NC stagnates on maternal and infant health, gets D+ from March of Dimes

by Jennifer Fernandez, North Carolina Health News
November 21, 2025

Since its opening in September 2020, 850 children have been born at UNC Health Chatham’s Maternity Care Center.

The center’s staff is made up mostly of family physicians instead of OB-GYNs. The care model aims to address the lack of maternal and infant care in rural areas, where obstetric units have shut down. 

A dozen rural hospitals across the state have stopped providing any inpatient care or closed entirely since 2005, according to the Cecil G. Sheps Center for Health Services Research.

North Carolina has struggled with access to care, especially in those rural areas. Of the state’s 100 counties, 20 are considered maternity care deserts because there are no hospitals offering obstetric services or birth centers, and no practicing obstetricians, gynecologists or certified nurse midwives.

“We need more hospitals to actually open up their maternity units again, because distance to care matters,” said Dana Iglesias, a family physician and interim medical director of UNC Health Chatham’s Maternity Care Center.

A recent study by March of Dimes researchers, published in Jama Network Open, puts an exclamation point on that statement. The study found that babies born in counties with little or no access to maternity care face a much higher risk of death in their first year.

Infant mortality is one of six measures tracked in the annual March of Dimes report that looks at how the U.S. is handling maternal and infant health. The 2025 report, released Monday, Nov. 17, gave North Carolina a D+, the same grade as last year and the same grade as the U.S. as a whole. Twenty-seven states received a C or higher, with New Hampshire earning the only A.

There was little movement in North Carolina on any of the measures tracked: preterm birth, infant mortality, the rate of low-risk Cesarean births, access to adequate prenatal care, severe maternal morbidity and maternal mortality.

“We’re the only high-income country struggling with this, who have moms and babies dying with supposedly all the resources that we have,” Iglesias said.

In its report, the March of Dimes said nearly 380,000 babies in the U.S. were born preterm last year. That’s one in 10 births, putting the country “among the highest rates in developed nations.”

“Behind that static letter grade lies a troubling truth: our nation remains stuck in a maternal and infant health crisis,” the nonprofit said, adding that progress “is not reaching the families who need it most.”

March of Dimes report card by Jennifer Fernandez

Little change

North Carolina’s preterm birth rate of 10.7 percent remained the same as the previous year. That’s even though some counties, including Durham, Guilford and Wake, saw their rates improve.

The state’s infant mortality rate continues to hover around 7 deaths per 1,000 live births, which is essentially the same as before. That means in 2023, 834 Tar Heel babies died before their first birthday.

In a bright spot in the report, the state performs a smaller percentage of C-sections for low-risk births, 24.9 percent compared with 26.6 percent for the U.S. (That also represents no change from the previous year for the state.)

North Carolina’s statistics reflect racial and ethnic disparities, which means that some babies continue to die at much higher rates than others. 

From 2021 to 2023, Black babies died at a rate of 12.1 per 1,000 live births. By comparison, the rate for white babies was 5.2 per 1,000 live births. Overall, babies born to Black moms die at 1.7 times the state rate.

Preterm birth and low birth weight account for 17.2 percent of all infant deaths. An array of other things cause infant deaths, ranging from birth defects, to homicides, to accidents and sudden unexpected infant deaths (previously known as SIDS). 

Meanwhile, 18.6 percent of North Carolina mothers receive inadequate prenatal care. That’s a larger share of women who lack this important care than the national average of 16.1 percent.

Only 72.3 percent of mothers in North Carolina start prenatal care in the first trimester, compared with 75.5 percent of U.S. moms.

Elizabeth Tilson, North Carolina’s former state health director and chief medical officer, said she wasn’t “too disheartened” by the report.

“These types of metrics take a really long time to move,” said Tilson, who was recently named executive director of Nurture NC, a new nonprofit focused on improving maternal and infant health in the state.

And North Carolina has been taking steps that will help address maternal and infant health, she said. Since 2022, the state has expanded Medicaid, as well as extended Medicaid coverage to women for one year after giving birth. The state also altered the law to allow certified nurse midwives to practice without physician supervision after meeting certain criteria. 

