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March 6, 2026
Quarterly Article
Emma Virginia Clark
Robyn Schafer
Rachel Lane Walden
Julie Blumenfeld
Carrie E. Neerland
Katie Page
Mavis N. Schorn
Sanjana Chimata
Heather M. Bradford
September 2025
June 2025
Back to The Milbank Quarterly
Policy Points:
Context: The alarming rise in US maternal mortality and disparities in perinatal, sexual, and reproductive health outcomes underscores the urgent need for effective, equitable, and evidence-based models of care. Care provided by certified nurse-midwives (CNMs) and certified midwives (CMs) has played a critical role in addressing these disparities, yet a comprehensive synthesis of its impact across health care quality domains is lacking.
Methods: A scoping review methodology following PRISMA-ScR guidelines was used to assess the association of CNM/CM care and perinatal, sexual, and reproductive health outcomes through the lens of the Institute of Medicine’s six domains of health care quality: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. This review included United States-based studies published since 2012 identified via PubMed and CINAHL. Studies were screened for relevance to the six domains and CNM/CM care. Data were extracted into a spreadsheet, grouped by domains, and analyzed using narrative synthesis.
Findings: A total of 66 studies met inclusion criteria. Within the safety, effectiveness, and patient-centeredness domains, CNM/CM care was associated with similar or improved perinatal, sexual, and reproductive health outcomes compared to physician care, including lower rates of cesarean birth, fewer interventions, improved neonatal outcomes, greater patient satisfaction, and reduced health care costs. CNM/CM care also demonstrated potential in mitigating racial and geographic maternal health disparities, though scope of practice restrictions and institutional policies limited CNM/CM integration. Despite this evidence, gaps remain in understanding the influence of CNM/CM care on health care quality as it relates to efficiency, timeliness, and equity.
Conclusions: These findings highlight the importance of expanding CNM/CM integration within the United States’ health care system to improve care delivery and associated health outcomes, reduce health disparities, and advance health equity. Future studies should incorporate standardized outcome measures and explore the role of CNM/CM care within collaborative models to enhance perinatal care quality and accessibility.
