Details

Published: 24 October 2025

To:

Fr: Joyce Kimball

Dt: October 24, 2025

Please share the following/attached letter with the Board of Registration in Midwifery members before the next meeting.

I have already sent 2 well-researched, annotated letters to the Board of Registration in Midwifery – 1 letter in August 2025 and 1 letter in September 2025. This letter comes from my heart, a MA home birth midwife with a 25 year history of attending continuity of care home birth clients who fully express their body autonomy in their birth choices. 

I was hopeful when I attended the in-person Board of Midwifery meeting in October 2025. We now have a Board positions filled. The Board members were saying comforting words such as “this law is about increasing access”, “the draft of the rules and regulations has a component for individual choice” and “the Board is focused on codifying the Midwifery Model of Care”. Lovely sentiments.

Then the yellow flags started.

• the Commissioner is the person that will make the final decisions about the rules and regulations.
• The Board is creating rules and regulations based on the “norm” to make the rules and regs move as quickly as possible through the process.
• The informed choice provided by home birth midwives to folks wanting a home birth after cesarean (HBAC) will no longer be good enough. Folks wanting an HBAC will need to have an informed choice discussion with ob/gyn or MFM – care providers that have never attended or seen a home birth.
• Some board members didn’t know how to create their own scope of practice and informed choice documents and will use these rules and regulations to practice the rules vs. practice to the client.
• Some board members seemed surprised that an ob/gyn or MFM could be coercive or threatening or biased and suggested that clients and midwives should report providers that behave badly.

Unfortunately, terrifyingly, providers in the U.S. maternal industrial complex - ob/gyns and MFM doctors - groom, terrorize, and frighten birthing people; not all ob/gyns or MFM doctors; but enough.

More than 30% of birthing folks come through the maternal industrial complex birth process reporting not being listened to, yelled at, told to be quiet, frightened, threatened, physically held down, and told that their baby will die if they don’t do what the doctors tell them to do. Check out Dr. Rebecca’s birth trauma at UMASS Memorial and how the complaint was handled. https://www.babiesincommon.com/show/item/32-filing-a-complaint-after-birth-trauma-with-rebecca-zanconato-md. I filed a complaint with the Board of Medicine when I watched an ob/gyn manually tear a birthing person’s perineum with her hands. I received a form letter to my complaint. The ob/gyn is still practicing.

Birthing folks are discriminated against, gaslit, coerced, fear mongered, threatened and assaulted. Check out the obstetrical violence map: https://birthmonopoly.com/obstetric-violence/. Birthing folks have been told,

“It’s not about what you want, we are going to follow my plan.”

“I’m not going to take my hand out of you until you calm down.”

“If you deliver your baby at home, you and your baby will die.”

“You don’t want Pitocin? Do you want to die? Don’t you want your baby to have a mom?”

“You don’t need a birth plan; were a Baby Friendly hospital.”

“I’m not going to stop rubbing your baby.”

“I’m not comfortable with you pushing in any position than on your back.”

The idea that MA birthing folks and midwives could report harmful MA ob/gyns and MFMs to an MA authority that will actually change behavior is victim-blaming and part of obstetrical-violence culture.

The fact that ob/gyns and MFMs are the chosen folks, in these rules and regulations, to have informed choice conversations with certain folks wanting a home birth continues the violence.

The fluffy words, Midwives Save Lives, were slapped on this bill/law. These rules and regulations are being written so that home birth clients will be required to “collaborate” and/or “consult” with the U.S. maternal industrial complex – the very complex that has harmed so many birthing people; the complex that has the poorest mother and baby outcomes in the developed world. 

No one is coming to save MA home birth midwifery from being swallowed by the medical industrial complex. The commissioner has already shown his bias when the bill became law. The Commissioner doesn’t know a thing about home birth midwifery and wrote in restrictions on who can be on the Board. Someone, maybe someone from the Mass Medical Association, maybe someone from the midwifery community, called him and asked him to write into statute that certain CPMs can’t be on the Board. It’s possible that every rule and regulation that this Board writes will be re-written by a Commissioner who listens to the MA maternal industrial complex folks. He’s already done it.

