Nurses Face Challenges of Decreased Maternal Care Availability

July 12, 2023
Lack of maternal care inspires healthcare facilities to increase midwifery training options.

The Mayo Clinic School of Health Sciences and the University of Minnesota School of Nursing have joined together to expand the nurse-midwifery workforce in the Upper Midwest, which has experienced an increase in maternal care “deserts”— areas with no access to prenatal or delivery services. Through a program that begins in the fall of 2024, this collaboration allows students admitted to the U of M School of Nursing’s Doctor of Nursing Practice Program to complete some required clinical training at Mayo Clinic hospitals in Minnesota and Wisconsin.

Judith Pechanek, DNP, RN, CENP, assistant dean of the Doctor of Nursing Program at U of M, said, “The U.S. is facing a maternal mortality and morbidity crisis that is particularly affecting rural areas. Through this collaboration, we will educate and train nurse-midwives to meet the reproductive needs of women both regionally and across the nation.” 

The new program offers a “hybrid structure, designed to maximize education while offering flexibility.” Instructors for the courses will include both U of M faculty, as well as Mayo Clinic-certified nurse-midwives. The program is expected to “facilitate the recruitment, training and hiring of the next generation of midwives across rural Minnesota and Wisconsin,” said Miri Levi, DNP, CNM, MBA, director of midwifery services at Mayo Clinic in Rochester, Minnesota, who forecasted, “Mayo Clinic expects a significant expansion of midwifery services across the Midwest over the next decade.” 

Leah McCoy, DNP, CNM, incoming nurse-midwifery program director at Mayo Clinic School of Health Sciences, added, “We are seeking new ways to engage learners to build the workforce of the future.” 

According to the March of Dimes 2022 U.S. report on maternal care, areas where there is low or no access to maternal care affect nearly 7 million women across the country, with a two percent increase in locations that are considered maternal deserts. 

Also looking to address maternal healthcare is Westchester Medical Center Health Network, who launched the Center for Women's Health Equity to address maternal morbidity and mortality across New York State's Hudson Valley. The Center for Women's Health Equity was established with the help of a $750,000 grant from New York State, and will have operations at Westchester Medical Center in Westchester County and HealthAlliance Hospital in Ulster County. 

Recent statistics from The Commonwealth Fund show the United States had the worst maternal mortality rate compared to 10 other developed countries, with maternal mortality particularly problematic for Black women. According to the CDC’s National Center for Health Statistics, in 2021, “the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births, which was 2.6 times the rate for White women.” 

Sean Tedjarati, MD, MPH, MBA, director of obstetrics and gynecology at Westchester Medical Center, said the Center for Women's Health Equity is designed to address a pressing need. “The primary goals of the Center for Women's Health Equity are to marshal resources in the health system and develop community partnerships.” 

He pointed out, “"Despite the advances we have made, we now have the highest maternal morbidity and mortality in the United States in 65 years. Clearly, that by itself denotes the reason why we should have this kind of center that is going to bridge the gaps. We have made great discoveries and great advances, but we are not getting them to the right people who need care. The United States spends 20 percent of its gross domestic product on healthcare, and we should not have the type of maternal morbidity and mortality that we have, especially in underserved communities and among women of color." 

Tedjarati said the center will be built on five pillars: clinical integration, education, research, advocacy, and technology, and will help “help lead efforts to address mothers' determinants of health” through community partnerships and advocacy within the state of New York.        

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