How midwives are helping to fill OB/GYN gap in North Carolina

North Carolina

SILER CITY, N.C. (WNCN) – You can see it. The connection Rebeca Moretto has with baby Abril as she holds her in her arms.

“Really, to be able to connect with that person on those needs, but also just have a really positive celebration of that creation of a new family in a way that is otherwise not possible when you don’t build that relationship over the course of time,” Moretto said. She is a certified midwife who delivered Abril and provided prenatal care for her mom Daisy at Chatham Hospital.

Until the fall of 2020, Chatham County was one of more than two dozen counties in North Carolina with no practicing physician specializing in obstetrics and gynecology. Mothers would have to travel up to an hour for care and to give birth.

That’s still the case in areas across the state.

“There are about 30 counties in North Carolina that lack any kind of maternity care, and we know that midwifery care could be an answer to that maternity care crisis,” Moretto said.

Midwives have helped fill the gap. To qualify, they need a master’s degree in midwifery and have to pass a national qualification exam. But there is another step that midwives say is holding them back.

“I call it a permission slip. It’s an expensive permission slip, though,” said Suzanne Wertman. She is a certified midwife and state government affairs consultant for the American College of Nurse-Midwives.

A certified midwife must have a supervising physician. But that doctor does not see or get involved in the care of the midwife’s patients. North Carolina is one of only three states that require this.

In May, CBS 17 reported that the proposed SAVE Act would eliminate that same requirement for nurse practitioners. That also applies to midwifery. The SAVE Act is currently stuck in the health committee.

“Our rural communities are basically like developing countries, and that’s the fallacy of American health care. We spend more than any other country in the world on maternity care for the most abysmal return on investment,” Wertman said.

It can also be a major challenge to find a local supervising physician in rural counties where care is needed most. Wertman said, “I have stories of many midwives who have ended up working in Raleigh, or working in Chapel Hill when really they wanted to be working in Henderson, when really they wanted to be working out in the western part of the state.”

The United States is one of just three countries with rising maternal death rates. The most recent data from the CDC shows 29.6 deaths per 100,000 births. North Carolina’s overall rate is a touch lower than the national average, at 27.6 per 100,000 births.

It’s an issue that Wertman said midwives can help address.

“We have the training to know, OK, this person’s platelets are low and she’s got to be seen by a physician, or this person has a rash I can’t figure out, she definitely needs to see a dermatologist. We’ve got that expertise and the education,” she added.

Safety was a factor in Daisy’s decision to use a midwife.

“If you have someone there to help you, who cares about you and knows how to do their job, all of your fears start to go away,” Daisy said.

Moretto said poverty, mothers who work full-time, and travel distance to care are less of an obstacle if midwives are an option.

“So, when you introduce a midwife, you not only see neonatal and maternal mortality and morbidity decrease, but you see the community thrive overall. And I wanted to be a part of that change,” she said.

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