I am going to get political today.
If you have been a long time reader, you know that I have some ranty posts about midwifery, homebirth, legal issues of those, and related topics. You also know that I am one hundred percent against any kind of state, federal, or otherwise lincensure and regulation of midwifery — that I am one hundred percent against any kind of regulation of midwives that limits the choices of consumers (gestating/birthing folks and their families).
I affirm that the only person who decides where to give birth, how to give birth, when to give birth, and with (or without) whom to give birth is the person giving birth. This in turn means that there can not be third parties deciding who can and can not attend out-of-hospital (OOH) births.
Midwife Katie Jenkins McCall, who is the owner/director of Sacred Transitions Midwifery Institute (for whom I teach midwifery skills and freebirthing skills classes), has spent a considerable amount of time working on the map in the picture below. She is open to people sending in errors/corrections and questions; contact information is found in the image.
Upon first glance at this map and its key, one might be quick to point out perceived errors. (There probably are in fact actual errors, but this map has probably already been updated since I posted it here.) However, let us be clear about what is actually being measured or represented by this map.
“The support of women’s human rights in client directed out of hospital midwifery care in the United States.”
This map is not specifically focusing on any one brand of midwife involved in providing OOH care for clients. This map is focusing on whether or not there exists limitations to the type of care or the type of care provider that pregnant/birthing people have access to in a given state.
Think about your own state where you live (and maybe practice midwifery) and ask yourself the following questions:
Can expectant parents and their families:
choose where they wish to give birth?
choose who they want to attend their birth?
decide to not choose an attendant and give birth unassisted?
Can midwives providing out-of-hospital care to expectant parents and their families:
offer care to clients without state or organisation regulations?
offer care to clients without obtaining a state or organisation provided license?
offer care to clients expecting and preparing for an OOH birth that includes birthing twins, breech positions, or Vaginal Birth After Cesarean (VBAC)?
Can midwives and clients do these things without:
protective services (CYF, CYS, CPS, DHS, etc.) being called on them?
being sanctioned with fines or jail time?
needing special permission or oversight by physicians, state boards, or organisations?
If the answer to ANY of these questions is either NO or YES, BUT then you do not live in a state that is supportive of women’s (expectant people's) human rights in client directed out-of-hospital midwifery care. Full Stop. Period.
There are people who sincerely believe that if (certain*) midwives are licensed and regulated in every state, more expectant parents and their families could have more support for their choices and better access to midwives who can support their choices. Oh if it were true.
*Part of the problem with the lack of unfettered support and access to care stems from the desire to push for legislation that names a specific brand of midwife and excludes others. What this ‘naming’ does is:
ostensibly place one type of midwife (and model of care) above other types.
invalidate multiple pathways of midwifery education.
pit midwives against one another.
criminalise many indigenous, tradition, and religious midwives.
limit the types of care and type of care providers expectant parents and families can legally choose from.
continue to allow disenfranchised, underserved, and mis-served populations to slip through the cracks.
At the time of writing this, in my state, the Commonwealth of Pennsylvania, Certified Nurse-Midwives (CNMs) are the only midwives with licensure opportunities and they are the only midwives with written and legal regulations. Only a handful of CNMs attend homebirths and most of those are strictly the homebirths of Amish and other Plain people. Under state law, CNMs must submit a collaborative agreement that includes the signature of two physicians — this is not autonomy and this does not allow for unfettered support and access for OOH clients.
All other midwives practising in Pennsylvania do so with the risk of sanctions being brought against them. Thankfully, after the Grand Jury decision in the Diane Goslin case, the Board of Medicine (BOM) can no longer file charges of “practising medicine without a license” against midwives since it was ruled by the court that Midwifery is NOT the practice of Medicine. Also, during a Summer session for the BOM, their own lawyer presented them with the fact that the BOM can not legally write regulations for non-nurse midwives under the current midwifery laws in PA, as those only pertain to nurse-midwives.
So, we are at an impasse. This is actually great for Traditional Community Midwives, like myself, and other non-nurse midwives, as we get to continue to serve our communities in the ways that they are needed and being directed by clients. The only limitations placed on our practices are those chosen individually, based on our own unique skill sets, levels of education, and comfort and experience levels. This allows clients in Pennsylvania to choose midwives that can and will support their desired care and individual needs. Now, if we only had enough independent, autonomous midwives to go around!
Is there a hypothetical legislative effort for Pennsylvania that I could support? Yes, there is. It would look something like this:
Expectant parents can choose anyone (or no one) to be their OOH provider and attendant.
All OOH providers/attendants (midwives) are autonomous with no limitations of practice and no license required.
All OOH providers/attendants (midwives) must fully disclose to all potential clients (in a document signed by both provider and client) their educational and experience background (including any continuing education efforts), their basic practice protocols, known risks of homebirth, known risks of homebirths with variations of normal birth (breech, twins, VBAC, etc.), and their consultation/referral/transfer of care protocols.
Neither client nor provider will face legal sanctions for engaging in a fully autonomous and fully disclosed (Informed Consent/Refusal) OOH midwifery care agreement and arrangement.
That is it. Keep it simple. This is what freedom and responsibility in autonomous healthcare looks like.
{Disclosure: I am a traditional community homebirth attending midwife. By choice (personal convictions and political positions) I am not certified by any midwifery organisation or state agency, nor am I licensed by any midwifery organisation or state agency. I live and practice the art of traditional midwifery and community herbalism in Pittsburgh, Pennsylvania where I serve, almost exclusively, the low-income, IBPOC, and queer/gender-diverse communities.}
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