# How to improve access to midwifery care and prevent perinatal morbidities

> **NIH NIH F31** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2022 · $35,924

## Abstract

PROJET SUMMARY/ABSTRACT
Significance: Compared to countries at similar development levels, the United States suffers from far worse
perinatal health outcomes at a much greater cost. Increasing the number of maternity care providers,
especially midwives, is a proposed solution to improve perinatal health outcomes in the United States.
Midwifery-led prenatal, labor and delivery, and postpartum care is characterized by increased education and
support for pregnant and laboring mothers, an emphasis on continuation of care from the prenatal to
postpartum periods, and limited use of technology and procedures. Compared with physician-led care,
midwives utilize fewer medical interventions during labor and delivery and produce similar or improved
perinatal health outcomes, particularly for low-income populations. However, many state-level policies prevent
integration of midwives into the existing health system. Increasing access to midwifery care could improve
perinatal health in the United States.
Specific Aims: The proposed project will (1) evaluate the impact of reimbursement equity between midwives
and physicians on the proportion of deliveries conducted by a midwife, (2) assess prevalence of perinatal
morbidities in counterfactual scenarios where access to midwifery care is increased by 10%, 20%, and 50%,
and (3) estimate prevalence of perinatal morbidities in a hypothetical intervention where all low-risk
pregnancies among Medicaid enrollees engage in midwifery-led prenatal care.
Approach: The proposed analysis will utilize data from three sources: (1) Legislative Updates from the journal
the Nurse Practitioner that provide historical information on Medicaid reimbursement to midwives; (2) National
Vital Statistics Data; and (3) data from the Pregnancy to Early Life Longitudinal Data System. Using a
generalized difference-in-difference approach, Aim 1 will assess the association between state implementation
of Medicaid policies that reimburse midwives at the same rate as physicians and access to midwifery-led
delivery care. Aims 2 and 3 will utilize a causal inference framework for observational data analysis and
application of the g-formula to determine the number of perinatal morbidities that could be averted if access to
midwifery care were increased among the total population (Aim 2), and among Medicaid Enrollees (Aim 3).
Fellowship information: The applicant is a PhD student in Maternal and Child Health and Epidemiology at
UNC Chapel Hill, and a predoctoral trainee on the NICHD-funded T32 training program at the Carolina
Population Center. Through coursework on perinatal health, epidemiology and health policy, support and
guidance from a multidisciplinary team of mentors, and UNC Chapel Hill’s collaborative research environment,
the proposed training plan will build on Ms. Simmons’ previous research experience. The training will assist
Ms. Simmons in successfully completing her dissertation work, and achieving her long-term goal of becoming a
suc...

## Key facts

- **NIH application ID:** 10536207
- **Project number:** 1F31HD110251-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Elizabeth Simmons
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $35,924
- **Award type:** 1
- **Project period:** 2022-08-15 → 2026-08-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10536207

## Citation

> US National Institutes of Health, RePORTER application 10536207, How to improve access to midwifery care and prevent perinatal morbidities (1F31HD110251-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10536207. Licensed CC0.

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