Midwifery & Global Models

A 2025 WHO position paper made the case that universal access to midwifery-led care could prevent more than 60 percent of maternal and newborn deaths globally. The estimate is based on modeling that compares current outcomes with what could be achieved if the midwife-led continuity model used in countries like Norway, the Netherlands, and the UK were implemented worldwide.

The paper projects 4.3 million lives saved annually by 2035 if the model is scaled up at the rate the WHO is proposing. Midwives are specifically trained for normal pregnancy and delivery, which is the vast majority of births. The model reserves obstetricians for genuine complications.

The current global pattern, where obstetricians manage routine births and midwives are marginal or absent, is the historical anomaly. The WHO data shows the cost is measurable, both in lives and in money.

The Scandinavian countries (Norway, Sweden, Finland, Denmark) along with the Netherlands operate maternity systems where midwives provide normal antenatal, labor, and postnatal care, and obstetricians are consulted only when complications develop. These same countries occupy the top of the global rankings for maternal and infant mortality. Norway records near-zero maternal deaths in most years. Sweden runs at 5 per 100,000. By comparison, the US runs 22.3.

The countries also share other features (universal healthcare, paid maternity leave, postpartum follow-up), so the midwife-led model is not the only variable.

But the cluster of features that produces good outcomes is well-defined, and the midwifery model is consistently part of it. Health systems that have shifted toward this model see outcomes improve. The UK NHS has been moving in this direction since 2016.

The National Academy for State Health Policy maintains a live state tracker on Medicaid doula service coverage. In 2020, two states (Oregon and Minnesota) covered doulas under Medicaid. By April 2024 the count was 12.

By March 2026 it had reached 26 states plus the District of Columbia. That is a 13-fold increase in six years. The policy shift was driven by the combined evidence from the Kozhimannil cost-effectiveness papers, the Cochrane review on doula effectiveness, and the maternal mortality crisis that has been growing across the same period. Reimbursement rates vary widely.

Labor and delivery doula support ranges from $459 to $1,500 across states, with at least 17 states covering doula services through 12 months postpartum. The expansion is among the fastest policy shifts in US maternal health.