Childbirth remains perilous. A traditional practice offers assistance.
In an effort to combat the high maternal mortality rates in the United States, the midwife-centric approach of Mother Health International (MHI) in Uganda offers a promising solution. This approach, which emphasizes personalized, continuous support during pregnancy and childbirth, can be adapted in the US to improve maternal health outcomes.
One key element to implement this approach is scaling midwifery-led care. MHI, a birth center in Northern Uganda affiliated with Yale University, has demonstrated the effectiveness of midwifery models, showing enhanced patient satisfaction and safer deliveries [3][5]. Similar efforts are already underway in the US, with midwifery programs growing at medical centers like NYU Langone's Joan H. Tisch Center for Women's Health.
Improving accessibility and cultural competence of midwives and maternal care providers is another crucial aspect. In Uganda, MHI involves midwives deeply invested in community engagement and mentorship, such as Eva Nangalo, who work tirelessly in low-resource settings [1]. Embedding midwives who understand community-specific needs can improve birth outcomes in the US, particularly in underserved areas with high maternal mortality rates.
Providing continuous education and training to health workers is essential to ensure readiness in delivering adolescent-friendly and culturally appropriate maternal care. Uganda's focus on training midwives and addressing gaps like communication and resource shortages [2] serves as inspiration for similar initiatives in the US.
Integrating midwives in hospital and home-birth settings is also vital. MHI's model promotes hospital deliveries while making them culturally acceptable and accessible, countering the US’s fragmented maternity care system where midwives are often underutilized.
Advocacy and policy support are necessary to strengthen midwifery's role in the healthcare system. This includes reimbursement, licensing, and collaborative practice, which allows midwives to lead efforts in reducing disparities in maternal health outcomes. The Centers for Medicare & Medicaid Services has introduced a new model, Transforming Maternal Health, to increase access to midwifery care and birth centers.
Adopting MHI’s midwife-centric principles in the US requires systemic investment in midwifery workforce expansion, community-tailored services, continuous professional development, and health system reforms to increase access to respectful, skilled midwifery care. This approach aligns with existing evidence showing such care significantly improves maternal outcomes [3][5].
It's worth noting that midwifery-led birth centers have childbirth costs that are 21 percent lower than traditional hospital births. As the demand for OB-GYNs could exceed supply by 2030, particularly in rural areas where pregnant women must increasingly travel to get care, midwifery care offers a cost-effective and accessible solution.
Moreover, the MHI center has assisted with over 20,000 births since 2007 and has never lost a mother, which is "extremely rare" in East Africa and the rest of the world. A systematic review found that midwifery significantly improves maternal and newborn health in low- and middle-income countries while also lowering newborn mortality and morbidity.
In the US, the percentage of births attended by midwives was 10.9 percent in 2022, up from 7.9 percent in 2012. However, there is still room for improvement, with the goal of 50 percent of births being attended by midwives by 2050 [Sakala].
Addressing social, structural, and political determinants of health is also crucial for a radical rethinking of maternal health in the United States [Goode]. Over 500 rural hospitals have closed their labor and delivery wards since 2010, with more poised to close in the near future.
In conclusion, adopting MHI's midwife-centric principles in the US can lead to significant improvements in maternal health outcomes. By investing in midwifery workforce expansion, community-tailored services, continuous professional development, and health system reforms, we can increase access to respectful, skilled midwifery care, potentially saving lives and reducing healthcare costs.
- Implementing midwifery-led care, as demonstrated by Mother Health International (MHI) in Uganda, has the potential to enhance health-and-wellness outcomes in the US.
- To effectively deliver adolescent-friendly and culturally appropriate maternal care, it's essential to provide continuous education and training to health workers, as observed in Uganda's midwife training programs.
- Integrating midwives in both hospital and home-birth settings can help counter the fragmented maternity care system in the US and make deliveries more accessible and culturally acceptable.
- Advocacy and policy support, including reimbursement, licensing, and collaborative practice, are necessary to strengthen midwifery's role in the US healthcare system, following the example of initiatives like the Centers for Medicare & Medicaid Services' Transforming Maternal Health model.
