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Direct-entry midwives at the core of access to rural maternity care: the experience of northern New Mexico

This presentation will address the findings of an ethnographic research project that explored access to maternity care in rural northern New Mexico (NM), where direct-entry midwives, credentialed as Licensed Midwives (LMs), represent a significant part of the childbirth workforce.  The study investigated and compared the facilitators of, and barriers to, providing care during childbirth for all represented provider types: Obstetricians, CNMs, LMs and Family Medicine physicians.  A central question of the research was what significance rural New Mexico communities place on having access to local childbirth services and providers.  Based on data derived from fieldwork and interviews, this presentation will focus on the role of LMs in promoting health equity and meeting the needs of birthing women.

Midwifery has deep cultural resonance in New Mexico, a state that has licensed midwives since 1979 and requires Medicaid plans to include LM care and out-of-hospital birth as covered services.  And yet, the practice of independent midwifery remains very economically marginal and outside of mainstream policy efforts to address rural access-to-care issues.  Despite the challenges, NM LMs represent an under-utilized and under-recognized community resource.  Findings indicate that, despite limited structural recognition or support, LMs articulate and pursue some of the most creative and innovative responses to health and access disparities.  The presentation will highlight examples and address policy implications with attention to the applicability of this experience to midwifery practice in other states with significant rural populations.


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