The Access and Integration Maternity Care Mapping (AIMM) Study explores the relationship between access, integration, and density of midwives in the United States and key birth outcomes. You are invited to explore the maps yourself here and see how your state ranks here.
You can find the full report here, a lay summary here, and access the data here.
The lead researchers have identified some of the key findings from the maps.
Higher integration scores link to improved population outcomes
Significantly lower rates of birth by cesarean section
Green outlines indicate states with lowest cesarean rates, while red outlines indicate highest rates. The darkest purple states received the highest MISS integration score.
Significantly higher VBAC rates
Green outlines indicate states with highest VBAC rates, while red outlines indicate lowest rates. The darkest purple states received the highest MISS integration score.
Significantly higher rates of spontaneous vaginal delivery
Green outlines indicate states with highest rates of spontaneous vaginal delivery, while red outlines indicate lowest rates. The darkest purple states received the highest MISS integration score.
Significantly lower rates of preterm birth
Green outlines indicate states with lower rates of preterm birth, while red outlines indicate higher rates. The darkest purple states received the highest MISS integration score.
Significantly lower rates of low birth weight babies
Green outlines indicate states with lower rates of low birth weight, while red outlines indicate higher rates. The darkest purple states received the highest MISS integration score.
Higher rates of breastfeeding at birth
Green outlines indicate states with higher rates of breastfeeding at birth, while red outlines indicate lower rates. The darkest purple states received the highest MISS integration score.
Higher rates of breastfeeding at six months of age
Green outlines indicate states with higher rates of breastfeeding at six months of age, while red outlines indicate lower rates. The darkest purple states received the highest MISS integration score.
Density of midwives is associated with perinatal outcomes
Higher density of CNM/CMs and CPMs was associated with
- Significantly higher rates of spontaneous vaginal deliveries
- Significantly higher VBAC rates
- Significantly lower preterm birth rates
- Lower rates of LBW
- Significantly higher breastfeeding rates at birth and at 6 months
The image above shows the association between density of midwives and VBAC, please see the full maps to view how density of midwives is associated with other outcomes.
Access to midwives across birth settings links to improved outcomes
Access to midwives was:
- Significantly associated with density and integration of midwives
- Significant correlations with access to midwives – health outcomes, birth setting, and MISS scores
- In addition, better access to CNMs/CMs was also linked to significantly lower induction rates
Impact of race and integrated midwifery
- Almost all the same states with high rates of Black births have the very lowest MISS scores and fewer midwives and fewer options for community birth.
- These states also have the highest rates of neonatal mortality.
- Analysis shows race accounts for 35% of the difference in neonatal deaths and integration of midwives almost 12%.
- Improving access to and integration of midwives in these states could have powerful positive benefits for African American families.
Red outlines indicate states with higher rates of neonatal mortality, while green outlines indicate lower rates. The darkest purple states received the highest MISS integration score. The darkest orange represent the highest percentage of black births.
New York demonstrates how integration can impact outcomes in a state with a high percentage of Black families.
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This project was funded in part by a generous grant from the Transforming Birth Fund of the New Hampshire Charitable Foundation.