Georgetown Nursing Faculty Publish National Review on Outcomes of Midwife-Led Care

(March 24, 2026) — A comprehensive review of U.S. research led by Berkley School of Nursing faculty finds that care delivered by certified nurse-midwives and certified midwives is consistently associated with lower intervention rates, improved birth outcomes, and high patient satisfaction compared to traditional physician care.

The work published in The Milbank Quarterly analyzed 66 US-based studies published since 2012. Using a scoping review methodology, the research evaluates outcomes associated with care provided by certified nurse-midwives (CNMs) and certified midwives (CMs) across six domains of health care quality defined by the Institute of Medicine (now the National Academy of Medicine): safety, effectiveness, patient-centeredness, timeliness, efficiency and equity.

The study’s lead author, Emma Virginia Clark, PhD, MHS, CNM, FACNM, assistant professor of nursing at Georgetown’s Berkley School of Nursing and director of nursing research at MedStar Georgetown University Hospital, said the review represents several years of collaborative work synthesizing a large and growing body of research on midwifery care.

“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,” said Clark. “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 also found evidence that midwifery care may help mitigate racial and geographic disparities in maternal health outcomes, an issue of growing concern nationwide.

At the same time, the authors identified important research gaps, particularly in understanding how midwifery care influences efficiency, timeliness and equity within health systems.

“Despite these outcomes, integration remains limited across U.S. health systems,” said senior author Heather Bradford, PhD, CNM, FACNM, assistant professor of nursing at Georgetown. “Outdated scope-of-practice restrictions and institutional policies often ignore the growing body of evidence supporting midwifery care.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 conclude that expanding and better integrating the midwifery workforce could help strengthen care delivery while addressing the rising maternal mortality rate and persistent disparities in perinatal and sexual and reproductive health outcomes in the United States.

For Georgetown nursing faculty and students, the study reflects the school’s broader mission to advance evidence-based practice, equitable care models, and improved health outcomes for families and communities.

In addition to Clark and Bradford, authors include Robyn Schafer, Rutgers University;  Rachel Lane Walden, Vanderbilt University; Julie Blumenfeld, Rutgers University; Carrie E. Neerland, University of Minnesota; Katie Page, University of Colorado; Mavis N. Schorn, Vanderbilt University; and Sanjana Chimata, Georgetown University.

The authors report having no personal financial interests related to the study.

This publication was partly funded by the Mary L. and Raymond T. Holden Endowed Professorship for Maternal and Infant Health at the Georgetown University Berkley School of Nursing.