The Benefits of Licensed Midwifery and Community Birth Among BIPOC Birthing People in New Mexico.

Abstract

Black, Indigenous, and people of color (BIPOC) families comprise a disproportionately low percentage of home and freestanding birth center births in New Mexico (NM), despite NM Medicaid coverage of care by Licensed Midwives (LMs) in these settings. The purpose of this study was to examine why low income BIPOC seek out LM care, how they benefit from this model of care, and which factors facilitate and obstruct access. We conducted 7 focus groups with 55 low income BIPOC individuals who had birthed in New Mexico in the past 5 years. Participants in four of the groups intended to birth with an LM in the community setting; participants in three of the groups intended to birth in a hospital. Prior negative birthing experiences at hospitals were the most-often discussed reason for choosing LM care. The aspects of LM care most commonly described as beneficial were: (1) the high quality of one-to-one individualized and holistic care offered by LMs, as well as (2) the respectfulness of care received. Medicaid coverage of LM care and special payment allowances made by LMs were cited as two important facilitators of access to LM care. Barriers to care included the lack of general awareness of LM care, the persisting stigma against community birth, the small number of LMs, and payment and insurance coverage challenges. LM care is beneficial for many families seeking respectful and accessible care, especially in underserved areas. BIPOC birthing individuals' reflections on their experiences with LM care provide valuable information that should be considered when designing and revising perinatal care systems and policies with the intent of increasing access to high-quality maternal and newborn care in New Mexico and, more generally, the United States.