Sustainable Reimbursement for Midwifery-Led Birth Center Care
The Commission for the Accreditation of Birth Centers (CABC) asserts that safe and satisfying health care is a fundamental human right that can best be provided by a system in which midwives and birth centers play a pivotal role. We recognize that the current system of reimbursement in the United States creates significant barriers to implementing midwifery-led care models to their fullest extent.
Background
Despite spending more per capita on perinatal health care than any other nation1, the United States has disproportionately high rates of poor outcomes for pregnant individuals and their newborns compared to those of other high-income nations. In 2020, the U.S. ranked 64th in maternal mortality and 54th in infant mortality among 186 countries.2 The CDC reports that the maternal mortality rate increased from 23.8 per 100,000 in 2020 to 32.9 per 100,000 in 2021.3 There are significant racial and ethnic disparities in outcomes.
Whereas 75% of births occurring in other industrialized nations are attended by midwives, only 12% are attended by midwives in the United States.4 This is even though most pregnant individuals are at low risk of complications during the perinatal period. Based upon strong evidence, the World Health Organization recommends that midwives “take the lead in providing care through pregnancy, childbirth, and afterwards.” 5
CABC supports the following measures to increase access to the proven models of accredited birth centers and midwifery-led care to address the United States’ health care disparities and improve perinatal outcomes:
- Separate professional and facility services reimbursement for care provided for both the birthing person and newborn.
- Equivalent reimbursement for the same services, regardless of licensed provider type, licensed facility type, or location of services.
- Inclusion and reimbursement without discrimination of all licensed midwives by every insurance plan, public or private.
- Code sets that are standardized and used for all maternity and newborn services, regardless of location of services.
- National recognition of licensed midwives as primary care providers for pregnancy and birth.
- National recognition as the first line of care for freestanding birth centers as defined by the American Association of Birth Centers Standards for Birth Centers and accredited by the Commission for the Accreditation of Birth Centers.6
CABC asserts that midwives and midwifery-led accredited birth centers are underutilized in the United States and offer a critical resource in addressing the poor outcomes and disparities that currently exist in our country.
CABC further asserts that equitable, timely reimbursement from public and private insurances will support the continued operation and expansion of birth centers and midwifery care models in the United States; and that increasing access to these services will directly improve persistently poor outcomes in maternal and child health.
References
- Wager E., McGough M., Rakshit, S., Amin K., and Cox C, (2024, January 23). How does health spending in the U.S. compare to other countries? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
- The World Factbook 2021. Washington, DC: Central Intelligence Agency, 2021. https://www.cia.gov/the-world-factbook/countries/
- Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. 2023. https://dx.doi.org/10.15620/cdc:124678
- Tikkanen R., Gunja M., FitzGerald M., and Zephyrin L. (2020, November 18), Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries(Commonwealth Fund, Nov. 2020). https://doi.org/10.26099/411v-9255
- United Nations Population Fund, International Confederation of Midwives, World Health Organization. State of the world’s midwifery 2021. New York: United Nations Population Fund; 2021. https://www.unfpa.org/sites/default/files/pub-pdf/21-038-UNFPA-SoWMy2021-Report-ENv4302.pdf
- Levels of maternal care. (2019). Obstetric Care Consensus No. 9. American College of Obstetricians and Gynecologists. Obstet Gynecol: 2019; 134:e41-55.