Reimagining Perinatal Care in Alabama Through Innovative Partnerships

Abstract

Childbearing families in the United States, especially in rural communities, face inconsistent access to high-quality maternity care, with many experiencing sparse and fragmented services. In response to long-standing disparities in Alabama, we created the Women and Children Health Initiative (WACHI), a coordinated hub that advances midwifery workforce growth, expands practice partnerships, and catalyzes policy change to support collaborative, risk-appropriate care. Central to WACHI is integrating certified nurse-midwives (CNMs) within systems that have historically imposed practice barriers. Grounded in the belief that Alabama can do better, WACHI convenes academic fields, health systems, public health sectors, and community partners to codesign and implement evidence-informed interventions. Program pillars include (1) reopening and expanding the state's nurse-midwifery education pathway, (2) embedding Nurse-Family Partnership home visiting with integrated behavioral health, (3) launching the Moms and Kids Mobile Health Clinic to reach underserved rural areas, and (4) building durable CNM-physician collaborations and standardized protocols for team-based care. These coordinated strategies align workforce development, health care delivery, and policy to increase first-trimester prenatal entry, improve postpartum follow-up, and reduce preventable complications. Early results include growth in the CNM workforce, new rural practice partnerships, and health-system engagement with respectful, team-based models that prioritize patient preferences and cultural safety. In this article we describe the WACHI model and early outcomes to inform adaptation and support replication by diverse regional coalitions and systems nationwide.