Certified professional midwives’ groups, including The North American Registry of Midwives (NARM), have continued to rally for more defined state licensing requirements.
Currently, the laws in states regarding where a midwife can practice vary widely, some with no laws at all. “It’s a huge consumer issue. Expectant mothers want midwives whose qualifications are recognized by the state,” explained Ida Darragh, NARM’s executive director.
In the past three years, Maryland, Indiana and Rhode Island have authorized licensing for midwives while other states have remained hesitant. Professional healthcare groups, including nurse-midwives and obstetricians, continue to voice their opposition in states like Illinois, Alabama and South Dakota.
Safety concerns surrounding home births remain at the heart of the opposition. The American Journal of Obstetrics and Gynecology published a 2014 study which found neonatal deaths to be four times higher when a midwife attends to an at-home birth rather than an in-hospital birth. When the birth was a first-time delivery, the fatality rate went up to seven times greater.
Jennifer Crook of Birmingham, Alabama is a certified midwife with more than 200 births, but due to Alabama’s stance on not licensing midwives for non-hospital births, Crook travels to Tennessee with her patients. Twenty other states follow Alabama’s current guidelines. In addition, Medicaid will only authorize payment for services by certified midwives in 12 states.
Home births are especially popular in states like Alaska, Montana and Oregon, which are more rural and have less professional care within driving distance.
In an effort to increase licensing requirements, the American College of Obstetricians and Gynecologists assisted in brokering a deal wherein midwives could obtain a state license if educated by an accredited midwifery teaching university. The group also added a stipulation that only allows midwives to proceed over low-risk pregnancies.