In 2020, a maternal death occurred almost every two minutes, according to the World Health Organization. There’s an urgent need to address the prevalence of maternal mortality and for strategies to reduce and prevent it — and nurse midwives can play a large part.
When it comes to maternal health, nurse midwives are pivotal in the care of many pregnant patients. In their roles, they provide continuous, personalized care throughout the pregnancy journey, which is vital for early detection and management of potential complications. This holistic approach not only enhances the overall pregnancy experience for the patient but also significantly contributes to reducing maternal mortality rates.
Let’s explore the role of nurse midwives and the strategies they use to reduce maternal mortality.
Understanding maternal mortality
Maternal mortality is defined as the death of a person during pregnancy, childbirth, within 42 days of termination of a pregnancy, or up to 365 days postpartum. Despite advances in healthcare, maternal mortality rates remain seriously high in many parts of the world.
While maternal deaths are preventable with timely and appropriate medical interventions, disparities exist with access to quality care, lack of education, and socioeconomic barriers contributing to higher rates. Nurse midwives are in a position to reduce maternal mortality through a combination of clinical expertise, patient education, and advocacy.
The role of nurse midwives in maternal health
Nurse midwives are highly trained healthcare professionals who specialize in reproductive health, pregnancy, and childbirth. Their role extends beyond assisting with childbirth; they provide comprehensive care that includes prenatal, intrapartum, postpartum, and neonatal services. This continuity of care is critical in identifying and managing complications early, reducing the risk of maternal mortality and morbidity.
Jessica Brumley, PhD, APRN, CNM, President of the American College of Nurse-Midwives, shared her insights on the impact of nurse midwives on maternal health in a recent video interview with host Alice Benjamin, MSN, ACNS-BS, FNP-C, Chief Nursing Officer Consultant at Nurse.com.
“There is longstanding evidence that finds that when people are cared for by midwives, they have better health outcomes,” Brumley said. “And in states where midwives are well integrated into the healthcare system, those states have better maternal health outcomes.”
Brumley, who also serves as Director and Associate Professor of Midwifery, Obstetrics, and Gynecology at USF Health, explained that, historically, midwifery has been considered community-based care, where midwives provide care in and out of the home, helping maintain continuity of care.
Midwives build strong, trusting relationships with their patients, enabling them to offer tailored care that addresses the needs and concerns of each individual. Because of this, nurse midwives help support patients during every stage of pregnancy through:
1. Providing comprehensive prenatal care
During prenatal care, nurse midwives offer regular prenatal check-ups, which help monitor the health of both the birthing parent and the fetus. They perform routine assessments, such as measuring blood pressure, monitoring fetal growth, and identifying risk factors that could lead to complications.
“Nurse midwives help reduce the risk of complications by providing holistic medical and supportive care that promotes the health of the mother and baby,” said Ruth Mielke, DNP, APRN, CNM, a certified nurse midwife based in California.
Early detection of conditions like preeclampsia, gestational diabetes, and anemia can significantly reduce the risk of maternal mortality by ensuring timely medical interventions.
And according to Mielke, some key interventions are:
- Managing common pregnancy complaints such as nausea and heartburn using both natural and medical approaches
- Early detection and management of complications, including diabetes and high blood pressure
- Offering emotional and psychological support, including mental health screening and referrals, to ensure the mother's overall well-being
2. Skilled assistance during childbirth
The intrapartum period — the time during labor and delivery — is critical in preventing maternal mortality. Complications such as hemorrhage, obstructed labor, and infections are leading causes of maternal deaths. Nurse midwives are trained to manage normal deliveries and recognize the early signs of complications. Their ability to provide skilled assistance during childbirth, including performing emergency interventions when necessary, helps reduce the risk of mortality.
The 2024 Maternal Mortality and Morbidity Prevention Report by Relias, Nurse.com’s parent company, highlighted perceptions of maternal health practices among obstetric care providers, including certified nurse midwives. In the report, respondents were asked about their familiarity with maternal health practices at their organizations as a way to reduce variations in care and improve patient safety. For certified nurse midwives, 76% reported being “extremely familiar” or “very familiar” with these practices.
In many settings, especially low-resource areas, nurse midwives may be the primary or only healthcare provider available to assist with childbirth. Their presence ensures that pregnant individuals have access to professional care, which can be lifesaving in emergency situations.
