Why state licensure is not the answer for midwifery

One more advocate for the Big Push for Midwifery licensure recently shared her birth story with a Boston newspaper. Her birth exemplified one of the major flaws of lay midwives, but I have to point out, as I have before, that state regulation of midwifery will not make home birth safer.

The assumption is that if a certified or lay midwife is required to be licensed by the state that they will all of a sudden offer better midwifery care, and that they will have better communication with medical care providers, and that they will be held accountable if they practice negligently.

While state licensure may enable midwives legal access to necessary obstetric medications, it will not improve communication with hospital staff who are anti-homebirth, thus preventing necessary transfer of care or co-management of care in some cases.

Licensure of midwives limits them to offer services only to the women AMA paid politicians consider good candidates, which rules out VBAC’s at home, and breech and twin births, even if the midwives had decades of experience in these situations.

If a midwife has her license revoked, she can still practice midwifery if she finds clients willing to accept the risk. In comparison, a non-licensed midwife accused of malpractice will have her face plastered in every anti-homebirth website and may be jailed for “practicing medicine without a license”, even though midwifery is not medicine. Either way, licensed or not, a careprovider offering bad care will get a bad rep. Anyone wanting to keep their job is going to practice in a way that will keep their job, aka keep moms and babies safe.

What about the bad birth stories? Yes, what about those stories? They happen far more often in the hospital, but those docs aren’t being publicized as negligent. Much of the war against midwives is by a group of people who think they must decide for women that their home is not safe to give birth in.

To counter that attack, midwifery groups are promoting licensure to meet in the middle. I believe this is asking for trouble because when you let the government put their foot in the door they will force their way to total control, the type of scenario many moms turn from the hospital in order to escape.

What is the alternative? Saying no to licensure doesn’t mean midwives shouldn’t be held accountable or that they should do whatever they want. It simply means that government is not necessary for safe home birth.

Instead, home birth advocates should spend their time informing the public on how to have a safe home birth, how to find a good midwife, and teach responsible decision making.

A key componant of home birth is the mother taking responsibility for her birth. That means going to the hospital if she feels something is wrong, maintaining a healthy lifestyle, and being careful about which midwife she hires (ie. one that is well trained and experienced).

Government control through licensure just puts one more office between the mother and the safe birth she wants for herself and her baby. The homebirth community has already done an excellent job at keeping midwives accountable, hence the great safety statistics associated with planned home birth.

We all want mothers and babies to be safe and healthy. I believe people on both sides of the argument value this. Yet before we assume that giving authority to the government will solve the problem, we really need to ask ourselves if it will. The government has not exactly given us a good example of their work in other fields, and has only proven that their involvement complicates issues.

If we have a problem with midwifery and home birth in the U.S.A. we the people are smart enough to resolve it. We are intelligent, discerning, and responsible; we don’t need to pass off regulation of midwifery to a third group. Let’s promote good home birth policies, complete informed consent and full disclosure documents, and peer review and continuing education systems. If the consumers are demanding better care, let’s give it to them! But whatever you do, don’t vote for government control where it does not belong.

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  1. “The homebirth community has already done an excellent job at keeping midwives accountable, hence the great safety statistics associated with planned home birth.”

    You have GOT to be kidding!! I would *love* to see a homebirth community that keeps midwives accountable. I’ve never seen it nor heard of it. All I’ve heard from mothers *and* midwives around the country is how incestuous and coffee-klatchie the governing boards are… from Peer Reviews to Midwifery boards. I’ve known women to bring midwives to NARM for midwifery neglect/abuse and the “governing” midwives are great friends of the accused midwives… therefore, if anything, a slap on the wrist is all that’s given. A “tsk tsk, don’t do that again” is not, in my opinion “keeping midwives accountable.”

    And, the “great safety statistics” are also suspect. But, that’s a whole ‘nother topic.

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