For some Board members, the desire to have government permission to have CPMs work in (currently non-existent) birth centers in MA has made them choose rules and regulations that:

1. Make CPMs more palatable to the medical industrial complex and
2. align with the (non-autonomous, heavily government regulated) birthing practices of birth centers

I’m thrilled to hear that it takes the average new licensing board 3-10 years to pass rules and regulations because of all the people that need to review, comment and approve the rules and regulations. But the damage is done – Bay State Birth Coalition pushed this bill to license home birth midwives, surrounded it with feel-good legislation about lactation consultants and postpartum visits. At some point in the future, long after most have forgotten about it, this law, and its rules and regulations, will decimate the autonomous practice of home birth midwifery in MA.

My plea is that the informed choice clause 274 MR 5.03 (3) is not destroyed or reduced in the years of review that these rules and regulations will go through. To all MA midwives, please reach out to your midwifery colleagues if you need an informed choice document. Please utilize documented informed choice with your clients to the fullest extent. With the rules and regulations undercutting autonomous midwifery, please do the best you can to practice client-centered autonomous midwifery.

Details

Published: 24 October 2025

September 23, 2025

Dear Executive Director Burke and Chairperson Herman,

Thank you for the work you are doing in creating rules and regulations.

I am interested in attending the in-person October 16, 2025 meeting.

Could you please email or make available the documents you have been using to create the rules and regulations so that I may follow along at the October meeting?

I respectfully submit a request that, at the October 2025 meeting, the Board discuss how informed choice, informed consent and informed refusal is provided for in all aspects of “An Act Promoting Access to Midwifery Care and Out-of-Hospital Birth Options”, especially and including the Rules and Regulations.

There is a large body of evidence to show that licensing midwives has a patriarchal, racist history. Licensing midwives has been used as a white, male, Christian government weapon to keep women’s bodies monitored and in-line. Please see Columbia Journal of Race and Law. “Midwives and Pregnant Women of Color: Why We Need to Understand Intersectional Changes in Midwifery to Reclaim Home Birth” by Danielle Thompson. https://journals.library.columbia.edu/index.php/cjrl/article/view/2312 “…the racist and sexist underpinnings of the change from home to hospital birth still operate in our current birthing systems to keep women of color in hospitals and out of the midwifery profession.” I have listened to the last several Board of Registration in Midwifery meetings and respectfully request that the rules and regulations discussion be less about what the (patriarchal, racist, misogynistic) “evidence” shows (i.e. risk of death with postdates, GBS, cardiac disease, etc.) and more about a person’s right to be informed and make a choice about the care they choose.

As Hermine Hayes-Klein, JD spoke about in her Gold Midwifery Conference in 2025 “Protecting Your Midwifery Practice: Legal Strategies for Practicing with Confidence”, barriers have been created/legalized/enforced on pregnant people who desire a vaginal birth, a vaginal breech birth, a vaginal birth of multiples, giving birth at home, giving birth at a free-standing birth center, giving birth unassisted, choosing when and whether to (have an abortion).

Hermine Hayes-Klein, JD recommends a 3-step process of informing, advising and supporting, essentially encouraging and maintaining an autonomous midwifery practice. The MA law has removed this ideal process of informing, advising and supporting choice and denies the practice of autonomous midwifery care to folks you, the Board of Registration in Midwifery, will deem “high risk”. I hope that the Board of Registration in Midwifery can follow Hermine’s advice of informing, advising and supporting rather than outlawing while finalizing the rules and regulations to be placed on birthing folks and community midwifery care in MA.

Body autonomy and reproductive choice are of the upmost importance. In ACOG’s “Refusal of Medically Recommended Treatment During Pregnancy” Ethics Committee Option No. 664 (June 2016) “Pregnancy is not an exception to the principle that a (sic) decisionally capable patient has the right to refuse treatment, even treatment needed to maintain life. Therefore, a (sic) decisionally capable pregnant (sic) woman’s decision to refuse recommended medical or surgical interventions should be respected.” And “Consenting freely is incompatible with being coerced or unwillingly pressured by forces beyond oneself. It involves the ability to choose among options and select a course other than what may be recommended.”

