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The Impact of Midwifery-Promoting Public Policies on Medical Interventions and Health Outcomes
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2006
Year
Healthcare ProvisionReproductive HealthMidwifery PracticeMaternity ServiceUnited StatesMidwifery-promoting Public PoliciesHealth OutcomesMedical InterventionsPrenatal CarePublic HealthHealth Services ResearchHealth Insurance ReformHealth PolicyMidwifery ServicesMaternal ComplicationHealth InsuranceMaternal HealthMaternal Health PolicyPublic Health PolicyMidwiferyNursingHealth EconomicsPreterm BirthDemography
The study aims to assess how midwifery‑promoting public policies affect maternity care in the United States. It analyzes national Vital Statistics birth data from 1989 to 1999 to evaluate policy impact. State laws mandating insurance coverage of midwifery services increased midwife‑attended births by 18 %, did not lower cesarean rates or consistently affect maternal mortality or Apgar scores, but significantly reduced neonatal deaths, and the discrepancy between OLS and natural‑experiment estimates indicates selection bias.
Abstract This paper measures the impact of midwifery-promoting public policies on maternity care in the United States, using national Vital Statistics data on births spanning 1989-1999. State laws mandating insurance coverage of midwifery services are associated with an 18-percentage rise in midwife-attended births. The laws did not decrease rates of cesarean deliveries or lead to consistent effects on maternal mortality or Apgar scores. They did, however, lead to a statistically significant drop in neonatal deaths. Divergence between OLS and natural experiment estimates suggests that women are selecting into provider groups based on unobserved preferences and health.