In the heart of Texas, a quiet revolution is taking place in the world of maternal care. As women seek more personalized and hands-on experiences during childbirth, midwives are stepping into the spotlight. This shift is not just a trend but a response to the evolving needs of expecting mothers and changes within the obstetric workforce.
The resurgence of midwifery care in Texas is driven by a desire for more attentive and patient-centered experiences. Dr. Sheila Chhutani, an obstetrician-gynecologist and executive medical director for women and infant services at Texas Health Resources, notes that nurse-midwives are experiencing a moment of increased visibility and demand. “Nurse-midwives have really been put into the spotlight and are really having a moment right now in the sense of patients wanting to have that care,” she said.
The Different Types of Midwives in Texas
Texas is home to two types of midwives, each with distinct training and capabilities. Licensed midwives do not require nursing training but must complete an approved educational pathway to receive a state license. On the other hand, certified nurse midwives (CNMs) have medical training as nurses and complete a graduate-level nurse-midwifery education. CNMs can write prescriptions, work in hospitals, and provide a range of services including prenatal care, basic gynecology services, well-woman exams, family planning services, and menopause treatment.
Carla Morrow, a certified nurse midwife, experienced firsthand the growing demand for midwife care. After graduating with her doctorate in nursing, she initially struggled to find a job as a CNM in Fort Worth. She eventually took a position at a hospital in Cleburne before returning to Fort Worth to open her own practice, Midwife + Co., with a few other midwives. Today, Midwife + Co. has 25 certified nurse midwives serving locations in Fort Worth, Dallas, and a satellite office in Willow Park.
The Appeal of Midwife Care
The appeal of midwife care lies in the personalized and hands-on approach that midwives offer. Historically, women preferred midwives over physicians due to their specialized knowledge of women and labor. While physicians have since caught up, the renewed preference for midwives is driven by social media discourse regarding maternal mortality and morbidity, as well as ideas about care from doctors.
Common complaints online include physicians who do not listen to patients, do not spend enough time with them during appointments, or are quick to perform a cesarean section. Dr. Chhutani disputes that these issues are the norm but acknowledges that patients want to feel heard and like they are “part of the process.” This desire for a more inclusive and patient-centered experience has created a space for midwives to thrive.
Midwives provide continuous support to patients going through labor, helping them through pushing, delivery, and repairing lacerations. If a birth goes through without complications that require a physician, patients may not see one. “We’re really hands-on, which is why women choose the model,” Morrow said. “It’s very different — not better, but different — than an OB.”
Shifts in the OBGYN Workforce
Shifts in the OBGYN workforce have also contributed to the growing role of midwives. Outpatient practice can demand a lot of time, and some physicians are seeking a better work-life balance. Hospitals began implementing designations for maternal levels of care in 2018, which required higher levels of care to have an OBGYN present 24/7. This shift caused hospitals to hire more in-house doctors, or hospitalists, to meet the demand.
This preference for hospitalist roles among OBGYNs has left a gap that midwives are well-positioned to fill. “What we’re seeing in the area are women waiting longer for appointments, and the access to care has been impacted by this, so midwives are ideal to fit that need,” Morrow said. Hospitals are increasingly reaching out to midwives to start new practices and fill the gap in care.
Dr. Chhutani notes that while hospitalist roles have grown, she does not attribute the increase in popularity of midwives solely to this trend. Research has pointed to midwives improving maternal health outcomes, and Morrow believes that a greater investment in midwife education could help to improve maternal mortality rates in the state. “It probably has to do with our relationships that we develop,” she said. “We really try to get to know them and know them as a person.”
The maternal mortality conversation is particularly important given that Black women face higher maternal mortality rates. For 2015-24, Tarrant County had an 5 deaths per 100,000 live births. For Black women, that rate was more than double at 59.6 per 100,000. Studies and online discourse reflect that women get better care from women, and Black women are also better cared for by Black women. Dr. Chhutani suggests that women may have an easier time finding a midwife they are comfortable with than a physician.
