PROVIDENCE — As maternity professionals in the United States grapple with rising cesarean section rates, workforce shortages and calls for more equitable, community-centered care, midwives in Rhode Island are quietly reshaping how women give birth as well as how the state thinks about maternal health.
From hospital labor wards to planned home birth, midwives provide a mix of primary prenatal care, labor support and postpartum services. Though Rhode Island is compact in geography, its is complex in maternal care. State health documents and stakeholders describe a mixed landscape. Many births take place in hospital settings; options for out-of-hospital births, such as birthing centers, are limited; and access to culturally concordant midwifery care is an active policy conversation. The Rhode Island Department of Health is prioritizing maternal-child health in recent legislative reporting and strategic planning, stating that workforce capacity and disparities are ongoing concerns.
Midwives are health professionals who provide care to people during pregnancy, labor, birth, and the postpartum, or after-birth, period. They focus on supporting normal physiological birth, offering personalized and often less-intervention-driven care. In the United States, midwives may practice in hospitals, birthing centers, clinics, or homes depending on licensure, credentialing, and state regulations. Midwives take extra time to listen to their clients while keeping in mind their feelings, emotions, values, and well-being while planning and encouraging their clients to participate in their care.
In Rhode Island, midwifery is increasingly part of the maternal health care landscape. The Rhode Island Code of Regulations defines “midwifery” to mean attending normal childbirth, prenatal, intrapartum, postpartum care including newborn immediate care, in continual collaboration with a physician, and in accordance with acceptable standards of practice.
There are different credentialed types of midwives. The first is a Certified Midwife (CM). This is a person who is certified in midwifery only. The second is a Licensed Midwife, LM, or a Certified Professional Midwife, CPM. These individuals receive training that is specific for community needs, such as home births and birthing centers. The final is a Certified Nurse-Midwife, or a CNM. These individuals are nurses who received additional midwifery education. All three levels of credentials must graduate from an accredited midwifery program and pass an examination to be licensed or certified. Once credentialed, the state Health Department has the authority to deny, revoke or discipline a midwife’s credentials. According to federal labor statistics, in May 2023, there were an estimated 40 nurse-midwives employed in the state. This figure reflects only those midwives who are credentialed in nurse-midwife roles. According to the same data, as of February 2024, there were 97 licensed midwives. The total number of midwives highlights a gap between the number of credentialed professionals needed to meet public health targets and the number of midwives available.
Midwives practice in a variety of settings, depending on their credentials and training. There are many hospital-based midwifery practices, which are often staffed by CNMs and CMs who work within hospital obstetrics departments. Midwives also practice in the community. Though more limited in Rhode Island relative to some other states, there are licensed midwives practicing in home birth or birth center-style settings. But as of Sept. 1, 2025, Rhode Island has no freestanding licensed birth centers or registered birth centers. Historically, the state has not had any active network of freestanding birthing centers. This means that the majority of assisted births take place in hospitals or are planned home births, though access to home birthing services is limited due to the number of midwives currently credentialed. In recent decades, research studies have shown that midwife-led care in any setting is associated with many positive outcomes.
Some Rhode Island residents experience maternal health challenges, including disparities by race and ethnicity and rising pregnancy-associated mortality ratios, according to statistics. But systematic reviews and observational studies show consistent benefits of midwifery-led care for a range of outcomes.
Due to the involvement of midwives, there are higher rates of physiological vaginal birth and lower intervention rates. Midwifery models are associated with higher spontaneous vaginal birth rates and lower rates of cesarean delivery, routine episiotomy, and labor induction among low-risk populations. Because midwifery care reduces the cascade of interventions, improved breastfeeding and improved mental health outcomes. It also reduces associated complications such as postpartum hemorrhage in some study contexts and lowers severe maternal morbidity where midwife-led practices are well integrated. Lower intervention rates are themselves protective: cesarean sections carry risks of infection, hemorrhage, future placenta problems and have a lengthy recovery time.
Beyond the intrapartum period, midwives provide extended postpartum follow-up, early identification of postpartum hemorrhage risk, hypertension, and infection, and improved care coordination for chronic conditions — all of which can reduce progression to severe morbidity and death when systems are integrated.
Midwife-led care also leads to improved patient experience and mental-health outcomes. Continuity of caregiver, longer prenatal visits, and shared decision-making are tied to higher satisfaction, stronger breastfeeding initiation and duration, and more timely recognition of postpartum mood disorders. This is not to say that complications cannot or will not occur, so there will still need to be clinical pathways in place in case complications develop.
Rhode Island performs well on some child-health metrics but faces concerning trends in maternal outcomes and disparities that midwifery expansion could address. Rhode Island’s recent Maternal and Child Health report notes the pregnancy-associated mortality ratio (PAMR) for 2019–2022 was 70.8 deaths per 100,000 live births, an increase from the 2018–2021 figure of 58.2 per 100,000. That upward movement highlights the need for system-level interventions across prenatal, intrapartum, and postpartum care. Because Rhode Island’s pregnancy-associated morality ratio has increased in recent years, system-level adoption of midwife-physician collaborative models, with clear transfer protocols, offers a safety pathway that improves outcomes without increasing risk for low-risk patients.
State data and analyses indicate Rhode Island has experienced comparatively high rates of severe maternal morbidity and that maternal morbidity and maternal-health burdens are concentrated among Black and Hispanic birthing people and those covered by public insurance. These disparities underscore the need for culturally competent, accessible models of care.
