In 2012, there were a total of 3,952,841 births in the United States and of these, 55,758 were born in the state of Kentucky (Martin et al., 2013). Hardin County, Kentucky is the home of about 107,025 people (Kentucky Health Facts, 2008). The main cities that make up Hardin County include Elizabethtown, Radcliff, and Fort Knox. Hardin County is considered a rural community. The majority of all births in Hardin County occur in a hospital or at home. The community of Hardin County Kentucky extends residents the choice of a hospital delivery or a home delivery. Currently there are no free standing birthing centers in this community. There are a total of 10 medical doctors that specialize in obstetrics (Kentucky Health Facts, 2008), approximately 5 certified nurse-midwives, and no certified midwives. There is a small population of lay midwives that practice mainly in Amish communities of which statistical data was not available. Residents of Hardin County have a choice in the type of provider they seek for medical care during pregnancy.
According to the American College of Nurse-Midwifes (ACNM), certified nurse-midwives (CNMs) have been practicing in Kentucky for 70 years. The organization also reports a total of 48 nurse-midwifery practice sites in Kentucky and that CNMs delivered a total of 2,838 births equaling 4.8% of all births in Kentucky in 2007 (http://midwife.org/index.asp?bid=59&cat=11&button=Search&rec=190). In 2012, “98.6% of all U.S. births occurred in hospitals” (Martin et al., 2013, p. 10). Of the 1.4% of births that occurred outside of hospitals, 65.6% were home births: the home birth rate is currently the highest since reporting began in 1989 (Martin et al., 2013). While 85.8% of hospital deliveries occurring in the U.S. are done by medical doctors, as of 2011 7.6% of hospital births are attended by CNMs (Martin et al., 2013). In addition, 30.4% of all births delivered outside of a hospital in 2011 were attended by CNMs (Martin et al., 2013). The rates of CNMs who attend births are increasing.
Medicaid, as a source of payment for infant deliveries, accounts for approximately 43.4% of births in the United States and 43.6% of births in the state of Kentucky in 2010 (Curtin et al., 2013). Hardin county Kentucky has a Medicaid utilization rate of 17% (Kentucky Health Facts, 2008). Of the births in Hardin county Kentucky, 17.7% of mothers utilized Medicaid as source of payment for delivery (County Health Rankings, 2007). CNMs in Kentucky are reimbursed by private insurance and Medicaid health plans (http://midwife.org/index.asp?bid=59&cat=11&button=Search&rec=190). Medicaid health plans benefit several people who are economically disadvantaged and help provide needed prenatal support.
Maternal mortality measures the number of women who die as a result of a complication of childbearing within 42 days of delivery...