The peer-reviewed study in the American Journal of Obstetrics and Gynecology says a pregnancy checkbox on national death certificates inflates the death rate.

More than half of American counties don't have an obstetrician. Family physicians, working in teams with proper support, could be the answer to the crisis in rural obstetric care.

As maternity wards continue to close across the U.S., demand for midwives has grown, especially in rural areas. But hospitals and health care providers have raised concerns about licensing and safety.