Infant mortality and preterm birth indicators reveal gaps by race/ethnicity. For example, infant mortality for non-Hispanic Black infants has been reported at multiples of the white infant mortality rate, demonstrating structural inequities that affect both maternal and infant outcomes. Midwifery models that emphasize continuity, social-determinants screening, and community-based support can help address some of these upstream drivers. Evidence indicates midwifery-led models, especially when combined with targeted prenatal care that screens and addresses social determinants such as housing, nutrition and stress, can modestly reduce preterm birth rates. For Rhode Island, where preterm birth and infant mortality show racial disparities, midwives’ community-based, relationship-centered approach and extended prenatal engagement can support earlier identification and mitigation of preterm-birth risk factors.
Midwives typically provide earlier and more frequent postpartum contact than standard obstetric care models, including lactation support and screening for postpartum depression, experts say. Rhode Island data showing changes in reported postpartum depressive symptoms underline the importance of sustained postpartum follow-up, an area where midwives’ continuity model has proven value. Outcomes hinge on integrated systems (shared protocols, electronic communication, transport agreements). Rhode Island’s licensing of CPMs and the presence of midwives in hospital programs provide a foundation; strengthening formal transfer agreements and joint training can improve safety even further. Ensuring midwifery services are accessible through Medicaid and private insurers and deliberately reaching historically underserved communities are crucial to avoid a two-tiered system where only advantaged families can access low-intervention, continuity care.
There are multiple midwife groups in Rhode Island that provide care. The Women’s Care Midwifery Group, based at Women and Infant’s Hospital, provides person-centered care during pregnancy, labor, postpartum and more. The group also provides services related to family planning and contraception, testing and treatment of sexually transmitted infections, menopause management, and preconception and pregnancy planning, as well as routine gynecological and well-being care across the lifespan.
Elizabeth Kettyle, the Director of the Division of Midwifery, part of the Department of Obstetrics and Gynecology at the Warren Alpert School of Medicine at Brown University, says midwifes work with a broad age range of women. “You see young women looking for reproductive health services, women going through menopause, the whole spectrum of the age range,” she said in an interview. “Woman and Infants Hospital offers a lot of midwife work in obstetrical triage units, work on labor and delivery floors and [midwives] also take care of patients postpartum.”
Of the variety of practice settings of midwives, Kettyle says, “in some cases, you are cared for by a practice of nurse midwives so that the midwives you see would be the same pool of midwives you see when you come in to have your baby. Most midwives work collaboratively with a physician practice for things that they are needed: for example, a c-section or for assistance delivering a baby with forceps. We work with our position colleagues because you never know when a person who was anticipating having a normal birth may develop a complication.”
Many midwives are also professors in nursing schools. Dating to 1990, the Academic Nurse-Midwifery Program was established to meet the department’s clinical, academic, and teaching needs. Academic nurse-midwives work in close collaboration with specialists in obstetrics and gynecology and maternal-fetal medicine, contributing significantly to patient care, medical education, and mentorship. They provide care across Women & Infants Hospital, including the Antenatal Care Unit, Emergency Department, Labor Floor, and Postpartum Units. These nurse-midwives also teach medical students and OBGYN residents and will see patients side-by-side with those training physicians.
Public and private insurance programs determine midwifery access. Medicaid and some commercial plans have changed in recent years to expand coverage for perinatal services. Coverage expansions for midwifery services and better postpartum supports are part of the state policy landscape. Insurance changes can ensure that midwifery services and continuous support are more affordable for families. Insurance changes can also strengthen the businesses of hospitals and independent practices.
Several Rhode Island hospitals maintain midwifery services and family-friendly birthing options, such as the Alternative Birthing Center at Women & Infants Hospital, which allows low-risk patients to give birth in a less interventionist, more home-like environment. Hybrid birthing models such as this are a pragmatic path to expanding midwife-led care without the regulatory and financing hurdles of freestanding birth centers. In some hospitals, by default lower risk patients are initially care for by a midwife and if complications develop, the patient will be passed onto a physician.
Kettyle says that “midwives care for people who have done a little bit more research about what they would like for their birth experience. Midwives care particularly for patients who desire a low-intervention birth or desire to attempt their labor without anesthesia. I would say that they get more support from a midwife then they do a physician with respect to other birthing options.”
Some patients who end up under the care of a midwife are not necessarily seeking care from a midwife. In some cases, it is the way the health system has been set up, which is typically to maximize the utilization of various resources. It is important to note that the patient would still have the same options available to them during a hospital birth.
Experts agree that every woman has the right to respectful, person-centered care, especially during pregnancy and birth. They say that women deserve to make their own decisions about their body; to feel safe, respected and valued; and to feel comfortable with their own plan of care. Midwives empower women to feel confident in their care while helping them feel heard and understood.
Midwifery bridges the ancient and the modern, blending traditional wisdom with evidence-based practice to ensure that every birth is safe, supported, and deeply human. Whether guiding a family through a hospital delivery or attending a birth at home, midwives serve as advocates for choice and champions of holistic health. As Rhode Island, and the nation, continue to recognize the vital role they play, midwives stand as a reminder that childbirth is not just a medical event, but a profound life experience best nurtured with skill, trust and heart.
