A new education campaign aims to raise awareness of midwifery care in Southwest Virginia by highlighting stories of Appalachian midwives past and present.
The nonprofit Virginia Interfaith Center for Public Policy has long advocated for midwives to be able to provide more services and receive more robust insurance coverage, particularly as rural labor and delivery units have closed across Virginia.
Midwives provide prenatal care and support through pregnancy, birth and the postpartum period for both the mother and baby. Depending on their training and credentials, they can provide care in hospitals, birth centers, clinics and homes, and they collaborate with doctors when patients need additional medical care.
The interfaith center promotes collaborative care models in which midwives provide care within or alongside hospital systems and consult with doctors when needed.
Kathryn Haines, the center’s director of policy, said in a phone interview Wednesday that expanding access to midwives could help address gaps in infant and maternal care, reduce health disparities and decrease unplanned out-of-hospital deliveries.
One of the biggest barriers to expanding midwifery care is misinformation and public misconceptions about the profession, Haines said. She often hears people characterize midwives as an option only for people who cannot afford hospital care or don’t have access to a car.
The campaign aims to counter those perceptions through personal stories, historical information and resources on a new website, midwiferyswva.org.
“When you collect stories, right, then you start to see the connections, and it becomes something that is tangible,” Haines said.
The campaign is funded through a federal Rural Maternity and Obstetrics Management Strategies grant awarded to the Virginia Rural Health Association in 2025. The $1 million grant supports efforts to improve access to maternity care in rural communities, including through partnerships and education. The Virginia Interfaith Center is using part of the grant funding for its midwifery education campaign in 16 Southwest Virginia counties.
This push for greater education comes as Southwest Virginia faces a growing shortage of maternity care. With rural labor and delivery units closing and more pregnant patients facing long drives to reach care, advocates say expanding access to midwives could provide another option for families, particularly in communities where hospital-based maternity services are limited or unavailable.
A deep history of midwifery
Midwives were the primary providers of infant and maternal healthcare for families across Southwest Virginia long before modern health systems were established, according to the campaign’s website.
The website highlights the work of Appalachian community midwives and traditional Black midwives, who provided care to families in their communities for generations.
One of the Appalachian midwives was Orlean Hawks Puckett, who moved to Carroll County with her husband in 1844. According to the website, Puckett helped deliver a neighbor’s baby in 1889 and then began providing midwife services. She traveled throughout the Blue Ridge for about 50 years and is credited with delivering 1,000 babies without a single maternal or infant death.
Traditional Black midwives also played a central role in childbirth across Virginia. Many were born into slavery, including Margaret Jones of Lynchburg, who was born in 1823 and later became a well-known midwife who provided care to families in the region, according to the website.
The website traces how changes in medical practice, licensing requirements and regulations gradually restricted the work of community midwives. Haines said some midwives were arrested as laws made practices they had followed for generations illegal.
Virginia had about 9,000 midwives in 1918, according to the website. By 1950, that number had fallen to about 1,500. Now, there are 753 midwives practicing in Virginia, according to the interfaith center.
Fewer maternity services, longer drives
The campaign comes as rural communities across Virginia face shrinking access to hospital-based maternity care.
Rural labor and delivery units have closed across the state since at least 2018. The most recent closure was in Farmville, where Centra Health ended labor and delivery services at the end of 2025. Seven of the state’s 28 rural hospitals still offer labor and delivery services.
About 64% of Virginia counties are now classified as maternity-care deserts, meaning there are no hospitals or birthing centers offering obstetric care and no obstetric clinicians. In rural counties, that figure rises to about 85%, according to a 2026 March of Dimes report.
Distance from maternity care can have consequences for patients. A 2022 study by the American College of Obstetricians and Gynecologists found that pregnant patients who had to drive farther to reach a hospital for delivery faced higher risks of adverse maternal outcomes and admissions into the neonatal intensive care unit. Those risks remained even after researchers accounted for the patient’s health and pregnancy risk.
The researchers said the findings suggest that long travel distances may be a consequence of gaps in access to maternity care.
Haines said that Southwest Virginia is also seeing more births occur outside the hospital than the national average of 2%, most of which are likely unplanned.
About 13% of births in the Cumberland Plateau Health District — serving Buchanan, Dickenson, Russell and Tazewell counties — in 2023 were classified as out-of-hospital births, according to data from PUSH, a Virginia maternal health coalition. But that figure does not necessarily represent planned out-of-hospital deliveries.
Birth certificates do not have specific categories for births that occur unexpectedly outside a hospital, such as roadside deliveries, Haines said. Those births may instead be recorded under an “other” category.
The percentage of out-of-hospital births in the Cumberland Plateau Health District has consistently exceeded national rates since at least 2021, according to PUSH data.
The region’s primary hospital is Clinch Valley Medical Center in Richlands, a 175-bed short-term acute care hospital that operates an inpatient labor, delivery and postpartum unit. From some of the health district’s most remote areas, the hospital is about a 90-minute drive away.
Changes in Virginia
Virginia has taken several steps in recent years to expand the role of midwives, particularly as rural communities face shortages of maternity care.
In 2023, lawmakers clarified that licensed midwives can practice independently rather than being required to have a written agreement with another healthcare professional. The law also allowed licensed midwives to carry and administer certain lifesaving drugs.
Another important change came in 2025 when lawmakers updated practice-agreement requirements and directed the Virginia Department of Health to recognize independent-practice midwives as members of hospital staff.
Another 2025 law addressed a more specific barrier: newborn care in hospitals. It allows a certified nurse-midwife or licensed certified midwife with appropriate pediatric privileges and neonatal-resuscitation training to serve on a hospital’s 24-hour on-call roster for general-level newborn nursery services when a physician is unavailable. A physician can provide consultation by telehealth if the physician cannot get to the hospital within 30 minutes.
Virginia also changed Medicaid reimbursement in 2025. The Department of Medical Assistance Services said Medicaid reimbursement for services provided by a licensed certified midwife or licensed midwife would be set at the same amount paid to a physician.
