Statistics

  • Racial disparities in maternal mortality and morbidity, climbing cesarean section rates, fragmented perinatal services with lack of out-of-hospital birthing options, lack of healthcare coverage, criminalization of community midwives, and  disrespectful care have led to a public health crisis for birthing people in New York State (NYS). 1, 2 ,3  The causes for these conditions are rooted in structural racism and wealth inequality that fuel health inequities; gender oppression undermining birthing people’s rights and autonomy; consolidation and monopolization of healthcare services by large hospital networks; and institutional barriers to evidence-based birthing practices and midwifery practice. 4, 5  The COVID-19 pandemic has exacerbated the maternal health crisis as New Yorkers lack access to out-of-hospital birth centers, lack postpartum Medicaid coverage or pay high premiums for healthcare insurance, and lack adequate paid family leave. 2 

    Currently in NYS, 98% of births take place in a hospital when it’s estimated that 85 % could safely occur at birthing centers if this option was available. 6,7 In addition, only 9.8% of births are attended by midwives, and only 38% of maternity hospitals have midwife-led care. 8 The US is an outlier as the only developed country without midwife-led care and by far the highest overall maternal mortality rate, which continues to increase as it decreases in other countries. 9,10

    • Cesarean Section Rate: 33.9% of live births, (CDC, 2022)

    • Maternal Mortality: 22.4 per 100,000 live births, 24th highest in the U.S. (CDC, 2018-2022)

    • Racial Disparities in Maternal Mortality: Black women in New York State died at over four times the rate of White women from 2018-2020 (55.8 vs. 13.2 deaths per 100,000 live births). (New York State Maternal Mortality and Morbidity Advisory Council Report, 2023)

    • Racial Disparities in Maternal Morbidity: 2.3x likelihood of a Black mother in New York State experiencing severe maternal morbidity, compared with a white mother. (NYS Health Foundation, 2018)

    • 10.6% of all births in New York were attended by midwives in 2015. (CDC, 2007-2015)

    • From 2021 - 2023, the pre-term birth rate among Black birthing people was 13.8 (per 100 births) while the rate among White birthing people was 8.2. (March of Dimes, 2024)

    • From 2021 - 2023, the preterm birth rate among Pacific Islander birthing people was 1.5x higher than the rate among all other birthing people (15.5 per 100 births). (March of Dimes, 2024)

    • In 2014, 26.4% of hospitals in New York State had no births attended by midwifes, while 44% of hospitals had only 1-15 % of births attended by midwives. (University of Minnesota School of Public Health, 2017)

    • Number of licensed birth centers: 3

    • Percentage of births in hospital: 98%

    • Percentage of birth center births: 0.08%, compared to 0.52% in the US in 2017 (MacDorman & Declercq, 2017)

    • Percentage of home births: 1.02% in 2017 (MacDorman & Declercq, 2019)

    • From 2020 to 2021, the percentage of home births declined by 5% in New York. (National Center for Health Statistics. 2022)

    • Percentage of hospitals offering midwifery care: Estimated at 38% in 2017

    • Hamilton and Seneca Counties classified as maternity deserts, with no access to maternity care. (March of Dimes, 2023)

    • Eight additional counties have limited access to maternity care

Studies

  • Maternal Outcomes in Birth Centers: An Integrative Review of the Literature

    — Alliman, J. (2016)

  • Community-Based Models to Improve Maternal Health Outcomes and Promote Health Equity.

    — Zephyrin, L Seervai, S, Lewis, C, Katon, J, The Commonwealth Fund (2021)

  • Impossible Math: Financing a Freestanding Birth Center and Supporting Health Equity.

    — Kozhimannil, K. B. (2019)

  • The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity.

    — Leonard, S. A. (2019)

  • Next Steps for Transforming Maternity Care: What Strong Start Birth Center Outcomes Tell Us

    — Alliman, J, Bauer, K (2020)

  • Improving US Maternity Care: A 2020 Call to Action to Scale Up Midwifery

    — Romano, A (2020)

  • Midwife-led continuity models versus other models of care for childbearing women.

    Sandall, J (2015)

  • Pregnancy, Birth and the COVID-19 Pandemic in the United States

    – Davis-Floyd R, Gutschow K, Schwartz DA (2020)

  • The Criminalization of the American Midwife

    – Block, J (2020)

  • Structural racism and severe maternal morbidity in New York State

    – Liu SY, Fiorentini C, Bailey Z, Huynh M, McVeigh K, Kaplan D. (2019)

  • Mapping integration of midwives across the United States: Impact on access, equity, and outcomes.

    – Vedam, S (2018)

  • Trends and state variations in out-of-hospital births in the United States, 2004-2017t Item

    – MacDorman MF, Declercq E. (2019)

  • Outcomes of care in birth centers: demonstration of a durable model

    Stapleton SR, Osborne C, Illuzzi J. (2013)

  • NYS Health Profiles Births Attended by Licensed Midwife

    – New York State Department of Health

  • Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries

    – Tikkanen R, Gunja MZ, FitzGerald M, Zephyrin L. Commonwealth Fund (2020)

  • The staggering toll of complications due to pregnancy and childbirth.

    – Zephyrin L, O’Neil S, Zivin K. (2021)

  • Midwife-led care and obstetrician-led care for low-risk pregnancies: A cost comparison.

    – Attanasio LB, Alarid-Escudero F, Kozhimannil KB. (2020)

  • Comparison of labor and delivery care provided by certified nurse-midwives and physicians: a systematic review, 1990 to 2008.

    – Johantgen M, Fountain L, Zangaro G, Newhouse R, Stanik-Hutt J, White K. (2012)

  • Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births

    – Souter V, Nethery E, Kopas ML, Wurz H, Sitcov K, Caughey AB. (2019)

  • African-American pregnant women and their babies are at greatest risk in the USA

    – Joseph, J (2020) from Birthing Models on the Human Rights Frontier

  • Community-Based Models to Improve Maternal Health Outcomes and Promote Health Equity

    – Zephyrin L, Seervai S, Lewis C, Katon J. (2021)

  • AMCB 2020 Demographic Report

    – American Midwifery Certification Board