Midwife Travels Alabama to Deliver Vital Maternity Care

Nadia Gramby, an Alabama midwife, plays a vital role in maternity care as maternity deserts expand across the U.S., according to the March of Dimes report. She juggles her responsibilities as a midwife with her roles as a mother and wife. Each day, she travels significant distances to provide care to pregnant women in areas lacking hospital-based labor services.

Gramby’s services stand crucial given the March of Dimes report that indicates over 52% of U.S. counties lack hospital labor and delivery services. The 2026 report also shows nearly 35% of counties are maternity care deserts with no birthing facilities or obstetric clinicians.

Dr. Michael Warren of the March of Dimes highlighted the risks women face in these regions, with maternal mortality rates especially higher for women of color, including both Indigenous and Black women. The CDC further reports over 20,000 infant deaths and around 600 maternal deaths annually from pregnancy-related complications.

Miles for Moms

Gramby drives hundreds of miles daily, offering care throughout Alabama. As a licensed and certified midwife based in Chelsea, she emphasizes the importance of long-distance travel to ensure families feel safe and supported. Her husband Shamar provides crucial support, enabling Gramby to assist women across various locations.

Gramby founded Crown of Glory Birth Services in 2018, aiming to address care needs in maternity deserts. Her role involves assisting families through pregnancy, labor, and postpartum care. As one of only about 1,200 Black midwives in the U.S., she provides personalized care and post-birth services, such as holistic care and home visits.

Research indicates that midwife-assisted births often result in fewer cesarean sections and complications. Midwives collaborate with doulas and work in different settings, including hospitals, birth centers, and homes, to ensure comprehensive care.

Challenges in Maternity Care Access

The March of Dimes’ ‘Nowhere to Go’ report reveals critical barriers to maternity care access. It identifies high proportions of maternity deserts in the south and midwest, with counties housing significant numbers of women of reproductive age. These areas experience longer travel times for prenatal appointments and emergencies.

In 2024, 25% of women faced delays in receiving prenatal care during their first trimester. The March of Dimes report traces these difficulties to policies like President Trump’s One Big Beautiful Bill Act, which cut Medicaid funding and did not extend Affordable Care Act tax credits. Additionally, over 500 hospital maternity wards closed between 2010 and 2022.

Health officials say closures often eliminate a county’s lone birthing facility, worsening infant mortality rates. These challenges are more pronounced in rural and urban areas and disproportionately impact Black and brown women and babies.

Gramby emphasizes her commitment to addressing these disparities, providing culturally sensitive care that respects and understands the unique needs of Black mothers.

Expanding Access to Care

While improvements in health outcomes for mothers and babies have been gradual over 40 years, the March of Dimes underscores the significance of midwives in expanding maternity care access. Currently, 12% of U.S. births involve midwives, a rise of 4% over the past decade.

However, insurance coverage for midwifery varies, and restrictive state laws hinder practice. Midwives, including those in Alabama, have filed lawsuits against such regulations. Proponents argue that involving doctors in every childbirth isn’t always necessary for safety, and advocate for midwives’ independent practice.

In its latest report, the March of Dimes supports expanded hospital privileges for midwives and alignment on policies enabling their independent practice. Gramby looks forward to fostering collaborative networks that assure compassionate and accessible maternity care for all mothers and babies.