Date of Award

Spring 4-3-2023

Embargo Period

4-12-2023

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Abby Kazley

Second Advisor

Daniel Brinton

Third Advisor

Jillian Harvey

Abstract

Background and Need: Midwives are healthcare professionals that are educated, trained, licensed, and regulated to provide primary care; gynecologic, prenatal care; care during pregnancy, childbirth, postnatal care; and care of the normal newborn during the first 28 days of life (Florida Senate, 2021; Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN], 2016). The Midwives Alliance of North America also defined these professionals as providers who support labor and birth through relationships of trust and confidence with their patients (Midwives Alliance of North America [MANA], n.d.). If complications arise during pregnancy, midwives collaborate with other physicians and refer the case if necessary (AWHONN, 2016). Individualized care is one of the strengths that distinguish midwives. In the United States, there is evidence that shows the benefits of midwives in maternal care, such as promoting physiologic processes, fewer lower cesarean rates and repeats cesarean births, lower rates of health complications, lower rates of health complications, fewer repeat cesarean births and higher rates of breastfeeding (Neerland and Skalisky, 2022). Midwives have been recognized as an alternative to improve patient outcomes when working with maternity needs (Thumm et al., 2022). Ensuring the health of mothers and babies is a public health goal in the United States (Healthy People, n.d.); therefore, providing prenatal and postnatal care is essential for their wellbeing and decreases the possibilities of risks. In 2020, 209,645 infants were born in Florida (Ladapo, 2021). Florida Health reported that midwives attended 27,629 (13%) births in a hospital, versus 176,842 (84%) attended by an obstetrician, and 884 births (3%) were attended by other/unknown providers (Ladapo, 2021). In other high-income countries, midwives are 8 considered the standard of care for low-risk pregnant women. In these countries, midwives attend between 30-65% of births providing services to low-risk pregnancies, childbirth, and postpartum, compared to 9.1% in the United States (Thumm et al., 2022). Midwives' utilization is lower in the United States, with only 10% of deliveries by midwives compared to 50-75% in other countries (Vedam et al., 2018). Midwifery care can benefit pregnant women with good outcomes and cost savings (MANA, n.d.). Childbirth is one of the most common reasons for hospitalization, being a high expense to the health care system (Bernecki, 2010). In Florida, the cost of a vaginal childbirth can be $7,745 with insurance and $14,757.28 out of pocket, and a cesarean (c-section) can cost $11,162.80 with insurance and $19,328 out of pocket. Increasing awareness among women about the midwives' scope of services and better collaboration between other providers would benefit maternity services.

Problem Statement: The American Public Health Association (APHA) supports midwifery to increase maternity care options that can result in good outcomes for mothers and babies (APHA, 2014). After decades, midwifery is still undeveloped in the U.S., where the scope of practice is not understood in the healthcare field. Regulations and lack of autonomy result from physician supervision in some states affecting the midwife's inclusion in women's healthcare (Ollove, 2016). Public health is committed to improving individuals' health and well-being, including safe pregnancies and childbirth (Health and Human Services [HHS], n.d.). Nevertheless, while there have been discussions of the benefits of midwives' care, the percentage of patients seen by midwives is still low, which leads to a slow move toward change. It is unclear why low-risk pregnant women do not utilize the midwives' services. Literature and anecdotal evidence indicate 9 many types of barriers, bias, lack of marketing, lack of consumer awareness, no physician backup, state mandates, and how they are perceived may all be critical factors that may prevent pregnant women from seeking midwifery services (Bernecki, 2010; Kristienne, 2020; Murphy, 2018; Thumm, 2022 and Wertman, 2020). Midwifery care still is not a routine care among women in the United States (Thumm et al., 2022).

Research Aims and Objectives: This research aims to understand women's perceptions influencing their decision to utilize midwifery care. Understanding the midwife's role in maternity care can be affected by misinformation (Johnson, 1998). The objectives are to get more information about how women in Florida perceive midwives and how familiar they are with this practice to determine the possible barriers that prevent them from receiving care from a midwife. In addition, findings about accessibility to a midwife's office, the options given for prenatal/postnatal care, and their awareness about insurance coverage can contribute to filling some gaps to understand better why low-risk pregnant women may not select a midwife as their provider.

Rights

Copyright is held by the author. All rights reserved.

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