As the Board discusses the rules and regulations to be placed on midwives and birthing bodies, especially when to consult and when to transfer, I am reminded of the “Midwife Permit” and the “Certificate of Examination” cards I saw on display at the National Museum of African American History and Culture. https://www.searchablemuseum.com/midwives-tradition-and-transition/#regulation-and-restriction

As the exhibit label says, “…midwives faced increasing restrictions on how they could practice…states passed laws that required midwives to be formally trained and certified as “suitable” by local health officials and physicians. Eventually, the practice of midwifery was restricted to registered nurses or certified nurse midwives, who were required to work under a doctor’s supervision. These regulations, in part fueled by the white medical establishment’s prejudiced views of Black and immigrant midwives, effectively eliminated the traditional lay midwife…Black midwives were also often excluded from…training programs which privileged white applicants.”

In some parts of the U.S. in the 1950s and 1960s, both midwives and women were examined by white, racist, elitist men to be deemed suitable to practice midwifery and suitable to be attended by a midwife at home. The Certificate of Examination cards say, “Name: _________, Has been examined during this pregnancy and may be delivered by a midwife if no complications develop.” And it is signed by a man. Maybe we are continuing this practice in a fancier form through “An Act Promoting Access to Midwifery Care and Out-of-Hospital Birth Options” https://malegislature.gov/Laws/SessionLaws/Acts/2024/Chapter186?

I respectfully submit a request that, at the October 2025 meeting, the Board discuss how informed choice, informed consent and informed refusal is provided for in all aspects of “An Act Promoting Access to Midwifery Care and Out-of-Hospital Birth Options”, especially and including the Rules and Regulations.

Thank you for your consideration.

Sincerely,

Joyce Kimball

508-728-6588

Details

Published: 24 October 2025

August 4, 2025

Dear Executive Director Burke and Chairperson Herman,

I have been an active, practicing home birth midwife in Massachusetts for 25 years. My livelihood is now covered under the actions and regulations made by the Massachusetts Board of Registration in Midwifery. I respectfully request this letter be read at the next Board meeting to develop discussion points so that the public can hear and understand the Board’s perspective.

While not in MA, I understand that midwives in many states across the U.S. were persecuted and prosecuted for home birth midwives. I understand that this effort to license MA home birth midwives was with good intent.

1. Could the Board be curious about how home birth midwifery in MA is working now? MA home birth midwives have been working with Massachusetts Midwives Alliance (MMA) practice guidelines since the 1980s. http://massmidwives.org/for-midwives/forms-and-documents/ We have well-developed practice guidelines that, before COVID, had been reviewed regularly by actively practicing MA home birth midwives. Could the Board review the MMA practice guidelines as a way to develop rules and regulations from a bottom-up approach vs. a top-down approach? Is there a way to codify what’s currently working vs. create mandates and restrictions on choices for birthing bodies? Please note that pages 31 and 32, Appendix 1: Transfer Criteria of the MMA guidelines include transfer criteria during pregnancy, during labor, during the postpartum period and for the newborn. But most importantly, throughout the MMA guidelines, the emphasis is on bodily autonomy, informed decision-making, birthing person as ultimate decision-maker…”When a primary care provider decides that a (sic) woman and/or baby must be transferred, the family will participate in the decision-making process and will be given a full explanation of the immediate problem and reason for the decision.” If MA home midwifery care has had the best outcomes, can we use the existing MMA practice guidelines for rules and regs?

2. MA home birth midwives have been practicing under the auspices of bodily autonomy and choice. Every MMA guideline ends with: “If the client declines any recommended (prenatal) care in the presence of variation, the midwife should document client education and discussion of why the care is recommended and obtain signed evidence of informed choice.” Please see the attached Group Beta Strep guideline. The emphasis is on “offer” and “discuss” and not “not allowed” and “prohibited”. Could the Board develop rules and regulations that are less about having “teeth” to punish home birth midwives and home birthing families for not following the government rules and include provisions such as the above that include choice, bodily autonomy and informed consent/refusal and non-abandonment of care?

