BOX 5-1
Workforce Issues
Key Points Made by Individual Speakers

  • Catherine Dower noted that many different types of health care professionals are involved in the care of birthing mothers and their babies, with obstetricians comprising the largest sector of the workforce and midwives the second largest sector.
  • According to Dower, the impact of teams of birth setting professionals working together is unknown, and researchers still do not know how to define or measure teams.
  • While education and training among obstetricians and the different types of midwives varies, all professions are challenged by insufficient interprofessional education and a lack of awareness about what people in other professions can do. In Dower’s opinion, much of the mistrust, or distrust, that exists among different types of perinatal care professionals stems from the lack of interprofessional education.
  • According to Debra Bingham, registered nurses (RNs) have played an increasingly important role in birth settings because of the many intervention and outcome changes that have occurred over the past few decades, most notably dramatic increases in Cesarean deliveries, severe maternal morbidity, and women receiving blood transfusions during hospital birth admissions.
  • Bingham stated that there has been significant recent growth in the number of births attended by midwives. It is unclear whether and how demand for midwives or other professionals would change if women were fully informed about all of their birth setting options.
  • While nurse staffing and nurse education have been shown to affect patient outcomes, Bingham stressed that little is known about perinatal RN staffing patterns, the qualifications of perinatal nurses who provide care to women and newborns, and how those patterns and qualification impact outcomes.
  • Susan Stapleton observed that the list of what is unknown about the maternity care workforce is much longer than the list of what is known.

Workforce Supply and Demand

Physicians comprise the largest segment of U.S. health care professionals working in birth settings, with an estimated 50,000 obstetricians nationwide. Dower warned, however, that the numbers she was presenting were “squishy,” saying that every time she reports a number, there are many ways to qualify that information. For example, not all obstetricians work in labor and delivery. Nonetheless, they do comprise the largest sector of birth setting professionals. Second to physicians are midwives, which are composed primarily of four groups: (1) CNMs, with an estimated 13,000 to 18,500 nationwide (Dower suspected that the number was closer to 13,000, with many of the 18,500 estimated by the Health Resources and Services

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