Independent researcher, Boston, Massachusetts.
School of Public Health, Boston University, Boston, Massachusetts.
J Midwifery Womens Health. 2020 Jan;65(1):119-130. doi: 10.1111/jmwh.13007. Epub 2019 Jul 18.
Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level.
Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs.
Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwife-attended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P < .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P < .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P < .0001).
Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States.
研究将助产实践法与助产士的可获得性联系起来，但通常没有将劳动力数据与生殖健康服务的潜在需求联系起来。我们检查了州级监管结构与州和县一级的助产士分布和人口统计数据之间的关系。
助产士分布数据来自区域卫生资源档案，育龄妇女分布数据来自美国人口普查，生育统计数据来自 2012 年至 2016 年的美国出生率档案。助产士法规取自美国护理助产士学院年度报告。我们使用双变量分析来检查州助产实践法规与各州和县现有助产士数量之间的关系，以满足妇女的医疗保健需求。
在 2012 年至 2016 年期间，有 20 个州和哥伦比亚特区有自主实践监管框架，而有 24 个州有合作实践监管框架。在此期间，有 6 个州修改了法规。2016 年，一个州每千名助产士接生的婴儿数量与监管框架无关。然而，与合作法定框架州相比，拥有自主框架的州每千名育龄妇女的助产士人数多 2.2 倍（P <.0001），每千例总分娩的助产士人数多 2.3 倍（P <.0001）。在县一级，70.1%的美国县没有助产士。在实行自主实践的州中，只有 59.7%的县没有助产士，而在实行合作模式的州中，这一比例为 74.1%（P <.0001）。
助产士有可能有助于解决产妇和生殖健康服务提供者短缺的问题。我们的研究表明，增加实行自主监管框架的州的数量可以成为扩大美国妇女获得护理的一种方式。