3. I’m assuming the law to license midwives was intended to increase home births and increase home birth midwives. Last month’s discussion included “cardiac disease” as an immediate transfer of care item. Board member Kristin mentioned a case of a client who had an unrelated cardiac issue and had had 2 home births. If “cardiac disease” were to be put in the rules and regulations, this client, who has had home births, would no longer be allowed to have a home birth in MA with a MA licensed midwife. Adding a government regulation that suddenly makes a birthing body illegal to have a home birth may not have the intended consequences; it may not compel this birthing person to go to the hospital for their next birth. It may compel the birthing person to bypass this restriction on their body by, for example, crossing state lines, renting a room in another state or flying in a care provider to get the midwifery care they want and has had in their previous pregnancies. Or they could have an unassisted birth.

“Women seeking alternatives to the hospital system are increasingly in a position of not having access to midwife-supported care. This can lead women to plan a birth ‘outside the system’, without the presence of a health professional (Jackson et al., 2012; Rigg et al., 2018)." “Birthing Outside the System: The Canary in the Coal Mine by Hannah Dhalen, Bashi Kumar-Hazard and Virginia Schmied. Can the Board develop rules and regulations with an emphasis on increasing or embracing home midwifery care vs. denying access to care/restricting midwives from attending previous home birth clients who would become illegal under the regulations?

4. Could the rules and regulations be made from a place of “most common” scenarios vs. “dead mom/baby” scenarios? Can the discussion about birthing bodies’ choices and the midwives who support them come from an increases access to home birth midwifery perspective? Recounting “dead/damaged mom/baby” scenarios is a form of emotional manipulation. Recounting worst case scenarios can be misused to pressure individuals into making decisions they might not otherwise choose and is counterproductive to fostering respectful and open dialogue. It can escalate emotions, create defensiveness, weaponize safety, infantilize birthing people and hinder the possibility of meaningful communication about sensitive topics.

5. On that note, is the Board developing rules and regulations via vote or consensus? Whose voice counts the most? I know home birth midwives have been trained to be quiet, stay under the radar, don’t make waves, don’t push back; but can the public hear more opinions during the public Board meetings from the 5 home birth midwives on the Board? We know that our culture is racist and misognistic and anti-midwifery. We know that the U.S. maternity industrial complex weaponized "safety" and prosecuted Granny Midwives out of existence. We know that ACOG and AAP have been organized around a white, male, power gaze and maternity studies have been done looking at metrics on bodies without considering impact on the human. I believe midwifery rules and regulations should be from actively practicing home birth midwives and not from the studies and culture and organizations and opinions that are not run by home birth midwives, that are not home birth midwifery focused, that are not supportive of home birth, from folks who have never attended a home birth. Can the Board develop the most open, welcoming, midwifery-model-of-care-centered and human-centered rules and regulations in the nation?

Sincerely,

Joyce Kimball, MBA, CPM, ADN, RN, LM

Details

Published: 10 November 2024

On August 23, 2024, the Governor of MA signed Chapter 186 of the acts of 2024, An Act promoting access to midwifery care and out-of-hospital birth options (very mis-titled if you ask me) establishing the Board of Registration in Midwifery within the Department of Public Health (DPH). https://malegislature.gov/Bills/193/H4999

I was devastated that the bill to license MA home birth midwives passed. When the mostly white, male, wealthy, non-midwifery folks went behind closed doors in August 2024 to discuss and decide on this bill, there were lots of scary provisions in the bill. Did you know that there were no midwifery folks in the room where it happened? Legislators go behind closed doors and horse-trade provisions based on conversations and dealings they’ve had with a huge variety of folks – friends, educators, midwives, Massachusetts Medical Association, lobbyists, and national organizations. Per America, the folks with the most time and money seem to be listened to the most.

