The 'State' of Midwifery: Pushing for Legalization

When women want out-of-hospital maternity care, they deserve legal access to midwives trained to provide it. In 23 states, Washington D.C., Puerto Rico, and Guam, Certified Professional Midwives (CPMs) face prosecution for serving women who have decided not to give birth in a hospital. Families in these states are forced into an underground economy of providers whose training and credentials could be difficult to ascertain, and are left without any means to report a practitioner who lacks adequate skills. If they do opt to hire a midwife who is practicing illegally, smooth and efficient transfer to a higher level of care can be compromised in the event that it becomes necessary, putting mothers and babies at risk. That’s why more and more states, pushed by consumers and their allies who are part of The Big Push for Midwives Campaign, are passing legislation to license CPMs.

No federal law, Supreme Court decision, or Constitutional amendment can ensure access to CPMs, because licensing and regulation of health professionals occurs at the state level. The Big Push for Midwives engages with consumers in state-by-state efforts to secure a path to legalization and integration of CPMs. Advocates have been on the ground doing this work for years, and are gradually achieving success. Groups like the Alabama Birth Coalition, Ohio Families for Safe Birth, North Carolina Friends of Midwives, the Coalition for Illinois Midwifery, and Massachusetts Friends of Midwives, and others, are tireless grassroots organizers for women and families who chose to give birth outside of the hospital.

Aggressive, well funded forces of organized medicine seem determined to keep Certified Professional Midwives underground.  This includes the American Congress of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA), organizations that wield their reputations and considerable financial influence over state legislators.

The medical journal The Lancet recently published an editorial that concluded “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.” This is a familiar message to reproductive health activists: women don’t have the right to value our own lives when babies are involved. And, if the opinion of a doctor or judge about the wisdom of a particular woman’s choice for maternity care differs from her own, she may be forced to accept medical treatment that she doesn’t want or need.

Punitive attacks on women’s rights in birth are not the sole province of the medical establishment. Child protective services in Illinois and Ohio have seized custody of newborns of women who chose home birth with midwifery care - even though the babies born at home were perfectly healthy.  Families have lost custody of their children or faced CPS investigations simply because the mother gave birth at home with a midwife in a state where her legislators have failed to regulate and license Certified Professional Midwives.

Whether or not state legislatures respect the wishes of their constituents and vote to legalize CPMs, women will continue to choose home birth. This is why licensing and integrating CPMs, trained and experienced experts in out-of-hospital birth, makes sense for American women.

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