Role in Informing Recommendations

Yesterday, the U.S. Department of Health and Human Services (HHS) released Healthy Women, Healthy Pregnancies, Healthy Futures: Action Plan to Improve Maternal Health in America, with the goal to make the United States one of the safest countries in the world for women to give birth. U.S. Surgeon General Jerome M. Adams also issued a complementary Call to Action to Improve Maternal Health.

Over the past 14 months, ACNM played a key role in educating and providing feedback to multiple agencies within HHS during their “listening tour” to help inform their recommendations on how to help combat the nation’s maternity care crisis. ACNM participated in several roundtable discussions alongside other key maternal health stakeholder organizations and provided perspective on why better integration of midwives into health systems and communities and investment in midwifery-led care models help to achieve lower maternal mortality rates.

Midwives can help address the shortage of maternity and reproductive health service providers and improve preventable maternal deaths and morbidity. Decades of research and hundreds of studies have documented that care by certified nurse-midwives (CNMs) and certified midwives (CMs) is safe and the most prudent use of increasingly scarce resources. Furthermore, midwifery has been associated with more efficient use of resources and improved outcomes including increased rates of spontaneous labor, vaginal birth, and breastfeeding. Additionally, women who receive midwifery care have higher rates of satisfaction with care, pain relief in labor, and maternal–newborn interaction. Despite this, midwives and midwifery-led care models remain regrettably underutilized in the United States.

“CNMs and CMs have consistently delivered high quality primary and maternity care to patients of all races and ethnicities in a variety of settings and communities across the country,” stated ACNM President Cathy Collins-Fulea, DNP, CNM, FACNM. “Unfortunately, restrictive laws in several states and at the federal level prevent many from effectively serving the maternal health needs of thousands of Americans. ACNM applauds the Department of Health and Human Services for prioritizing maternal health care and committing to address some of the root causes of our nation’s maternal health crisis. We stand ready to work with the HHS Secretary and the various agencies within the Department to help improve the culture of maternal health through eliminating racial and ethnic disparities and ensuring access to the full spectrum of maternity and reproductive health care providers and services.”

In the push to improve quality of and access to care and reduce maternal morbidity and mortality rates, we anticipate that execution of this action plan will help to bring midwives to the forefront of maternal care in the United States. The plan’s initiatives that are specific to midwives and midwifery-led care models include:

  • Encourage increased access to birth centers and midwives in state Medicaid programs.
  • Encourage access to birth centers by recommending states increase Medicaid payments to licensed birth centers and remove state scope of practice barriers that prevent care from being delivered by CNMs and/or certified professional midwives (CPMs). ACNM recognizes HHS’s omission of CMs and is working to clarify and correct.
  • Reduce unnecessary utilization of cesarean delivery among pregnant women at low medical risk.
  • Utilize lower cost professionals, such as certified midwives, to expand the capacity of the health care system to address the needs of pregnant women and increase access to care. Certified midwives in this context refers to CNMs, CMs and CPMs.
The plan also establishes three overall goals:
  • Reduce the maternal mortality rate by 50 percent in five years.
  • Reduce the low-risk cesarean delivery rate by 25 percent in five years.
  • Achieve blood pressure control in 80 percent of women of reproductive age with hypertension in five years.
We all have a role to play, and ACNM is ready to do the work necessary to elevate these crucial priorities. We encourage all our members and interested stakeholders to get involved by reviewing the plan, spreading the word about it on social media, and considering the steps you and your practice, hospital, school, or other employer can take to contribute.

American College of Nurse-Midwives
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