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There is a large body of evidence to show that licensing midwives has a patriarchal, racist history.

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Published Date

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

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