Could a Nurse Midwifery Program Decrease the Arkansas Maternal Mortality Rate?

• Arkansas has the highest maternal mortality rate in the United States, but a recently approved (though not yet accredited) nurse midwifery program could help shift that trend.
• In Arkansas, the pregnancy-related mortality ratio was 35 per 100,000 live births between 2018 and 2020, according to a December 2023 legislative report from the Arkansas Maternal Mortality Review Committee, or 100 pregnancy-associated deaths. 
• The University of Arkansas for Medical Sciences hopes to have a two-year program active and accredited by 2026.

Arkansas has the highest maternal mortality rate in the United States, but if a recently approved nurse midwifery program — the first of its kind for the state — receives accreditation, the trend could shift.

University of Arkansas for Medical Sciences (UAMS) leaders hope to have a two-year program active and accredited by 2026, according to the Arkansas Democrat Gazette, with its first graduating class in 2028. 

Leslie Taylor, UAMS vice chancellor of communications and marketing, told the Democrat Gazette that they hope to admit five to 10 students annually, pending “sufficient clinical sites.” 

In late April, a legislative panel approved shifting $500,000 in an appropriations bill from a state healthcare data hub to establish the program.

UAMS currently is searching for a director to oversee the nurse midwifery education program. 

Nurse Midwifery Programs in the U.S.

UAMS could join nearly 50 Accreditation Commission for Midwifery Education (ACME) accredited programs nationwide. ACME considers the following criteria when evaluating a new program: 

1. Organization and administration 
2. Faculty
3. Students 
4. Curriculum 
5. Resources 
6. Assessments and outcomes 

In addition to Arkansas’ plans, Montana State University’s Mark and Robyn Jones College of Nursing will add a nurse midwifery track to its Doctor of Nursing Practice program — also the first program of its kind in the state.

“Women who have to travel long distances for prenatal care tend to delay going to providers early in their pregnancy,” Susan Raph, associate dean for academic affairs at MSU’s nursing college, said in a news release. “Late prenatal care is associated with higher risks and poorer health outcomes. Educating more nurse-midwives for women in our rural settings will increase early access to prenatal care and help to reduce Montana’s poor maternal health outcomes.” 

The inaugural cohort, which begins in August, will include eight students who will be required to have a bachelor’s degree in nursing and hold Montana residency. Plans to establish the program began in 2021 with a $101 million philanthropic investment from the nursing college’s namesakes and a $3 million donation from an area hospital.  

An estimated 6,960 people in the U.S. are employed as nurse midwives, according to May 2023 Bureau of Labor Statistics data, with a median annual wage of $129,650. The data also show that physician offices have the highest level of nurse-midwife employment and the highest concentration of nurse midwives. 

However, the top paying industry is outpatient care centers (annual mean wage of $164,080), while physician offices rank fourth with an annual mean wage of $127,550. 

History of Midwifery

Midwifery was “the most customary practice for pregnancy care and childbirth” in the United States during the 19th century, according to the Oregon Health and Science University Center for Women’s Health. Training occurred through apprenticeships with more experienced midwives, who, in many cases, were the only primary care provider. 

In 1925, Mary Breckenridge founded Frontier Nursing Service, making nurse midwifery a more official profession, but her “racist and xenophobic past is controversial.” 

“Mary Breckenridge’s beliefs reflected racist values and did not allow African American women to be educated as midwives,” said Venay Uecke, C.N.M., OHSU Midwifery clinical instructor and practice manager of the Hillsboro Medical Center Midwife Faculty Practice Uecke.

This led to a trickle-down effect that negatively affects communities of color today, with Black mothers two to three times more likely to die in childbirth than white mothers, according to OHSU. 

A recent Centers for Disease Control and Prevention analysis found there was a significant decrease in maternal mortality among Black, white, and Hispanic women in 2022. But Black women still had the highest mortality rate at 49.5 deaths per 100,000 live births, compared to 19, 16.9 and 13.2 for white, Hispanic, and Asian women, respectively. 

Midwives and Maternal Mortality

In Arkansas specifically, the pregnancy-related mortality ratio was 35 per 100,000 live births between 2018 and 2020, according to a December 2023 legislative report from the Arkansas Maternal Mortality Review Committee, or 100 pregnancy-associated deaths. 

The report identified cardiovascular-related disorders as the leading cause of those deaths.

“Systems should increase access to comprehensive health services during pregnancy, the year after pregnancy, and throughout the preconception and interpregnancy periods to facilitate continuity of care, implement effective care transitions, promote safe birth spacing and improve lifelong health of women,” the report stated. 

Nearly 50 certified nurse midwives have active licenses in the state, a state Department of Health spokeswoman told the Democrat Gazette. 

A 2023 Government Accountability Report on midwives noted an increase in the number of midwives and midwifery students. In 2021, there were nearly 13,500 certified nurse midwives (CNM) and certified midwives and more than 3,000 students studying to become midwives. Meanwhile, there were more than 2,700 certified professional midwives (CPM) and 853 CPM students. 

The GAO report found a “wide variation” in the proportion of births that included a midwife, using 2021 data from the CDC. Alaska had the highest percentage of midwife-attended births at 31.9% compared to 1.1% in Arkansas. 

The Bottom Line

The University of Arkansas for Medical Sciences hopes to earn accreditation for a nurse midwifery program within the next two years, ultimately addressing its maternal mortality rate (the highest in the country). Once active, the hope is that it will help decrease the state’s maternal mortality rate. UAMS would join nearly 50 other accredited universities. 

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