Midwifery Workforce Shortage: The $260K Cost of Burnout and Turnover at Birth Centers
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The birth center model is experiencing unprecedented growth. From 2011 to 2021, birth center births grew by 65%—even as overall U.S. births fell 7%. Today, about 400 birth centers operate across 40 states and D.C., with a projected compound annual growth rate of 13.2% through 2034. Families are choosing community-based maternity care in record numbers, seeking safer, more personalized birth experiences.
But there's a critical tension threatening this momentum: growth is meaningless without the people to staff these centers. The midwifery workforce shortage has become the single biggest threat to realizing the birth center model's potential, and it's a crisis with staggering financial implications that most operators haven't fully calculated.
The Scale of the Midwifery Workforce Shortage: 980,000 Midwives Short Globally
In January 2026, new research revealed that the world needs an additional 980,000 midwives across 181 countries. This global shortage leaves millions of women without access to essential care before, during and after pregnancy. It's not just a developing-world problem. High-income countries like the United States are facing severe structural shortages that directly impact maternal health outcomes.
The World Health Organization sets a minimum standard of 6 midwives per 1,000 live births. The U.S. currently has only 4 per 1,000. With approximately 3.7 million annual births, meeting WHO's minimum would require at least 22,000 midwives in practice. Currently, there are only about 14,000 midwives working in the United States.
U.S. Birth Centers Face Critical Midwife Shortage: 8,200 Midwives Needed
This means the U.S. is short approximately 8,000 midwives just to meet WHO's minimum standards. Only a few states currently meet this benchmark.
The training pipeline offers little relief. The net gain in new CNMs and CMs has averaged only 390 to 401 per year since 2016. At this pace, the gap won't close anytime soon and may actually widen as more midwives leave the profession due to burnout.
Midwife Burnout Statistics: 40.6% Meet Burnout Criteria
The midwifery workforce shortage isn't just about numbers, it's about sustainability. Research shows that burnout is both a cause and consequence of the workforce crisis:
50% of midwives globally experience moderate-to-high personal burnout
40.6% of U.S. CNMs and CMs meet clinical criteria for burnout, strongly correlated with patient load, birth volume and acuity
One quarter of U.S. midwives intend to leave the profession within the next few years
Working more than 55 hours per week is significantly associated with reduced likelihood to recommend midwifery as a career
The Birth Center Advantage: Lower Burnout in Community Settings
Here's the critical finding for birth center operators: Community-based midwives and those in low-volume settings showed significantly lower burnout rates than hospital or high-volume counterparts.
This means your scheduling structure is itself a retention tool, but only if you design it intentionally. Birth centers have the opportunity to create sustainable work environments that hospitals simply cannot replicate. However, if you're scheduling midwives for 24-hour shifts followed immediately by clinic days, you're creating the exact conditions that accelerate burnout.
The Hidden Cost of Midwife Turnover: Why Losing One CNM Costs $260K
Most birth center operators understand that turnover is expensive. Few have calculated what it actually costs.
According to the 2025 NSI National Health Care Retention and RN Staffing Report, the average cost of replacing one bedside RN is $60,090 a 17.6% turnover rate. For a midwife, industry-standard multipliers (0.5-2x annual salary per SHRM/Gallup) put the replacement cost between $64,400 and $258,000 when applied to the CNM median salary of approximately $128,790.
What's Actually in That Number?
Turnover costs include far more than job posting fees:
Recruiting, screening and credentialing: Advertising costs, multiple rounds of interviews across staff calendars, background checks, license verification
Orientation and onboarding: Often 3+ months before someone is fully independent and productive
Vacancy coverage: The national average time to fill an RN position is 83 days—that's 83 days of overtime and agency costs. In a recent poll of birth center operators and clinical directors, 43% reported they are still searching to fill their last midwife vacancy, while only 14% filled positions in less than one month. This leads to overtime for existing staff, per diem coverage at premium rates or reduced client capacity.
Morale impact: Turnover triggers more turnover; remaining staff absorb additional workload
Lost institutional knowledge: Client relationships and operational expertise that cannot be replaced
The Turnover Rate Reality
Understanding national benchmarks helps contextualize your center's experience:
National RN turnover rate: 16.4% (2024)
31.9% of newly hired nurses leave within their first year
For hospitals, even a 1% change in RN turnover can represent hundreds of thousands of dollars annually
Even at a small birth center with just 5 clinical staff members, losing one midwife per year represents a 20% turnover rate. If that person is your most experienced provider, you're likely looking at a six-figure replacement cost plus immeasurable impact on client continuity and team morale.
