Birth Services

Joyce Kimball, CPM


Midwifery Licensure Restricts Women's Birth Choices

From the licensing and regulation of American granny midwives out of existence, to the Skype midwives, traveling midwives, women who birth unassisted, and women who cross state lines to birth with whom and how they want, there is 100 years of evidence that licensing midwives restricts women’s birth choices.

The evidence shows that the 2000 term breech study was flawed and vaginal breech birth should be an option.

The Maine compromise was not a pause; it was acquiescence to make it “politically palatable” to the Maine Medical Association and the Maine nurse midwife association due to the pressure the MMA and Maine chapter ACNM was getting from their national organizations. Now HBACs are not allowed, per statute in Maine.

I looked at every state’s licensing laws. 23 of the states that license have severe restrictions (everything from required physician permission to home birth to no HBACs to only certain types of midwives can attend home birth to required vaginal exams, required testing, required transfer if woman doesn’t “progress” according to the state, to outright making home birth midwifery illegal, etc.) on a woman’s right to choose. These states are: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Indiana, Louisiana, Maine, Maryland, New Hampshire, New Jersey, New Mexico, New York, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, Wyoming.

No state has rescinded nor lessened their restrictions. Only Minnesota, Montana, Virginia, and Wisconsin license midwives without restricting women. 13 states do not license midwives and therefore do not restrict women’s choices - Connecticut, Hawaii, Kansas, Massachusetts, Mississippi, Missouri, Nevada, North Dakota, Ohio, Oklahoma, Oregon (voluntary licensure), Pennsylvania, Tennessee. 7 states do not license but make home birth midwifery illegal - Alabama, Illinois, Iowa, Kentucky (no permits given since 1975), Nebraska, North Carolina and South Dakota. Michigan just licensed and rules and regulations have not yet been written. West Virginia is licensed but I couldn’t find their regs.

It is educational elitism to require trained, experienced, educated home birth midwives to complete additional expensive unnecessary education. Requiring additional education was just one way that the U.S. regulated “dirty” and “uneducated” granny midwives out of existence. Additional education does not make birth safer. Additional education means that poor women can’t access midwifery as a career choice to serve their community.

As Autumn Vergo wrote, “Refusal to accept that safe practice may mean turning some clients away is a factor in keeping midwifery unintegrated with the rest of maternity care.” I accept birth. I accept that words “safe practice” means “practice the way the state wants a midwife to and not according to a mother’s wishes.” I accept that turning women away by declining their birth choices sends them to either the often abusive hospital system or to unassisted childbirth. I accept and I’m ok with home birth midwifery not being integrated with hospital midwifery care.

By restricting a woman’s right to choose, we end up with court-ordered cesareans. While I may not agree to attend a woman having triplets at home, it’s her choice. It’s not “some” clients who are restricted by criminalizing home birth midwifery. It’s every woman who has her health choices restricted. When the state determines that they know better, women have lost their childbearing rights.

As a home birth midwife I am fully integrated with the maternity care system. I collaborate daily with all aspects of the maternity system and have transferred smoothly to the hospital about 100 times in 15 years. I don’t need a piece of paper to develop deep, trusting relationships with my community maternity care system. Nor do I need a license to transfer smoothly and professionally.

I do not agree that “midwifery is accessible to practitioners who choose to be socially and financially marginalized…privileged.” I am not, nor are the midwives I work with privileged nor socially or financially marginalized. I do agree that expensive, required, elitist education makes midwifery a privileged and financially marginalized career, out of reach for poor women.

I have students of all kinds shadow me for days – all types of residents, lab techs, paramedics, nurses. Every practitioner in the room can watch how I support a woman’s right to informed consent/declination. I do not need a piece of paper to model the midwifery model of care.

My community is Massachusetts. My clientele is mostly urban and rural middle class and poor. It includes young and old, white and women of color, super wealthy and homeless. Home birth midwifery needs marketing, not restrictions.

I see no benefit to licensing; only harm to midwives and human rights violations to women. As Nikki Chamoy said, “Making certain women’s health choices illegal has never improved women’s health.” Why oh why would women agree to legislative restrictions on their bodies?

Keep your laws off my uterus.