Maternity care as an essential public service: a proposed role for state government

This paper describes some of the current problems in assuring basic maternity care as an essential community service in the rural state of Vermont. Solving the cost of care problem will still leave large gaps in the ability of our maternity care system to provide continuous and high-quality maternity care for all pregnant women. The problem of access is not only a temporary aberration of the current medical care system, but a central and identifying characteristic of it. Maternity care services are as essential as other community services such as utilities and education. The authors propose that the state should assure the availability and quality of maternity care services as it would other essential services. The development of a statewide care system using a nurse midwife model of services is suggested.