Nadia Gramby, a licensed and certified professional midwife based in Chelsea, Alabama, operates Crown of Glory Birth Services and travels extensively throughout the state to provide prenatal care, labor support, and postpartum services to women and families. The midwife recently drove 302 miles in a single day to reach patients in multiple cities and continues to prioritize home births and community outreach despite opening a new office in Birmingham.
According to the March of Dimes “Nowhere to Go” report released recently, more than 52% of U.S. counties lack hospital-based labor and delivery services. Nearly 35% of counties, or one in three, qualify as maternity care deserts with no birthing facilities or obstetric clinicians. The south and midwest regions have the highest concentration at 38.7% of counties, while 26.4% of western counties and 5.1% of northeastern counties are designated as deserts. These areas collectively contain 2.4 million women of reproductive age and account for 150,000 births annually.
The absence of accessible maternity care carries significant health consequences. More than 20,000 babies die before their first birthday each year in the U.S., and approximately 600 women annually do not survive pregnancy-related complications. Risks are substantially elevated for women of color, with Indigenous and Black women experiencing significantly higher maternal mortality rates than white women. Travel times for patients in affected counties average three times longer for appointments, treatment, or emergencies.
Gramby represents a critical resource in addressing these disparities. She is one of approximately 1,200 Black midwives in the U.S. according to the American Midwifery Certification Board. Research indicates midwife-attended births result in lower rates of cesarean sections and complications. Midwives currently attend about 12% of births nationwide, an increase of 4% over the past decade. The March of Dimes identifies midwives as essential to expanding maternity care access, particularly in rural and under-resourced communities. However, varying insurance coverage policies and restrictive state licensing requirements present ongoing challenges to midwifery practice in several states, with midwives having filed lawsuits in southern states over these limitations.
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