Workforce Composition and Distribution: Problems and System Goals


Overall, workforce composition is misaligned with needs of childbearing women and newborns

The education and practice style of the current maternity workforce in the United States is poorly aligned with the needs of most childbearing women and newborns. Although most childbearing women and newborns are essentially healthy, care for the majority is managed by specialist physician caregivers whose training focuses primarily on high-risk pregnancy and disease management with minimal emphasis on the skills and knowledge to protect, promote, and support physiologic childbirth, the most appropriate form of care for these mothers. Primary maternity care providers—most consistently midwives and family physicians who through the focus of their training and experience in maternity care attain skills that are often better suited for supporting physiologic childbirth in women with low-risk pregnancies—are the least likely to attend births in this country and often face barriers to providing such care, even where they are available. Thus, there is a shortage of these primary maternity care providers.

Geographic maldistribution of maternity care providers

Regional inequities of workforce distribution manifest in oversupply of services in some urban areas, and lack of services in many rural settings. At the same time, supplier-induced demand contributes to overutilization of health care services in areas with high provider density.

Ineffective workforce collaboration and inefficient coordination of care and resources

The dominant model for provider care utilization in the U.S. maternity care system features silo-based micro-systems with individuals delivering care in parallel. Such systems are vulnerable to duplication of effort, gaps in care, competitive environments, and waste of finite resources.

Without coordination among caregivers, the maternity system is unreliable and inefficient. It may not deliver an appropriate level of care, services of value from other domains, and care that meets women’s preferences. Lack of interdisciplinary cooperation can also lead to unsafe conditions when primary maternity care providers cannot access reliable resources for consultation, collaboration, and referral.

Workforce attrition and inadequate recruitment across all maternity care professions

Multiple trends negatively impact the capacity of the maternity professional workforce. These include retirement of an aging provider population; barriers within educational pipelines, such as school closures, insufficient financial support, and lack of faculty; lack of interest in providing maternity services; and attrition owing to provider dissatisfaction with the quality of professional life.

System Goals

  • There is a national plan for achieving a workforce composition that advances and supports the goals of maternity care.
  • Primary maternity care is the standard for all childbearing women and newborns without a demonstrated need for a higher level of care.
  • There is adequate diversity within the maternity care workforce to serve the diverse American childbearing population.
  • Optimal use of the maternity care workforce and improved quality and safety are assured through effective interprofessional collaboration and care.


Download this entire Blueprint section (PDF)

Access the full Blueprint for Action from Women’s Health Issues