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AMS News Flash

Members of the Coalition of Texas Birth Centers

Press Release: The Poor State of Texas Maternity Care & How Midwives & Birth Centers Can Help

Presented by The Coalition of Texas Birth Centers

March 16th, 2024

What is the state of maternity care in the US and in Texas?

Unfortunately, the quality of maternity care in Texas and in the United States generally is poor and declining. As a result, US maternal morbidity rates are higher than 60 other countries and increasing. In particular, Texas outcomes are among the worst in the nation.

Does poor maternity care in Texas unequally affect pregnancy outcomes?

According to a state committee on maternal care outcomes the answer is yes. There is indeed a severe inequity especially for black women. They die at more than twice the rate of white women. For more information, please see Appendix E in the most recent biennial report of the Texas Maternal Mortality and Morbidity Review Committee at the link below.

Why is maternity care in Texas substandard?


There are several reasons why maternal care in Texas is of low quality and creates risks for Texas women. (background: Texas ranks worst in the country for access to healthcare; 50% of women are eligible for Medicaid but it is difficult to find providers who take it)


First, it is increasingly based on an interventive approach and is expensive. The result is a virtual epidemic of costly care and stubbornly high rates of Cesarean section. These C-sections are also linked to a greater likelihood of morbidity and mortality. Please visit the CDC website at the link below for more information.


In addition, there is a persistently large number of preterm births every year. So much so that the March of Dimes gave Texas a failing grade due to its high premature birth rate. See the link below for more about this.


Are there reasons to believe Texas pregnancy & birth outcomes will improve?


Yes, there have been positive changes and more are anticipated. For instance, a recent vote in the Texas legislature extended postpartum Medicaid support for an additional year. We’d like to thank everyone who supported the initiative during the prior legislative session. This extension is critically important as a significant portion of pregnancy-related morbidity and mortality occurs postpartum simply due to inadequate care or follow up. In fact, before the extension 40% of women actually received no postpartum care at all after leaving the hospital. Please see more information at the link below.,Increasing%20engagement,interval%20pregnancy%20and%20preterm%20birTh.


How can midwives in birth centers help solve the maternity care crisis?

Midwives who deliver in birth centers can make a huge difference in improving maternal care outcomes. They have very low rates of C-section and other expensive interventions. Midwifery support also reduces the risk of preterm birth and the need for expensive neonatal intensive care. Further, postpartum visits by a midwife can catch problems earlier and address them. Lastly, the midwife model of care is person centered and focused on equity for all clients. We invite you to investigate one of many references concerning the clear advantages of midwives at the link below. (Midwives provide continuity of care and give clients a great deal of time for communication and education)


CMS’ Strong Start Initiative showed the clear advantages of birth center care in this report:


In their effort to improve dismal maternity care outcomes and save women’s lives, midwives and birth centers have a vital role to play in Texas. “Transforming Maternity Care” is a CMS program which offers Texans an opportunity to be leaders in the drive to provide person centered equitable care that will save lives. Please see the link below for more information.


























What is a birth center?


Birth centers are freestanding facilities staffed by midwives offering person-centered care with minimal intervention. They support low risk pregnancies and have provided safe, satisfying, affordable care for women in our state for fifty years. 


Here is a description from The American Association of Birth Centers:


And also from The Coalition of Texas Birth Centers:


Lastly, CMS’ Strong Start Initiative showed the clear advantages of birth center care.

Birth center sustainability in Texas

More than 50% of pregnant people in Texas use Medicaid for care, but almost none use birth centers. This is due in large part to the unsustainable reimbursement rate for centers. While Medicaid pays hospitals $6000 for low risk vaginal births, birth centers receive only $1800 for mom and $80 for baby. Practices like this contravene the pay parity requirements of the Affordable Care Act and are unacceptable


Steps you can take to help

First, we urge you to help ensure that Texas Medicaid is a participant in the CMS Transforming Maternity Care initiative. The Federal Government is making $17 million available for additional person centered, equitable care by midwives and birth centers in Texas. This money will save many lives and Medicaid reimbursement should be included in it.

Second, birth centers cannot serve the Texas public if our model is unsustainable. Of the 91 birth centers in Texas very few accept Medicaid families due to the extremely poor reimbursement rates.

Our birth centers are a unique Texas treasure and deserve to be reimbursed equitably. Please help!


Thank you from Texas birth centers & the following people


Joan Doglio Smith, President: Coalition of Texas Birth Centers 

Certified Nurse Midwife

Owner, Abundance Midwifery Service in Austin

Clinical Director, Manor Birth Sanctuary 

Joan can be reached at


Carla Morrow, Sustainability Committee Chair: Coalition of Texas Birth Centers

Certified Nurse Midwife

Owner, Midwife and Co, Fort Worth Birthing and Wellness Center 

Carla can be reached at


Dinah Waranch 

Certified Nurse Midwife

Founder, Lovers Lane Birth Center in Richardson

Dinah can be reached at


Joan Doglio Smith, President of the Coalition of Texas Birth Centers, and Victoria Meinhardt at the Texas State Capitol

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