The ‘State’ of Midwifery: Pushing for Legalization

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The ‘State’ of Midwifery: Pushing for Legalization

Rebecca A. Spence

Women want out-of-hospital maternity care, and they deserve legal access to it. Yet in 23 states and Washington D.C., Certified Professional Midwives (CPMs) face prosecution for serving women who do not want to give birth in a hospital.

This post is one in a series of pieces Rewire is publishing to highlight National Midwifery Week 2010 (Oct 3- 9).

Women want out-of-hospital maternity care, and they deserve legal access to midwives trained to provide it. In 23 states, Washington D.C., Puerto Rico, and Guam, Certified Professional Midwives (CPMs) face prosecution for serving women who have decided not to give birth in a hospital. Families in these states are forced into an underground economy of providers whose training and credentials could be difficult to ascertain, and are left without any means to report a practitioner who lacks adequate skills. If they do opt to hire a midwife who is practicing illegally, smooth and efficient transfer to a higher level of care can be compromised in the event that it becomes necessary, putting mothers and babies at risk. That’s why more and more states, pushed by consumers and their allies who are part of The Big Push for Midwives Campaign, are passing legislation to license CPMs.

No federal law, Supreme Court decision, or Constitutional amendment can ensure that we have access to the maternity provider of our choice, because licensing and regulation of health professionals occurs at the state level. The Big Push for Midwives engages with consumers in state-by-state efforts to secure a path to legalization and integration of Certified Professional Midwives. Advocates have been on the ground doing this work for years, and are gradually achieving success. Groups like the Alabama Birth Coalition, Ohio Families for Safe Birth, North Carolina Friends of Midwives, the Coalition for Illinois Midwifery, and Massachusetts Friends of Midwives, and others, are tireless grassroots organizers for women and families who chose to give birth outside of the hospital.

Like other movements for social and reproductive justice, securing safe access to choice in childbirth demands solidarity from individuals and organizations not traditionally thought of as allies of midwives and out-of-hospital birth. The mainstream reproductive justice and women’s rights movements must actively stand by women who are demanding our rights as citizens and as mothers.  Aggressive, well funded forces of organized medicine are determined to keep Certified Professional Midwives  underground, threatening women’s autonomy and the public’s health.  This includes the American Congress of Obstetricians and Gynecologists (ACOG), a self-proclaimed “advocate for quality health care for women,” and the American Medical Association (AMA), organizations that wield their reputations and considerable financial influence over state legislators to keep birth in the hospital and make women outlaws.

Roe is gone. The chaos is just beginning.

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The medical journal The Lancet recently published an editorial that concluded “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.” This is a familiar message to reproductive health activists: women don’t have the right to value our own lives when babies are involved. And, if the opinion of some doctor or judge about the wisdom of a particular woman’s choice for maternity care differs from her own, she may be forced to accept medical treatment that she doesn’t want or need.

Punitive attacks on women’s rights in birth are not the sole province of the medical establishment. Predictably, and tragically, paternalistic enforcement comes from many sources.  Child protective services in Illinois and Ohio have seized custody of the newborn babies of women who exercised their right to choose home birth with midwifery care — even though the babies born at home were perfectly healthy.  Families have lost custody of their children or faced CPS investigations simply because the mother gave birth at home with a midwife in a state where her legislators have failed to regulate and license Certified Professional Midwives.

Whether or not state legislatures respect the wishes of their constituents and vote to legalize CPMs, women will continue to choose home birth. So long as midwifery remains illegal in so many states, and even in our nation’s capital, these assaults on our rights will continue.  This is  why licensing and integrating CPMs, trained and experienced experts in out-of-hospital birth, makes sense for American women. Happy Midwifery Week, everyone. Won’t you join us?