Maternal Health Workforce

Providing adequate access to maternal health services for women can be a challenge for many rural communities. Health centers are often few and far between and skilled providers are limited. Nearly half of the counties in the U.S. do not have access to a local obstetrician. In rural areas, it is more common to find family physicians than obstetricians attending births. Yet the number of family physicians (FPs) attending births in rural communities has decreased. There are many factors contributing to this decline in FPs attending births in rural communities, including lack of birth volume and resultant inability of FPs to maintain competencies in maternity care. Additionally, rural FPs reported a broader scope of practice than their urban counterparts, which could lead to greater feelings of overburden by caring for community members across the life course.

Shortages of healthcare providers, public health nurses, and human service personnel that support mothers and families are important barriers to maternal health in rural communities. These include shortages of:

• Maternity care clinicians
• Mental or behavioral health providers
• Physicians holding waivers to prescribe buprenorphine for opioid use disorder or certified to practice other medication-assisted treatments (MATs)

Public health nurses (PHNs) play a critical role in filling gaps in maternal health services. As with other healthcare professions, there is a shortage of PHNs in rural communities due to an aging workforce, insufficient funding, low salaries, lack of qualified applicants, and poor recruitment and retention efforts. Additionally PHNs provide services to community members across the lifespan, from infants to seniors. This vast experience contributes to having additional responsibilities, leading to a circumstance called complexity compression, which is unsustainable and contributes to burnout. This can lead to further workforce shortages.

Certified nurse-midwives also play an important role in addressing rural maternal health workforce shortages. Programs are offering distance education opportunities for nurses already practicing in rural communities. Students are then given opportunities for clinical rotations in their rural home regions. Increasing the number of midwives in rural communities may help address shortages in available family physicians and obstetricians.

For more information on addressing maternal workforce shortages, see Module 6: Maternal Health Workforce Sustainability.

For more information on the rural healthcare workforce, see the Rural Healthcare Workforce Topic Guide.

Resources to Learn More

Certified Nurse-Midwives and Rural Health Care
Document
Overview of the role of certified nurse-midwives and certified midwives when providing rural care. Includes frequently asked questions related to licensing, reimbursement, and required education and credentialing. Describes several rural midwifery practices.
Organization(s): American College of Nurse-Midwives
Date: 7/2010