The Impact of Midwifery-Promoting Public Policies on Medical Interventions and Health Outcomes

Amalia Miller, University of Virginia

Abstract

This paper measures the impact of midwifery-promoting public policies on maternity care in the United States, using national Vital Statistics data on births spanning 1989-1999. State laws mandating insurance coverage of midwifery services are associated with an 18-percentage rise in midwife-attended births. The laws did not decrease rates of cesarean deliveries or lead to consistent effects on maternal mortality or Apgar scores. They did, however, lead to a statistically significant drop in neonatal deaths. Divergence between OLS and natural experiment estimates suggests that women are selecting into provider groups based on unobserved preferences and health.