Health wellness

New Maternal Health Initiative Expands Rural Midwife Training Programs

HRSA-Funded Initiative Launches Multi-State Expansion of Rural Midwife Training to Combat Maternity-Care Deserts

Denver, Colo. – November 26, 2025 The Colorado Rural Midwifery Workforce Expansion Program (CRMWEP) today announced a federally funded scale-up that will replicate its rural midwife training model across twelve states where more than half of hospitals no longer deliver babies. The initiative—backed by a new $19 million Health Resources & Services Administration (HRSA) grant—will graduate 120 additional certified nurse-midwives (CNMs) by 2028 and embed at least 75 percent of them in federally designated maternity-care deserts.

Rural America has lost 145 obstetric units since 2014, leaving only 45 percent of rural hospitals with labor-and-delivery services. Midwives now attend just 8 percent of births in non-metro counties—one-third the national urban rate—despite evidence that midwife-led care cuts cesarean rates by 24 percent and reduces preterm birth by 16 percent. The CRMWEP expansion targets those gaps with a 14-month, co-curricular curriculum that pairs high-volume urban clinical rotations with longitudinal rural preceptorships, mandatory perinatal mental-health certification, and business-skills labs that prepare graduates to open independent birth centers.

“When a rural county loses obstetric services, prenatal visits drop 32 percent and maternal mortality rises 38 percent within five years,” said Dr. Karen McShea, CEO of the Colorado Rural Health Alliance and program lead. “Training midwives who already live in these communities is the single fastest, most cost-effective way to restore access and improve outcomes.”

The program’s first cohort, launched in 2023 under an earlier HRSA MatCare award, placed 42 of 45 graduates in rural Colorado practices; 38 remain one year post-credentialing—an 84 percent retention rate that dwarfs the 35 percent three-year retention typical of physician recruitment contracts. Participating states in the new phase—Alabama, Georgia, Kentucky, Mississippi, Missouri, Montana, New Mexico, North Carolina, Oklahoma, Texas, Utah and Wyoming—collectively account for 41 percent of U.S. rural maternity deserts yet produce only 9 percent of new CNMs annually.

Recent federal data show pregnancy-related deaths rose 89 percent between 2019 and 2023, with rural residents facing a 63 percent higher mortality ratio than suburban women. Midwife integration could avert an estimated 41 percent of maternal deaths attributable to provider delays, according to a 2024 Commonwealth Fund analysis. The expansion will also create a tele-mentoring network modeled on Project ECHO, linking rural trainees 24/7 with obstetricians at regional perinatal centers; pilot data show the approach reduced emergency transfers by 22 percent.

“Every statistic is a mother, a baby or a family that deserved better,” McShea said. “By seeding locally trained midwives and sustaining them through loan-repayment and rural tax credits, we are not just filling vacancies—we are rebuilding the maternity-care ecosystem from the ground up.”

Applications for the first multi-state cohort open January 15, 2026; priority will be given to candidates from counties with no practicing CNM or OB-GYN. didactic coursework will be delivered online through the University of Colorado College of Nursing, while clinical placements will rotate through hybrid sites that include critical-access hospitals, tribal health centers and freestanding birth centers.

About the Colorado Rural Midwifery Workforce Expansion Program

CRMwEP is a consortium of the Colorado Rural Health Alliance, University of Colorado College of Nursing, and nine rural hospital systems. Since 2023 the program has trained certified nurse-midwives for practice in frontier communities, funded by HRSA’s Maternity Care Nursing Workforce Expansion (MatCare) grant.