3. Postpartum care and monitoring
The postpartum period is often neglected, yet it is a time when pregnant individuals are still vulnerable to complications such as postpartum hemorrhage, infections, and mental health issues like postpartum depression. Nurse midwives provide critical follow-up care during this period, monitoring for signs of complications and offering support and counseling.
“For pregnant and postpartum people, what we know is that the postpartum period is a time where people need support,” said Brumley. “They need to feel a community that's wrapped around them. When that support is provided, there's lower incidence of postpartum depression and anxiety.”
Postpartum visits allow these nursing professionals to assess the mother's physical and emotional well-being, ensuring that any issues are addressed promptly. They also provide guidance on breastfeeding, family planning, and infant care, which are essential components of maternal health.
Educating patients to reduce maternal mortality
Nurse midwives help educate individuals about reproductive health, family planning, and the importance of seeking care during pregnancy and childbirth. In many communities, especially in rural and underserved areas, some patients may lack basic knowledge about maternal health, which increases their risk of complications — and even death.
Unintended pregnancies and closely spaced births are associated with higher maternal mortality rates, according to research from the National Library of Medicine. Nurse midwives educate patients on the benefits of family planning and provide access to contraception.
Pregnancy education and empowerment help reduce maternal mortality as individuals are provided with the knowledge, decision-making skills, and confidence to take control of their health during pregnancy, said Mielke, who has over 22 years of experience as a nurse midwife.
“When educated and empowered, pregnant individuals can better recognize warning signs, access healthcare, and advocate for their needs,” she said.
In addition to one-on-one patient education, these nursing professionals often engage in community outreach programs to raise awareness about maternal health issues. These programs can include educational workshops, support groups, and collaboration with local organizations to reach a broader audience.
By empowering patients with knowledge and resources, nurse midwives help break down barriers to care and promote healthier pregnancies and childbirth experiences. Education and empowerment transform people into active participants in their healthcare, said Mielke.
Addressing social determinants of health
Maternal mortality is not always just the tragic result of a medical complication; it is also influenced by social determinants of health, including discrimination, poverty, access to healthcare, and cultural practices. Nurse midwives are in a unique position to address these factors through advocacy and community involvement.
In the Relias report, almost half (49%) of respondents perceived social determinants of health as a severe or significant issue in relation to maternal mortality and morbidity.
“I've spent my entire career looking at factors, such as experiences of discrimination and racism,” said Brumley. “And this is very clear in the science that these experiences are not only happening but impacting health outcomes. We have really solid research to support this notion. But what are we doing with this information?”
In the discussion of maternal mortality, it is important to not just recognize the barriers to safe and equitable maternal care but also advocate for the steps to get there.
Research shows that the maternal mortality rate for Black mothers remains significantly higher (49.5 deaths per 100,000 live births) than other racial and ethnic groups. Because cultural beliefs and practices can impact maternal health, it’s important to consider how racism, implicit bias, and other social determinants of health factor in.
Over one-third of respondents in the Relias report perceived racism and implicit bias as a severe or significant issue in maternal mortality. To reduce the risk, practices can be implemented to benefit both patients and providers, such as cultural competence training, standardized assessments, and patient education. In fact, the report also found that 54% of respondents provided cultural competence or implicit bias training for their entire care team.
Nurse midwives are trained to provide culturally sensitive care that respects the beliefs and traditions of the communities they serve. By understanding and working within the cultural context, they can build trust with their patients, encourage the use of healthcare services, and promote practices that improve outcomes.
Limited access to healthcare
Lack of access to quality care is another primary barrier to reducing maternal mortality. This is particularly true in rural and low-income areas, where individuals may have to travel long distances to reach a healthcare facility.
“In many underserved communities, there are few skilled healthcare professionals or facilities,” said Mielke. “The quality of care may also be inadequate due to underfunding or lack of resources. The result is limited access to prenatal, birth, and postpartum care, leading to an increased risk of complications.”
According to Mielke, nurse midwives can help overcome this barrier by working in low-resource settings with limited obstetricians.
“They bring skilled care to where individuals live. Nurse midwives also use innovative approaches like telehealth, mobile clinics, and group prenatal care to reach people in remote areas,” she said. “By meeting people where they are, they ensure timely prenatal care and appropriate referrals for complications.”
Nurse midwives are essential to reduce maternal mortality worldwide. Their role in providing comprehensive care, educating and empowering patients, and addressing social determinants of health is critical in preventing maternal deaths. As healthcare systems continue to evolve, the contributions of nurse midwives must be recognized and supported to ensure that every person has access to the care they need for a safe and healthy pregnancy.
