CARMEL, Ind. — Inside Ascension St. Vincent Carmel, eight-month-old Rowan stays busy exploring the room.
"The song that Rowan was born to is literally called 'Making a Move' and she's just not stopped moving since," said Amanda Thomas, Rowan's mom.
While playing with Rowan, Amanda catches up with the woman who helped deliver her baby, her midwife Desirae.
Choosing a midwife was a big decision for Thomas and one she didn't make lightly.
"I really felt like they cared about me as a person and not just a patient," Thomas said. “They were so mindful about checking in with me mentally and emotionally as well as looking at how my body was doing throughout pregnancy. And I thought that was so special and unique and I felt fully supported as a woman. I felt like I was getting to work with professionals that really cared about my mental well-being."
That focus on her mental and physical health, along with how well her baby was growing, she felt was key.
"During my labor, I ran into quite a few challenges and just unexpected experiences that had me making game-time decisions. That got to be this opportunity to lean into help and lean into feeling supported," Thomas said.
But for other women in Indiana and around the country, deaths from complications related to pregnancy are high, and getting worse.
"We have a problem in the U.S. and we have pretty terrible maternal morbidity and mortality rates, especially for how much money we spend on health care," said Desirae Michalisko, certified nurse midwife at Ascension St. Vincent Carmel.
Globally, data from the Commonwealth Fund shows the U.S. far exceeds other high-income countries.
And, Indiana's maternal mortality rate is ranked one of the worst states in the country, with the Hoosier state seeing an uptick in maternal deaths in recent years.
It's a problem made worse as one-third of Indiana counties don't have a delivery hospital, often hitting expecting moms in rural counties the hardest.
"When we compare across the board, we are doing very poorly and Indiana is top of the list. So, we are not doing well," Michalisko said.
Michalisko said pregnant women being unable to access qualified care providers, resources and services is a growing problem, especially in rural areas.
Expanding access to midwifery programs, she believes, can help reach and care for more expecting moms in the Hoosier state.
"I think there's a real opportunity for certified nurse midwives to move into that space and reach people where they're at and improve these numbers," Michalisko said.
But, she said, that often starts with educating Hoosiers more about what midwives do.
"I try and explain it to people as, I'm a nurse practitioner who also delivers babies," she said.
Michalisko explains while OBGYNs are better suited for high-risk pregnancies or women with health complications, midwives are the 'experts in normal', able to help a majority of expecting moms. And, she said, they're well suited to being able to reach expecting moms in these rural areas of the state. But right now, not many Hoosier hospitals have midwifery programs.
The Ascension St. Vincent midwife program in Carmel has been around for three years and growing all the time.
"Right now, almost exclusively patients come to us from word of mouth," Michalisko said. "So, our practice has doubled in size, even just from last year. So we're moving in the right direction and I think it's really great."
Thomas said for many expecting moms, the maternal mortality rate is concerning and women want to know they and their babies are in the best possible hands.
"Being able to give birth somewhere that I was so fully supported in what I knew to be the right decision for myself was everything," Thomas said.
For her and Rowan, having a midwife like Desirae in their corner made all the difference in the delivery room.
Nationally, the number of certified nurse midwives helping deliver babies is rising year after year, according to data from the American College of Nurse-Midwives.
Nationwide, roughly 10% of all babies are attended by a certified midwife or certified nurse midwife.