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When someone needs prenatal care, the ability to get an appointment should not depend on how many clinicians happen to practice nearby. Yet across Pennsylvania, too many families face that uncertainty.
In a statewide maternal health survey conducted by the Pennsylvania Department of Human Services, 22% of respondents who needed maternal health care said they had delayed it at least once. Among those who delayed care, half said they could not get an appointment, while 30% said they could not miss work or school. These are not minor inconveniences. Delays in prenatal care can mean missed opportunities to identify and address health risks early.
The geographic picture is troubling, too. According to the March of Dimes’ 2026 maternity care access data, 10.4% of Pennsylvania counties are maternity care deserts, with no hospital or birth center offering obstetric care and no obstetric clinicians. Another 16.4% have low or moderate access rather than full access.
Pennsylvania cannot solve every access problem overnight. But there is a question policymakers and health system leaders can address now: Are we making full use of the qualified maternal health professionals already available?
In May, Pennsylvania took an important step. Act 14 of 2026 created a licensing pathway for Certified Midwives. The law directs the State Board of Medicine to establish regulations for the new licensing pathway, making implementation an important next step. The legislation signals a willingness to expand the ways qualified clinicians can serve patients. Implementation now matters.
It also invites a broader look at how Pennsylvania uses its existing midwifery workforce.
Certified nurse-midwives are advanced practice clinicians who provide care during pregnancy, childbirth and the postpartum period. Their work also includes gynecologic, reproductive and primary care services across the lifespan. They serve patients in hospitals, physician practices, health centers, birth centers and other settings.
Midwives do not replace obstetricians or other physicians. Good maternal health care depends on teams that consult, collaborate and refer patients when additional expertise is needed. The question is whether the rules governing those teams support that care or create avoidable obstacles.
Under Pennsylvania law, nurse-midwives practice pursuant to a collaborative agreement with a physician or physician group, and regulations require that agreement to be filed with the State Board of Medicine. Clinical collaboration is essential. Requiring a contractual agreement as a condition of practice, however, is not the same as requiring clinicians to collaborate when a patient’s needs call for it.
At a time when Pennsylvania is trying to strengthen its health care workforce, that distinction deserves a serious examination. Do these requirements meaningfully improve patient safety? Or can they limit how health systems deploy qualified professionals, particularly in communities where care is already difficult to access?
I spent 28 years serving in the U.S. Army and have led complex health care organizations as a hospital chief executive officer and chief nursing officer. In every setting, workforce challenges required more than recruitment. Leaders also had to ask whether people were empowered to use the skills and training they already possessed.
Pennsylvania is rightly working to recruit and retain health professionals and has joined interstate licensure compacts designed to reduce barriers to practice across state lines. Those efforts matter. But bringing more clinicians into the Commonwealth is only part of the equation. We must also examine the rules that shape what qualified clinicians can do once they are here.
That is a practical challenge for lawmakers and health system leaders, not merely a debate among professional groups. It calls for thoughtful implementation of the new Certified Midwife pathway, a careful review of existing practice requirements, and care teams designed around clinicians’ training and patients’ needs.
For patients, the stakes are straightforward: more timely access to appropriate care, including early prenatal care. For communities, the stakes include whether essential services remain within reach. And for Pennsylvania, the opportunity is to make its maternal health workforce work better for the people who depend on it.
We should continue investing in the next generation of health professionals. But we should not overlook the trained professionals already here. Improving maternal health access requires both.
Michelle Munroe is Chief Executive Officer of the American College of Nurse-Midwives.