They provided prenatal care, attended home births, and provided postnatal care. They had a doctor providing backup if something went wrong during the delivery, meaning the patient would be admitted to the hospital and precious time wouldn't be los6 because the hospital refused to take a report on the patient's condition from a lay midwife (a big problem for them).
The area was underserved in a lot of ways and most people didn't have health insurance. The town finally got an Ob-Gyn NP a few months before I left.
Nurse midwives were originally proposed to fill the gaps in care, but qualifying requires a master's degree, meaning 6-8 years of combined education and specialized training. Most nurse midwives work in hospitals and birthing centers, they can't afford to work anywhere else. It's rare that you find one hanging out a shingle in a semi rural area.
I would love to see certification for lay midwives, something to allow them insurance payments, physician backup, and legal protection within the scope of their practice. I know how important a good midwife is in a lot of areas.