Labor is typically 56-60% of total hospital operating expenses. For birth centers—which run a clinician-intensive model with modest revenue per birth compared to hospital billing—staffing costs are proportionally even more significant. In a recent poll of birth center operators, 43% reported that labor costs consume 60% or more of their total revenue, with 14% exceeding 70%. Perhaps more concerning is that 29% of operators don't track this number at all, meaning they're operating without visibility into their single largest expense category. This makes retention not just an HR priority, but a core financial strategy.
Birth Center Staffing Solutions: Sustainable Scheduling to Reduce Burnout
The evidence is clear: your scheduling structure directly impacts both burnout rates and your bottom line. Here are actionable strategies based on healthcare workforce research:
The FT/PT Hybrid Staffing Model
One of the most effective tools for matching staffing to actual demand is called load leveling—a Six Sigma workforce management principle that the food service industry mastered decades ago.
Here's how it works in practice: If your FTE calculation shows you need 5.43 FTEs to cover all clinical work, you have three options:
Round up to 6 FTEs: Built-in buffer, higher fixed costs, safest for volume surges
Round down to 5 FTEs plus overtime: Lowest cost short-term, but burnout risk is high and not sustainable for midwifery teams
Staff 5 FTEs plus 0.43 FTE part-time: Load leveling approach with lower fixed cost, flexible coverage, and reduced burnout risk
Understanding Productive vs. Paid Hours
When budgeting for staff, remember that not all paid hours are worked hours. Every employee will have vacation days, holidays, sick days, continuing education and administrative time.
In healthcare, these non-productive paid hours are significant. If a midwife takes 15 days of PTO, 10 holidays, 5 sick days and 4 days of education per year, that's 34 days, or about 272 hours of paid but non-productive time, roughly 13% of a year's hours.
This is why FTE modeling matters: you need to plan around productive hours, not just paid hours.
How Community-Based Midwifery Models Lower Burnout Rates
Birth centers have a unique competitive advantage: you can offer the sustainable work environment that drives retention. But this requires intentional choices about scheduling, recovery time and role clarity.
24-Hour Shifts: Know the Trade-Offs
Many birth centers use 24-hour shifts, especially for on-call coverage. The research shows both benefits and risks:
Advantages for community-based midwives:
Clear on/off boundary: you're either on or completely off, which many midwives prefer over chronic low-level alertness
Fewer handoffs mean better continuity: laboring clients are less likely to meet a new provider mid-birth
Allows for more sustainable personal life on off days when properly structured
Physiological reality:
Extended shifts, especially beyond 20-24 hours, are associated with higher medical error rates and increased injury risk
Many midwives report fatigue-related near misses and even falling asleep while driving home from call
Shifts longer than 12 hours are consistently associated with elevated occupational fatigue risk
The key: If you use 24-hour shifts, you must build in adequate recovery time. The standard recommendation is a minimum of 24 hours off following a 24-hour shift, preferably 48 hours.
Shift Model Comparison
Shift Model | Pros | Cons |
8-hour | Flexible for PT mix, less fatigue per shift | More handoffs, harder for coverage-based roles |
12-hour | Fewer handoffs, preferred by many nurses | Fatigue risk increases in hours 8-12 |
24-hour | Continuity, clear on/off boundary, common in birth centers | Physiological stress, requires protected recovery time |
On-call/Per diem | Handles unpredictable demand efficiently | Expensive if overused, morale risk if call is burdensome |
Retention Strategies That Actually Work
Research on midwife and nurse retention consistently points to drivers that birth centers can control:
1. Predictable schedules with advance notice. Uncertainty is exhausting. Even modest improvements in schedule predictability significantly reduce burnout.
2. Transparent and fair on-call expectations. Built into job descriptions from day one. Surprises erode trust faster than hard work does.
3. Protected recovery time after long or complex labors. If someone catches a 24-hour birth, they should not be back on call in 8 hours. This is both a safety and retention issue.
4. Clear role definitions. Are your midwives doing work that a medical assistant or nurse or front desk employee could handle? Scope creep, asking highly skilled people to do low-skill work, costs money and erodes morale.
5. Investment in growth. Continuing education, mentorship and visible career paths matter, especially to early-career midwives. Many leave not because of pay but because of isolation and lack of professional community.