Tilson said organizations like Nurture NC are also looking at ways to make some headway on these issues. Some of that, she said, is simply making better use of existing resources.

Ensuring ‘a healthy start’

According to Tilson, Medicaid funding is vitally important for maternal and infant health. 

The federal health care program for low-income people covers 35.8 percent of live births in North Carolina, according to the March of Dimes report. In some, predominantly rural, counties Medicaid covers as many as eight in 10 births. 

In 2024, that amounted to 43,842 Medicaid-supported births in the state.

“We really want to be sure we are funding those things that are gonna help people have that healthy start,” Tilson said.

She said it is unfortunate that Medicaid cuts this year at the state level led to the loss of the Perinatal Quality Collaborative of North Carolina. The group coordinated initiatives at hospitals intended to improve perinatal and maternal outcomes, such as reducing cesarean section births, increasing exclusive breastfeeding in newborn nurseries and reducing central line infection rates.

“The investment in young families and infants are going to give you that long-term return on investment,” Tilson said. “That’s not an area we should disinvest public dollars.”

Since the transformation of Medicaid to being a program run by managed care companies in 2021, more young families are receiving a suite of value-added benefits from those companies that really help moms and babies. That help can be anything from providing car seats to offering breastfeeding support to paying for birth doulas, Tilson said. 

Unfortunately, she said, not everyone is using them. Nurture NC wants to make sure patients and providers are aware of and using those services, she said.

Another underutilized service Nurture NC hopes to promote is UNC’s NC MATTERS, a hotline for providers that need help addressing mental health issues facing pregnant and postpartum patients. 

The hotline is only getting about 12 to 15 calls per week, Tilson said, so they have a “huge amount of capacity not being used.”

Other states have seen success with using mobile care units to reach people for prenatal care, said Pat Campbell, a nurse who serves as director of maternal and infant health for March of Dimes of North Carolina. She said the state chapter is in the early stages of exploring that.

“I do think that has some potential for North Carolina, perhaps in the future, when we’re thinking about access to care,” Campbell said.

Campbell and Tilson lauded the state’s 2023 law change that gave certified nurse midwives the ability to practice without physician supervision after meeting certain criteria. Maternal and infant health advocates said the loosened restriction would pave the way for more certified nurse midwives to open practices, reaching into underserved areas.

At the time that law was passed, the state had only one standalone birth center where certified nurse midwives, under the supervision of a physician, provided maternal and infant care. Since then, five more have opened, according to the Commission for the Accreditation of Birth Centers. Three are in suburban areas — Buncombe, Iredell and Onslow counties. Most of the new centers are run by certified nurse midwives.    

“I’m really happy to see that, because people need more birth options, they don’t need less,” Iglesias said.

The North Carolina Child Fatality Task Force has been exploring another way to expand the maternal health care workforce. The legislative study group of volunteer experts, state agency leaders, community leaders and state legislators researches child health issues and makes policy and spending recommendations to the General Assembly. The task force has been gathering information about licensing certified professional midwives. 

This category of midwife does not have to be a registered nurse, but must meet certification standards set by the North American Registry of Midwives. North Carolina currently prohibits the practice of CPMs. 

Senate Bill 617, a bipartisan bill introduced this legislative session, would have created a license for certified professional midwives and established a North Carolina Council of Midwives to oversee CPMs in the state. The bill did not advance after it was filed in March.

The task force has not made a recommendation on CPMs.

Campbell said more work needs to be done to determine how certified professional midwives would operate in North Carolina, but she also sees the potential benefit. 

“Coming together and creating that type of thing with the professional midwife could help provide some answers for the maternity deserts,” she said.

Increasing the maternal health workforce is one of the focus areas for Nurture NC, which is ramping up its work after 18 months of research and planning. The group is also focusing on increasing access to care and optimizing public policy. 

“It’s going to take a long time to change, and it’s going to take investment in multiple sectors,” Tilson said. “It’s not just one thing.”

This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.