Document Type

Article

Publication Date

8-1-2026

Comments

This article is the author’s final published version in Health Services Research, Volume 61, Issue 4, 2026, Article number e70143.

The published version is available at https://doi.org/10.1111/1475-6773.70143. Copyright © 2026 The Author(s).

 

Abstract

OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce.

STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who maintained certification but reported not working in the discipline of midwifery (n = 1994) to understand why individuals left the workforce and the likelihood of returning. Data were analyzed with ANOVAs, chi-squares, t-tests, and thematic analysis.

DATA SOURCES AND ANALYTIC SAMPLE: Administrative data from the American Midwifery Certification Board (n = 9704) and an online survey from a national sample of currently and previously certified nurse-midwives and certified midwives who had left the workforce (n = 646; response rate of 33.8%).

PRINCIPAL FINDINGS: The most endorsed reasons for leaving were work-life balance (50.3%, n = 325), unsupportive work environment (34.7%, n = 224), and schedule (32.0%, n = 207). Participants from restrictive regulation states reported lack of opportunities for career advancement, state-level regulation restricting ability to practice, and lack of employment opportunities at higher rates. Respondents of color more frequently reported inadequate compensation, lack of opportunity for advancement, and workplace discrimination at higher rates. Themes included barriers to re-entry to practice and compensation.

CONCLUSIONS: Work-life balance and work environment drive midwifery workforce attrition. Individuals of color and those living in states with restrictive regulation face unique challenges. Challenges re-entering the workforce after leaving create barriers to remaining in the workforce, especially with inequitable compensation.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Additional Files
Data S1 Survey questions.docx (31 kB)

Language

English

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Available for download on Saturday, August 01, 2026

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