The Bottom Line: Retention Is a Financial Strategy
Three takeaways for birth center operators navigating the midwifery workforce shortage:
First: Staffing is your biggest controllable expense and your biggest quality lever. An efficiently staffed, well-retained team delivers better care and costs less to sustain.
Second: Simple workforce planning concepts: understanding productive hours versus paid hours, calculating demand-based versus coverage-based FTE needs, and strategically using full-time/part-time mixes help you make intentional choices rather than reactive ones.
Third: Every midwife you keep represents $61,000 to $260,000 you didn't spend on replacement. That math should be in the room every time you make a scheduling, policy or culture decision.
Take the Next Step: Optimize Your Birth Center Staffing Strategy
The midwifery workforce shortage is real, severe and worsening. But birth centers are uniquely positioned to be part of the solution by creating the sustainable practice environments that prevent burnout and retain excellent clinicians. This isn't just good for your staff. It's essential for your financial sustainability and your ability to serve the families who need you.
Struggling with birth center staffing challenges? Where in your staffing model are you making assumptions rather than intentional choices? Consider these questions:
What is your current on-call model? Is it sustainable?
Do you know your real cost of turnover?
What would a part-time or per diem hire change for your team?
What does your team's schedule signal to recruits?
If you're ready to move from reactive hiring to strategic workforce planning, I'd love to help.
As a labor and delivery nurse and former birth center operations manager, I've guided centers through CABC accreditation, Certificate of Need processes, and the operational challenges that threaten sustainability. I combine clinical expertise with business strategy to help birth centers build staffing models that protect both your mission and your margins.
Schedule a complimentary one-time call with me and let's talk about your specific staffing challenges. Together, we can create a plan that keeps your excellent team intact and your birth center thriving.
References:
Midwifery Workforce Data
American College of Nurse-Midwives (ACNM). (2025). Midwifery workforce study. Retrieved from https://midwife.org/midwifery-workforce-study/
International Confederation of Midwives. (2026, January 18). The evidence is out: Why the world needs one million more midwives.
Burnout and Retention Research
Thumm, E.B., Smith, D.C., Squires, A.P., Breedlove, G., & Meek, P.M. (2022). Burnout of the US midwifery workforce and the role of practice environment. Health Services Research, 57(2), 351–363. https://doi.org/10.1111/1475-6773.13922
Suleiman-Martos, N., Albendín-García, L., Gómez-Urquiza, J.L., et al. (2020). Prevalence and predictors of burnout in midwives: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(2), 641. https://doi.org/10.3390/ijerph17020641
Turnover Costs and Labor Economics
Thumm, E.B., Smith, D., & Giano, Z. (2024). Evaluating the roles of workload and practice climate in workforce retention across the midwifery career lifespan: A latent profile analysis of early-, mid-, and late-career US midwives. Women and Birth, 37(6), 101833. https://doi.org/10.1016/j.wombi.2024.101833
NSI Nursing Solutions, Inc. (2025). 2025 National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf
Salary and Compensation Benchmarks
U.S. Bureau of Labor Statistics. (May 2024). Occupational Employment and Wage Statistics: Nurse Midwives (SOC 29-1161). https://www.bls.gov/oes/current/oes291161.htm
U.S. Bureau of Labor Statistics. (2024). Occupational Outlook Handbook: Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
Society for Human Resource Management (SHRM). (2023). The real costs of recruitment. Retrieved from https://www.shrm.org.
Gallup. (2019). This fixable problem costs U.S. businesses $1 trillion. https://www.gallup.com/workplace/247391/fixable-problem-costs-businesses-trillion.aspx.
Birth Center Growth and Market Data
American Association of Birth Centers (AABC). (2022). Birth Centers Are Growing. https://www.birthcenters.org/birth-centers-are-growing
Global Market Insights. (2025). U.S. Birth Centers Market Opportunity, Growth Drivers, Industry Trend Analysis, and Forecast 2025–2034. https://www.gminsights.com/industry-analysis/us-birth-centers-market
Workforce Planning and Scheduling Research
American Hospital Association. (March 2026). Costs of Caring 2026. https://www.aha.org/costsofcaring
Birth Center Operator Poll Data
Birth Center Consulting. (2026, April). Poll of birth center operators and clinical directors (n=7):
Vacancy duration: 43% still searching to fill last midwife vacancy; 14% filled in <1 month; 14% filled in 1-3 months; 14% took >12 months
Labor costs as % of revenue: 43% reported labor costs at 60%+ of total revenue (14% exceeding 70%); 29% did not track this metric
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