80% of Maternal deaths are unnecessary. We can’t accept Florida’s maternal death rate.

By Debbie Deland

Florida has been facing a maternal health crisis marked by rising mortality rates, deep racial disparities, and shrinking access to maternity care. As hospitals close obstetric units and OB‑GYN shortages worsen, doulas and midwives have emerged as essential, evidence-supported solutions that improve outcomes, expand access, and provide culturally grounded care.

Florida is experiencing a real and worsening loss of OB-GYNs, driven largely by the state’s abortion bans and an already strained maternal‑care workforce. The trend is documented across multiple sources and is affecting both practicing physicians and incoming trainees. Florida’s six-week abortion ban (effective May 2024) has made it “literally impossible” for many physicians to practice full‑scope reproductive care. OB‑GYNs are leaving the state, declining to relocate here, or choosing not to train here because of legal risk and restrictions.

What You Can Do—See Below

A System in Crisis

Maternal mortality in Florida remains unacceptably high, and Black women are nearly three times more likely to die during childbirth than white women.

• Black women in Florida: 50.3 deaths per 100,000 live births
• White women in Florida: 14.5 deaths per 100,000 live births

Researchers point to systemic racism, implicit bias, and inconsistent access to quality care as major drivers of these disparities. Community-based midwives and doulas—especially those serving Black, Indigenous, Latinx, and LGBTQ+ families—help fill some of these gaps by offering culturally relevant, relationship-based support that traditional hospital systems often fail to provide.

At the same time, the nation is experiencing a projected shortage of more than 5,000 obstetricians by 2030, leaving many counties with little or no maternity care. Integrating midwives into the workforce and expanding access to doulas are widely recognized as strategies to increase provider capacity, improve outcomes, and reduce preventable complications.

What Doulas and Midwives Do—and Why It Matters

Doulas provide non‑medical emotional, physical, and informational support before, during, and after birth. Their presence has been shown to:

• Reduce C‑section rates
• Lower preterm birth rates
• Increase patient satisfaction
• Improve communication between families and providers
• Reduce stress and fear during labor

Midwives are licensed clinicians who manage pregnancy, birth, and postpartum care. Systems with strong midwifery integration see:

• Higher rates of vaginal births
• Fewer unnecessary interventions
• Lower rates of preterm birth and low‑birthweight infants
• Better overall maternal and infant outcomes

Despite this evidence, midwives oversee only about 8% of U.S. births, far below countries with better maternal health outcomes.

Barriers to Access

Even as demand grows, doulas and midwives face structural barriers that limit their reach:

1. Patchwork Regulation

Regulation varies dramatically by state. Midwives often face restrictive licensing rules, while doulas—who are non‑medical—operate in a largely unregulated environment. This inconsistency affects insurance reimbursement, hospital access, and the ability to build sustainable careers.

2. Insurance and Medicaid Coverage

Many states do not reimburse doula services, despite evidence that doula support reduces costly complications. Expanding Medicaid coverage for doulas is a key policy recommendation to improve outcomes and reduce disparities.

3. Hospital Integration Challenges

Research shows that fewer than 8% of U.S. hospitals have a hospital-based doula program, and more than 75% do not mention doulas at all on their websites. This lack of integration limits collaboration and can create tension between doulas and clinical staff.

4. Safety Concerns and Need for Clear Standards

Recent coroner reports in the U.K. and U.S. have highlighted cases where poor communication between doulas and midwives contributed to delayed hospital transfers and adverse outcomes. These cases underscore the need for:

• Clear role boundaries

• Standardized training

• Better collaboration protocols

• Regulatory oversight that protects families without restricting access to support

Why the Need Is Urgent—Especially for Marginalized Communities

Community -based doulas and midwives are uniquely positioned to address inequities. They:

• Provide culturally aligned care
• Build trust with families who have been mistreated or dismissed in medical settings
• Offer continuity of care across pregnancy, birth, and postpartum
• Advocate for patients in environments where bias can affect treatment

Research shows that 80% of pregnancy‑related deaths are preventable, and expanding access to doulas and midwives is one of the most effective strategies to close that gap.

Policy Solutions

Experts recommend Medicaid reimbursement for doula services. Nationwide credentialing standards for midwives, hospital integration of doula programs. removing restrictive scope‑of‑practice barriers, investing in community-based perinatal workforce pipelines.

These steps would expand access, improve quality, and reduce preventable deaths—especially in states like Florida, where maternal health disparities are severe and OB‑GYN shortages are growing.

What You Can Do, Especially As a Chapter

• Fight for Medicaid expansion and 12-month postpartum coverage.
• Support community birth workers (doulas, midwives, CHWs) and push for Medicaid reimbursement for doula care, which is linked to better outcomes and lower C-section rates.

• Center Black maternal health–Partner with Black-led orgs (e.g., Black Mamas Matter Alliance model) and follow their agenda, not just invite them to panels).
• Push hospitals and agencies to collect and publish race-stratified data on maternal deaths and severe complications.
• Normalize “urgent warning sign” education: Put simple symptom lists in churches, salons, WIC offices, food pantries, PTA meetings, and social feeds.
• Train volunteers to do 5-minute “Know the Signs” huddles at community events.
• Push health systems and clinicians to implement standardized protocols, confront racism in care, and strengthen postpartum, screen and treat for hypertension, depression, cardiomyopathy, and diabetes well into the first year.
• Push policymakers to protect and expand reproductive health care, fund maternal mortality review committees (MMRCs) with teeth, invest in social determinants