Rural America Has a Maternal Mortality Problem. Midwives Might Help Solve It.

This story has been updated to clarify how the U.S. maternal mortality rate compares to the rate in other countries.

HUNTINGDON, Tenn. — The sun is setting just as midwife Sheryl Shafer wraps up a long Thursday on the road visiting families in west Tennessee and Kentucky.

She knows the patient on her last stop, a 21-year-old Amish woman in a two-story farmhouse without electricity, is a week and a half past her due date. The baby is carrying high, and the woman is petite. If she’s unable to deliver on her own, a doctor may decide a C-section is the safest option. But Shafer hasn’t broached the subject yet.

“She deserves every opportunity to avoid it,” Shafer said. “I don’t want to put doubts in her mind, and I don’t want to alter her efforts knowing she might have more challenges than another woman.”

After the visit, Shafer’s drive back home to Middle Tennessee, over 60 miles of back roads and two-lane highways, takes more than an hour.

“My ideal in midwifery is to work within an hour range of my home,” Shafer said. “But there’s just greater need.”

Hospitals and obstetrics units are shutting down across rural America, creating a shortage of care that may be contributing to the country’s rising maternal mortality rate. The United States’ maternal mortality rate is higher than in Canada, Japan, or any Western European country — even higher than the rate in Saudi Arabia and Kazakhstan. And the mortality rate in rural areas tends to be higher than it is in cities and suburbs. Between 2011 and 2015, it was 23.3 deaths per 100,000 births in Tennessee and 19.4 in Kentucky.