Laws, laws, and more laws...
If you were to spend a leisurely vacation driving the length of the Atlantic coast from Florida to Maine in search of a good place to have a home birth, you would encounter:
- 3 states in which home birth attendees must be licensed Certified Professional Midwives* (CPMs)–(New Jersey, Virginia and South Carolina)
- 2 states that allow Certified Midwives** to attend home births, but only those who have taken a specific test from the American Midwifery Certification Board (New York, Rhode Island)
- 1 state which allows midwives to get a license if they pass a different exam than the one given in New York and Rhode Island. (Florida)
- 1 state which allows CPMs, but not CMs, to practice with a state-issued certificate (New Hampshire)
- 1 state which allows CPMs, but not CMs, to practice with a state-issued permit (Delaware)
- 2 states in which “direct-entry” midwives are flatly prohibited (North Carolina, Maryland)
…and 4 states inhabiting a kind of legal alternate-universe:
- 2 states in which direct-entry midwives are legal “by judicial interpretation or statutory inference” (Maine, Massachussetts). “Inferred legality”! What a concept!
- A Zen-like state (Connecticut) in which home birth attendance is neither legal nor illegal.
- And the grand prize winner (Georgia), where home birth attendance by direct-entry midwives is legal…but you can’t get a license!
(Source: Midwives Alliance of North America.)
The crazy-quilt pattern of home birth regulations around the country (the rest of the states are as scrambled as the Atlantic coast) and the varying education and training requirements for the different classes of home birth midwives are major stumbling blocks to integrating home birth into the larger maternity care community. The Consensus Agreements that came out of the Home Birth Consensus Conference in Airlie, Virginia, this past October reflect this.
Take Statement 4:
“It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.
We believe that guidelines should:
- allow for independent practice
- facilitate communication between providers and across care settings
- encourage professional responsibility and accountability, and
- include mechanisms for risk assessment ”
A national certification process for all midwives (similar to the process that already exists for physicians), acceptable to all the organizations involved in maternity care in the U.S., would go a long way toward resolving home birth’s legal limbo.
Ah, but there’s the rub in the factionalized world in which we live. Getting organizations with long histories of animosity to give up a bit of control in order to advance the greater good may strike some as a tilting-at-windmills exercise. But the Home Birth Consensus Summit, where representatives from major medical, midwifery, hospital, and insurance organizations reached agreement on some thorny issues, showed that it’s possible to move ahead.
The devil (probably a whole army of them) will be in the details. I’ll keep reporting on progress, or lack thereof, in future posts.
* * * *
* “A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.”
** “A Certified Midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.”
(Source: Midwives Alliance of North America)
Mark Sloan M.D. 
A national certification process for all midwives (similar to the process that already exists for physicians), acceptable to all the organizations involved in maternity care in the U.S., would go a long way toward resolving home birth’s legal limbo.
We already have it in place Mark – it’s the American Midwifery Certification Board. The AMCB certifies CNMs and CMs in all 50 states and it is acceptable to all organizations involved in maternity care in the U.S. Including (and perhaps most importantly – ACOG).
Perhaps what is needed is a more organized effort on the part of the Nurse Midwifery programs to incorporate homebirth into their curriculums and have CNMs who practice in the home setting on their faculty to train CNMs and CMs that specifically want to practice in the home setting??? EVERY CNM/CM should have exposure to birth in the hospital, birth center and home setting during their training as should EVERY OB and FP resident.
What is needed is a cultural shift in our country – let’s work WITHIN the paradigm of the OB/CNM relationship to address the issue. This would allow every woman within this country to have the birth of HER choice – whether it be an elective primary c/s (which by the way Beyonce did NOT choose 😉 ..to a home water birth. It can be done. Just takes patience, work and time.
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