Letter to the Editor: The Availability of Midwifery Care in Rural United States Communities

To the Editor:

In “The Availability of Midwifery Care in Rural United States Communities,” Sheffield et al state that 75% of rural hospitals that recently closed their maternity services had no midwifery care component present.¹ The article was informative and eye-opening.

The findings that rural birthing people have obstacles to obtaining maternity care and even more difficulty having choices in their care providers highlight an important area for further research that, understandably, was not within the scope of this study to explore. The article inspired further thinking about the reasons for the lack of midwifery care in rural America.

Educational, legislative, and economic barriers inhibit the growth of midwifery, especially in rural communities, where more than one-third of the rural counties lack trained perinatal providers.^{2, 3} Midwives may face unique difficulties with interprofessional collaboration due to health care provider shortages or maldistribution of the providers who are available as consultants. Lengthy geographic distance to access care is also an inherent barrier to rural health care. Finally, established institutions may lack the infrastructure to integrate midwives into their systems.⁴ Due to these barriers, and because of the tremendous shortage of perinatal resources available in rural communities, further studies looking at other potential barriers to midwifery care are warranted, especially in rural communities.

One factor that researchers could examine is whether current or past interprofessional relationships between physicians and midwives affect the availability of midwifery care to rural birthing people. For midwifery to reach the full potential impact possible, midwives must be well-supported and integrated into health care systems and teams everywhere.

Further research on interprofessional collaboration could create opportunities for innovative strategies for meeting the needs of rural communities. This could begin with resident physician education that focuses on integrating midwives into physicians’ early careers by using experienced midwives as teachers in residency programs. Midwives work closely with resident physicians at my practice setting, teaching hands-on skills and running simulations together. Reading this article has made me curious about the potential long-term consequences of a teaching strategy like this. Some research already focused on this type of interprofessional education model showing greater collaboration as a result. The recently published article, “Certified Nurse-Midwives as Teachers: Expanding Interprofessional Collaboration Learning Opportunities for Medical Students on the Obstetrics and Gynecology Clerkship,” is an exemplar; however, research on this topic is limited.⁵

Given the findings of the Sheffield et al article, including the number of closed maternity departments where midwifery services were absent, all factors affecting the availability of midwifery care are worthy of being explored.¹ My thanks to the authors. I hope the article along with these thoughts will foster further discussions and research.

The author has no personal, professional, or financial conflicts of interest to disclose related to this submission.