It’s time to take a look at midwifery laws. This is a touchy subject – one that induces heated debate and emotion on either side of the licensure issue. I have, quite honestly, avoided delving deep into the issue here because I was hoping I would come to some sort of concrete opinion of my own before I began the conversation. But, alas, as I’ve mentioned before, I find both sides of the debate compelling, and it seems the more I learn, the muddier it becomes.
I’ve become convinced that, presently, the best course of action is to take a look at the BAD laws as a starting place. Regardless of your feelings about legislation, we will likely agree that many states with regulation, just have piss poor laws. These states need to be our “ground zero” for action.
In this series I will explore a number of U.S. states that have some of the most atrocious midwifery laws. Each part in the series will focus on a particular state – their laws, limitations, and they ways in which they oppress women. But first, it’s important to lay the foundation of WHY, in general, these kinds of laws hurt the women and babies they aim to protect.
Putting Women at Risk
Laws from state to state vary widely. In some states, midwifery is expressly illegal, in others it is legal but not regulated. In others still, it is legal for a certain type of midwife to practice (usually a CPM or a CNM), and usually in regulated states there are stringent limitations as to which women and which kinds of births midwives may attend.
Now regulation sounds well and good – and I believe it can be if it’s done right (though it rarely is). All too often, the regulatory body holds a misguided understanding of birth, in general, and of homebirth, specifically, which leads to their regulating midwifery so heavily that only a small minority of women qualify as a candidate, and / or makes it so that nearly no midwife is able to qualify to legally practice. In some proposed legislations that I’ve read, the homebirth regulation resembles the rigidity of a Baby Factory without the assembly line of the hospital.
The trouble with this kind of system is that it leaves women with fewer options. Some states will not allow a midwife to attend a VBAC (woman who has had a prior cesarean) or breech presentation or a woman who has gestated more than 42 weeks. Whether or not the State deems one woman’s candidacy as “qualified,” that woman’s convictions may very likely still cause her to choose a homebirth, regardless. (And after all, who should be trusted with this intimate and personal decision? A woman, or a broad and impersonal checklist with no considerations for personal circumstances?)
Because women will still choose homebirth regardless of what regulations are in place, this means:
- More women will choose an unassisted homebirth.
- Some women will travel out of state to find a midwife who will attend them.
- In many circumstances, women will hire a midwife practicing “underground.”
In all circumstances, if a medical need arises, the lack of continuity of care and respectful interaction between care providers places women and babies at risk. A midwife who fears repercussions may hesitate to seek medical assistance when needed. Likewise, in the event of a transfer, women are placed in the precarious position of whether to disclose their prenatal care, which would place their midwife at risk; OR stay tight lipped and face the accusation of not receiving prenatal care and the potential repercussions and fallout from that.
*Please note – I do not believe that unassisted birth (UC), as a rule, is unsafe. I do, however, believe there is a difference in safety for the woman who would choose an unassisted birth in any circumstance based on her conviction and deep belief in her body’s abilities, and the woman who chooses UC solely because she feels she has no better option.
Who is the Decision-Maker?
The bottom line in all of these laws should be that the WOMAN has the right to choose the circumstances of her birth. She and only she has the right to decide where, with whom (if anyone), and how she will give birth. She should be free to make these decisions with access to any kind of care provider she sees fit. Any law or regulation that does not have this as the foundation, fails women.
This conversation about midwifery laws, while it affects midwives, isn’t really about midwives. Midwives serve women, and bad laws restrict midwives abilities to effectively serve women. When the conversation circles around benefits or protections FOR midwives we’ve lost sight of the point. This conversation is and should always be about women and babies.
There can’t be transparency in a system that punishes those who are forthright. There can’t be safety when women do not feel free to make the choices they feel are best for themselves and their babies.
Click here for Delaware. A state where families are receiving door-to-door visits from the state in order to collect the names of homebirth midwives.