We’ve been following Wisconsin State Journal reporter David Wahlberg’s series on the future of rural health in his state, particularly because Wahlberg’s willing to look pretty far afield for examples that put rural Wisconsin in perspective, and which point to possible solutions to local rural health issues. His latest story, on rural midwifery and child delivery, took him to the mountainous areas around Las Vegas, New Mexico. In a way, it seeks to answer the key dilemma raised in the Montana piece: How do you provide care in areas so remote that the population can’t support an obstetrician and delivery facilities?
Midwives have the potential to at least answer part of that equation, especially when they are used as obstetrician extenders. New Mexico is the nation’s leader in births overseen by midwives. Midwives account for 31 percent of births in New Mexico, a number that dwarfs the 8 percent national average.
Jaymi McKay, New Mexico’s maternal health program manager, said Hispanic midwives have long been a tradition in the state and activists pushed for midwife-friendly laws decades ago.
New Mexico still faces rural maternity care challenges, as 16 of its 33 counties have no hospital that delivers babies, McKay said. But without so many midwives, “it would be a lot worse,” she said. “They fill an important niche. That happens more in New Mexico than in other places.”
In addition to its culture, the New Mexico system stands out for its midwife licensing procedures. Wahlberg goes into greater detail, but here’s the national perspective:
All states offer licenses for nurse midwives. Most private insurers and Medicaid, the state-federal health plan for the poor, pay for their care.
Just 27 states license other midwives – including Wisconsin, which started doing so in 2006. Ten states ban them. Medicaid covers their care in 10 states, not including Wisconsin, and some private insurers cover them.