Tag Archives: Midwives Alliance of North America

Home birth’s crazy-quilt legal status: Part 2

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)

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Home birth’s crazy-quilt legal status: Part 1

What a difference a few miles makes...

Okay, so I was a wee bit wrong about North Carolina. (Thanks to Russ Fawcett, Deb O’Connell, and Ida Darragh for their clarifying comments.)

Home birth is technically legal in the Tar Heel State. I say “technically,” because by state law the people who would be attending most of the home births in North Carolina—direct-entry midwives*—are legally barred from doing so. This sounds like a bit of a legal end-run, kind of like saying acupuncture is a legal activity… as long as nobody with needles is allowed in the room.

According to the Charlotte Observer report, home birth attendance in North Carolina is limited to registered nurses operating under the direct supervision of a physician. Due at least in part to that requirement for physician supervision, only about a half dozen of the 300 certified nurse midwives in North Carolina attend home births. So, yes, home births are legal, but if you’re looking for a qualified home birth midwife, in most of the state you’re on your own.

My legal fuzziness about the situation in North Carolina is understandable (at least to me). The laws governing home birth in the U.S. vary dramatically from state to state and are often quite byzantine.

Nowhere is this more obvious than in Charlotte. I’ve never been there, but from the look of things on the map, if you were to walk to the south side of town and take a long leap you’d land in South Carolina—where home births and the midwives who attend them are completely legal, and midwives are even paid by Medicaid for their services.

But just meander up and down the Atlantic coast a bit and things change, and change again. More on that in my next post.

* * * * *

* “A Direct-Entry Midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.” (Source: Midwives Alliance of North America.)

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