And it is done. It is law. And I am so sorry to the birthing folks for the restrictions on birthing bodies that were listed in this law and are about to happen to their bodies from the new Board of Midwifery rules and regulations.

The law is about 50 pages long. Buried in there with laws on donor milk, lactation consultants, that Certified Professional Midwives (CPMs) can work in birth centers, that every person is allowed 1 postpartum home visit covered by insurance or the state, that postpartum mood screening is required by law, the creation of perinatal task force, no home ultrasounds by midwives, infant and fetal mortality reviews, new rules and regs to come for birth centers, dissemination of pregnancy loss stats, creation of a digital resource center on perinatal mood and anxiety disorders, creation of a lactation board and lactation licensure, there are about 15 pages that license MA home birth midwives. There is nothing in the law that says public or private insurance covers home birth.

Page 5 - The Board of Midwifery will be a group under the DPH and will include 5 midwives (appointed by the Governor), and an obstetrician, a maternal fetal medicine doctor and a consumer who are directed to create rules and regulations about which birthing bodies are allowed to birth at home and which are not. The Board will “administer the licensing process, investigate complaints and hold hearings and order disciplinary sanctions against a person who violates any part of the bill or any regulation promulgated by the board”. Did you know that on the 17 person Massachusetts Board of Nursing, 1 position is a physician? Did you know that on the Maine Board of Nursing, there are no physicians on the Board making rules and regulations on nurses? It seems like MA legislators have implemented a lot of medical male dominated oversight of home birth midwifery.

Pages 26, 32 and 33 – Lots of mentions in this law about “low risk” birthing bodies. Midwives licensed in MA are only allowed to attend “low risk” pregnancies, “including, but not limited to, factors related to …gestational age and presentation of the fetus at the time of labor and delivery.” I wonder if that means no home births for birthing bodies past 42 weeks of pregnancy and home births if the birthing body holds a baby not in a head down position?

Page 29 - They changed the malpractice requirement to “MAY” – i.e. the board of midwifery MAY require licensed midwives to have professional malpractice liability insurance. Good that expensive, unnecessary malpractice insurance is not now required but this provision is tenuous and subject to change at any time.

Page 30 – A person will be allowed to be licensed to practice as a midwife by the state of MA if they:

1. get their Certified Professional Midwife (CPM) certificate via the expensive MEAC midwifery school.
2. get their CPM via the apprentice process AND get a MEAC certificate.
3. get a midwifery license in a different state that doesn’t require MEAC.
4. get licensed in another state that has similar qualifications and standards.

Page 31 – No Granny midwives allowed. Only licensed MA midwives will be allowed to attend home births in MA. There is an “injunction against any person practicing midwifery without a license. Proof of damage or harm…shall not be required for an injunction.” Folks tattling to the Board of Midwifery about a midwife not following the law or board regs will not be held “liable”.

Pages 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 – I see where it says Mass Health/Medicaid must pay for non-invasive prenatal testing, postpartum depression screenings, donor human milk, doula services, postpartum home visiting services but I don’t see where it says that Medicaid must pay for home birth.

Page 45 – Creation of task force on “maternal health access and birthing patient safety”. I get a bit nervous when the government wants a task for on the reproductive health of birthing folks.

And the icing on the cake is page 47 where the midwives on the Board of Midwifery, the midwives who will work with an obstetrician and a maternal fetal medicine doctor and a consumer to determine who can and who can’t have a home birth, will be required to have their Certified Professional Midwife certificate from the expensive, elitist MEAC school. Midwives who received their Certified Professional Midwife certificate from any other avenue are not allowed to be on the Board of Midwifery. It feels like we are back to the time when those in charge claimed “Midwives are “dark, dirty, ignorant, untrained, incompetent women…”. It divides midwives into better and best. It excludes midwives with years and years of hands-on midwifery experience because they didn't get their CPM certificate from the "right" school.  

I don’t know how this will all play out. I only know that I can’t find a benefit to being licensed by the state of MA and I see the reduction of birth choice for birthing folks already baked in the law.

*** help us.