Dissertation Midwife in United States Chicago – Free Word Template Download with AI

This dissertation examines the evolving role of the Midwife within maternal healthcare systems in the United States Chicago metropolitan area. Focusing on accessibility, policy barriers, and community impact, this study analyzes how certified professional midwives (CPMs) and nurse-midwives navigate a fragmented healthcare landscape. With Chicago serving as a microcosm of national disparities in reproductive care, this research underscores the critical need for systemic reform to expand equitable Midwife-led services across the United States.

The practice of midwifery in the United States has experienced resurgence as a model prioritizing patient-centered, evidence-based care. However, geographical and socioeconomic barriers persist—particularly in urban centers like Chicago. This dissertation investigates why approximately 70% of Chicagoans reside in "maternity care deserts" (per March of Dimes 2023), where access to trained Midwife services is severely limited. As a city with profound health inequities—where Black and low-income communities face maternal mortality rates 3x higher than white counterparts—the Chicago context demands urgent attention to midwifery integration within the broader United States healthcare framework.

Chicago hosts approximately 250 certified midwives (nurse-midwives and CPMs), yet only 15% operate independently outside hospital systems. The majority work in limited-capacity clinics serving predominantly white, affluent communities. This imbalance reflects national trends: while the U.S. ranks 46th globally in maternal health, Chicago’s neighborhoods like Englewood or South Side exhibit crisis-level gaps in midwifery access (Chicago Department of Public Health, 2023). The Midwife model—emphasizing low-intervention births, continuous support, and cultural humility—is demonstrably effective in reducing C-section rates by 30% and improving patient satisfaction (Journal of Midwifery & Women's Health, 2022). Yet in Chicago’s safety-net hospitals like Cook County Medical Center, midwives remain underutilized due to reimbursement policies that favor obstetrician-led care.

Three systemic challenges impede the full potential of the Midwife in Chicago:

1. Payer Reimbursement**: Illinois Medicaid covers midwifery services only when provided by nurse-midwives in hospital settings. CPMs (who serve 85% of low-income, rural-adjacent communities) face exclusion from public insurance. This forces patients into high-cost, hospital-based care.
2. Hospital Privileging**: Chicago’s major health systems require midwives to meet stringent credentialing barriers not applied to physicians. A 2023 study found only 40% of Chicago hospitals grant full admitting privileges to certified midwives.
3. Workforce Shortages**: Illinois trains fewer than 50 new certified midwives annually, while Chicago’s population growth demands a 15% yearly increase in providers to meet needs (American College of Nurse-Midwives).