WASHINGTON – A nurse researcher at MedStar Georgetown University Hospital has led a national scoping review that synthesizes 66 U.S. studies published since 2012 on the outcomes of care provided by certified nurse-midwives and certified midwives.
The study, published in the March 2026 issue of The Milbank Quarterly, evaluates midwifery care across six domains of healthcare quality established by the Institute of Medicine, now the National Academy of Medicine: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity.
Emma Virginia Clark, PhD, MHS, CNM, FACNM, director of nursing research at MedStar Georgetown University Hospital and assistant professor of nursing at Georgetown University’s Berkley School of Nursing, served as lead author. The review began with more than 13,000 articles and narrowed to 66 that examined associations between certified nurse-midwife and certified midwife care and outcomes in perinatal, sexual and reproductive health.
“This project began with more than 13,000 articles and ultimately included 66 studies examining associations between CNM and CM care and outcomes in perinatal, sexual, and reproductive health,” Clark said. “Within the safety, effectiveness, and patient-centeredness domains, midwifery care was associated with lower rates of cesarean birth and other interventions, improved neonatal outcomes, higher patient satisfaction, and reduced health care costs.”
The analysis found consistent links to lower intervention rates, better birth outcomes and high patient satisfaction when compared with traditional physician-led care. Evidence also suggests midwifery care may help address racial and geographic disparities in maternal health, a priority concern in the United States where maternal mortality rates remain elevated.
Senior author Heather Bradford, PhD, CNM, FACNM, assistant professor of nursing at Georgetown University, noted ongoing barriers to wider adoption.
“Despite these outcomes, integration remains limited across U.S. health systems,” Bradford said. “Outdated scope-of-practice restrictions and institutional policies often ignore the growing body of evidence supporting midwifery care. We need a systemic shift to ensure access to midwifery care.”
The authors identified gaps in research, particularly regarding impacts on efficiency, timeliness and equity within health systems. They conclude that expanding and better integrating the midwifery workforce could strengthen overall care delivery while helping tackle rising maternal mortality and persistent disparities in perinatal and reproductive health outcomes.
MedStar Georgetown University Hospital serves as a major referral center for patients across the Washington region, including Southern Maryland residents in St. Mary’s, Calvert and Charles counties. Many families in the area rely on MedStar facilities for maternity services, making the findings relevant to local access to care models.
The review adds to evidence supporting midwifery as a key component of efforts to improve maternal and infant health. Certified nurse-midwives and certified midwives are licensed professionals who provide comprehensive care throughout pregnancy, birth, postpartum and reproductive health services.
Georgetown University’s Berkley School of Nursing emphasizes advancing evidence-based practice and equitable care models through research and education. Faculty and students contributed to the collaborative project, which involved multiple experts in midwifery and nursing.
The full article appears in The Milbank Quarterly, a peer-reviewed journal focused on population health and health policy. Publication occurred March 6, 2026.
Southern Maryland women seeking maternity care can explore options through local MedStar providers and other regional hospitals. Officials encourage expectant families to discuss care models with providers to determine the best fit for individual needs.
This national synthesis arrives amid continued national focus on improving maternal health outcomes and reducing disparities. Researchers hope the findings will inform policy discussions on scope of practice and workforce integration to increase access to midwifery services.
