A midwife plays a pivotal role in caring for pregnant women and delivering babies across Alabama, amid the growing maternity deserts in the U.S., as highlighted by the latest March of Dimes report.
Quiet Moments
Nadia Gramby revels in tender mornings with her baby daughter, River Emmanuel, who is beginning to find her voice. These moments are cherished in the midst of her responsibilities as a midwife, a mother of two, and a wife. Her work involves assisting mothers and babies across Alabama, where more than 52% of counties lack hospital-based labor and delivery services, according to the March of Dimes’ recent “Nowhere to Go” report.
Maternity Deserts Across the U.S.
The report reveals that over a third of U.S. counties are maternity care deserts, with one in three counties having no birthing facilities or obstetric clinicians. Dr. Michael Warren from the March of Dimes stressed that the absence of maternity care severely impacts pregnancy outcomes. The Centers for Disease Control and Prevention reports that over 20,000 babies die before reaching their first birthday each year, and approximately 600 women do not survive pregnancy-related issues. Women of color are particularly vulnerable, with maternal mortality rates significantly higher among Indigenous and Black women compared to white women.
The Midwife’s Journey
Each day, midwife Nadia Gramby traverses Alabama, covering hundreds of miles to support families in both urban and rural areas. Based in Chelsea, Alabama, Gramby relishes the satisfaction of seeing families feel safe under her care. Recently, she traveled 302 miles in one day for prenatal appointments across four towns. Her dedication is bolstered by the support of her husband, Shamar.
Gramby founded her midwifery practice, Crown of Glory Birth Services, in 2018 to serve women in maternity deserts. As one of only 1,200 Black midwives in the nation, she provides comprehensive, personalized care through pregnancy, labor, and postpartum. Midwives offer holistic, culturally aware services, including emotional and spiritual support, often collaborating with doulas. Research indicates that midwife-led births result in lower rates of cesareans and complications.
The Larger Picture and the Challenges
The March of Dimes emphasizes the critical role of midwives in expanding maternity care access, releasing their report every two years to discuss ongoing challenges. Maternity deserts are widespread, with the south and Midwest showing the highest proportions. These deserts affect 2.4 million women of reproductive age, requiring longer travel for care.
Recent political actions have introduced new barriers. For instance, the One Big Beautiful Bill Act, passed under President Trump, decreased Medicaid funding, impacting affordability and access to maternity care. Additionally, the consistent closure of hospital maternity wards, as seen in Maine and Washington, D.C., exacerbates these issues. The closure of such facilities often leaves counties without any birthing options.
Addressing Disparities
The persistent disparities faced by Black and brown mothers and their infants are troubling. Gramby’s commitment to improving care for Black women in Alabama highlights the need for sensitive, culturally informed care. The disconnect often stems from historical neglect and systemic bias.
Promoting midwives is a crucial part of expanding care access, with the report noting that midwife involvement in U.S. births has increased by four percent in the last decade. However, legal limitations and inconsistent insurance policies continue to hinder the practice of midwifery.
A Call for Change
The March of Dimes advocates for policy changes that would grant midwives independence in practice and increase their hospital privileges. Gramby seeks broader, collaborative solutions to ensure thorough, compassionate maternal care. Her vision of maternity care as a fundamental right fuels her mission.