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Primary Submission Category: Reproductive health
Why is Midwifery Utilization so Low in the United States? A patient perspective.
Authors: Shannon Maloney, Ciera Kirkpatrick, Kelli Boling, Harlan Sayles,
Presenting Author: Shannon Maloney*
Midwifery is a low-cost high quality pregnancy care option. Despite this, midwifery utilization in the United States remains low. It is estimated that midwives attend 10.5 percent of births in the U.S., with Indigenous pregnancies accounting for a greater proportion of these deliveries. Low midwifery utilization is not well understood. This study explored pregnancy risk perception, demographic factors and attitudes toward midwifery as potential explanations for midwifery utilization. We administered a national cross-sectional survey to individuals who were currently or recently pregnant. The sample included 507 participants from 46 U.S. states, comprising 109 Indigenous, 107 Asian, 136 Black or African American, 115 Hispanic or Latina, and 139 White respondents. Among respondents, 19.1% had used or planned to use a midwife and 21.2% of respondents wanted to use a midwife. Preferring a home or birth center birth (OR = 2.0, p<0.001), midwife awareness (OR = 2.1, p<0.01), and having positive perceptions of midwifery (OR = 2.53, p<0.05) were significantly associated with midwifery utilization. Personal pregnancy risk perception, racial identity, marital status, age, educational attainment, insurance type, number of previous pregnancies, and live births were not significantly associated with midwifery utilization or preference. These findings suggest that awareness, pre-formed attitudes toward midwifery, and birthing location are the main factors that predict midwifery utilization. Greater understanding of how midwifery attitudes are formed can help illuminate possible pathways for improving midwifery utilization in the United States.