Using midwives to deliver babies would save more lives if N.J. takes action, study says.

New Jersey’s dismally high maternal mortality rates could be improved if more midwives delivered babies and received reimbursement rates comparable to gynecologists and obstetricians, a report released this week found.

The term, midwife — meaning “with woman” — has likely become more recognizable due to the BBC’s long-running, popular show “Call the Midwife.” But these certified professionals, who must hold at a minimum a master’s degree, have been quietly amassing a strong record on healthy outcomes for mothers and babies, according to the Health Care Quality Institute of New Jersey and the Burke Foundation, which released the report.

Midwifery services are also more cost-effective, particularly when the mother is not at high risk of complications, according to the report. The cost of delivering a baby using midwife services was $2,262 less than an obstetrician’s care in low-risk patients.

A 2014 research paper published in the British medical journal, The Lancet, concluded care delivered by midwives was associated with fewer stillbirths, deaths among mothers and their newborns, premature births and fewer interventions, such as delivering the baby by cesarian section. Mothers also breastfeed three times longer when their babies were delivered by midwives, a 2018 study found.

“In the UK, France, and Australia, where maternal health outcomes are consistently better than the U.S., at least half of women’s care is provided by a licensed midwife,” the report said.

Yet despite the positive research on midwifery care, it is not widely understood discipline in America, according to midwives who presented the report in a press conference on Tuesday.

“Despite Nurture NJ’s recognition of midwives’ potential to improve maternal health outcomes in New Jersey, midwives remain an overlooked, underutilized and often undervalued resource in the state, regardless of the many midwives working actively to advocate for their field,” according to the report.

Midwives attended just 10% of 100,000 births in the state in 2020. There are 376 certified nurse midwives in New Jersey, and 12,218 nationally, according to the report. They hold bachelor’s degrees in nursing and a master’s or a doctorate in a nationally accredited midwifery program and must pass an exam to become board certified. There are also 16 certified midwives in New Jersey and 102 nationally, who hold a bachelor’s degree and a master’s degree in an accredited midwifery program.

Aside from surgery, certified nurse midwives provide all other prenatal and perinatal services an obstetrician does, including writing prescriptions. But they must have a “collaborative agreement” with a doctor in order to practice — an “outdated” policy that discourages people from joining the field, said Julie Blumenfeld, program director for the Nurse Midwifery and the Dual Women’s Health/Nurse Midwifery Program at the Rutgers School of Nursing.

There is no coverage for midwife services in birthing centers and for delivery services at home — options families should have the right to consider, the report said.

Certified nurse midwives are not reimbursed by Medicaid at the same rates as obstetricians in New Jersey, Blumenfeld said, although Gov. Phil Murphy last year raised the Medicaid reimbursement rates from 70% to 95% of what doctors earns. New Jersey should follow the lead of 24 states and Washington D.C. — including Delaware and Pennsylvania — and raise the reimbursement rate to 100% Blumenfeld said.

“Pay equity signals midwives are valued contributors shaping maternal health,” she said.

Murphy’s proposed state budget would do just that — raise the Medicaid rate to cover 100% of midwifery costs, said his spokesman Tyler Jones. It’s one of the many items in the proposed budget that must be approved by the state Legislature.

“This administration recognizes midwives as an invaluable asset to mothers during pregnancy, labor, and after the birth of their child,” Jones said.

First Lady Tammy Murphy has made reducing maternal and infant deaths a major priority, launching the public education and health policy campaign Nurture NJ in 2019. The campaign includes promoting the use of midwives and developing the midwife workforce by urging medical schools to hire midwives to teach alongside obstetricians and gynecologists, and recruit more Black people to join the profession, among other suggestions.

New Jersey has the fourth highest maternal mortality rate in the nation, largely because Black women are seven times more likely to die during or after they give birth. Black newborns are three times as likely to die than white babies before they reach their first birthday.

Midwives work for hospitals and some federally qualified health centers, but they also perform home births, according to the report. People who’ve used their services are its best promoters, praising it for its collaborative and approachable style, which may be more appealing to women of color. But more efforts must be made to recruit Black people into the midwifery field, which is about 90% Caucasian, the report said.

Insurance carriers and hospitals could do more to “demystify” the practice by listing and promoting midwives alongside other maternity care providers, said Linda Locke, a midwife for 40 years and a Quality Institute board member. “Patients have told me they’ve had to search” online listings and have found midwives with chiropractors and accupuncturists, she said.

“They have to be pushing midwives to the forefront and recognizing they are primary care health providers,” Locke said.

The report may be found at njhcqi.org.

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Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio.