Opinion: License Professional Midwives For More Childbirth (And Home Birth) Options

By Sarah Whedon
Guest Contributor

When I was expecting my first baby in 2009, I planned a home birth with a wonderful midwife. My pregnancy was healthy and normal, my prenatal care with my midwife was both empowering and attentive to my health needs and my labor began spontaneously at full term.

Everything was going according to plan, until about 20 hours into active labor at home when my midwife alerted me that my baby's heart rate indicated a serious problem and we needed urgent medical attention.

In the amount of time it took the ambulance to arrive at my Somerville home, my midwife cut an episiotomy (a skill in which home-birth midwives are trained but don't practice as a matter of routine) and performed an emergency delivery. My baby had aspirated meconium (the sticky tar-like substance in a newborn’s bowels that is occasionally expelled during birth) and was having trouble breathing even with the aid of the oxygen my midwife carried with her. She needed a transfer to the level III NICU at Children's Hospital, where she made a complete recovery.

I had a home birth because I wanted the kind of low intervention pregnancy and birth that Certified Professional Midwives (CPMs) offer. But I tell my birth story publicly because it demonstrates something important that people don't often realize about CPMs: they are skilled professionals who are prepared to handle emergencies, including facilitating transfer to medical care when needed.

CPMs are midwives who are specially trained in out-of-hospital care. They differ from Certified Nurse Midwives (CNMs) who are trained as nurses and typically practice in hospital settings. Currently, Massachusetts licenses CNMs but has no licensing system for CPMs, who provide care for approximately 500 women across the state each year.

So when I recently learned of a petition asking me to support licensing of CPMs in Massachusetts, I immediately wanted to get more involved. I found other moms who want this bill to pass and I’ve had the pleasure of lending my support to this work being carried out by a coalition of advocates from the Massachusetts Midwives Alliance, Massachusetts Friends of Midwives and others. More than 500 Massachusetts residents have now signed the petition.

The bills (HB 2008 and SB 1081) would require all midwives practicing out of hospital to become CPMs, create state licensing requirements for CPMs and establish a Committee on Midwifery under the Board of Registration in Medicine. The nine-member committee will include five CPMs, one obstetrician, one CNM and one consumer of midwifery services.

Supporters of the measures that would license and regulate home birth midwives were energized by an amazing turnout at a Committee on Public Health hearing last month, testifying to the professional skill of these midwives and the valuable ways they serve Massachusetts families. Several moms even brought their charming home birth babies along for the day at the State House.

I have heard from some midwifery supporters who oppose licensing, worrying that new regulations will hamper midwives' ability to truly practice the midwifery model of care. But midwives themselves will be involved in determining details of regulation. Overall, licensing of our midwives would mean more moms will feel able to choose home birth, because they’d have the security of knowing that in order to hang out her shingle, a midwife must meet state licensing standards.

The Massachusetts Medical Society has also opposed the bills, expressing disapproval of any health care that is delivered outside the team context with immediate M.D. supervision.

M.D.s will certainly continue to be a major part of maternity care, but everywhere people are realizing more and more that we can have good (and sometimes better) outcomes by utilizing all skilled healthcare providers to fill gaps in need.

Those of us who support licensing of midwives call on the Public Health Committee to report the bill out favorably so it can advance to the next step in the legislative process, the Health Care Financing Committee. After a favorable report by the Health Care Financing Committee, the bill is expected to move to the Steering, Policy and Scheduling Committee that will determine when the bill will be released to the floor for a vote. Let's catch up with the 29 other states that are already regulating home birth, making it a safer and more accessible birthing option.

In a recent survey of new mothers, more than a quarter said they would consider home birth in the future and two-thirds thought home birth should be a right. Shouldn’t Massachusetts be protecting that right to choose home birth?

Sarah Whedon, Ph.D. is a Somerville mom whose writing, teaching and advocacy are focused around spirituality, feminism and reproduction.