Midwives are permitted to practice in out-of-hospital (OOH) settings in 28 states. The Big Push for Midwives publishes information on their website regarding legality and licensing of Certified Professional Midwives (CPMs). The Big Push has one goal, and that is to increase the number of states that recognize CPMs.
The Big Push wants the public to believe that legalizing CPM practice confers safety. What licensing and legalizing CPMs often does is legitimize CPMs, allows them to bill insurance, but does not increase accountability and safety standards for out of hospital birth.
We would like to emphasize that licensing and legalizing CPMs does very little in certain states toward creating accountability, safety and true professional practice among midwives. In some states, midwifery is legal - but licensing is not required. There is hardly a difference between the practice of midwifery in these "legal" states than there is in Michigan, where CPMs and lay midwives are completely unregulated.
We believe there are multiple legal protections that must be written into a responsible midwifery licensing law in order to make OOH birth safe, and encourage accountability among midwives. Many of these provisions work together - it is not enough to have one provision in place.
Who cares if it is mandatory to have a license to practice midwifery, if there are no restrictions on scope-of-practice? (See Washington, Wisconsin, Tennessee for examples)
Who cares if licensed midwives are restricted to low-risk births, but licensure is purely voluntary? (See Utah, Minnesota, Oregon).
Who cares if the practice of midwifery is "legal" but there is no licensing what-so-ever available, and therefore no scope of practice standards, or guidelines in place? (See Maine, Missouri)
When considering licensing in Michigan, we urge everyone who cares about safety in the out-of-hospital setting to think about which provisions provide true protection for families, and which serve only to legitimize midwifery and increase their income through third-party payers.
Safer Midwifery for Michigan's position on the practice of OOH midwifery:
1) Licensing: a license should be mandatory in order to practice midwifery
2) Malpractice insurance: all midwives should be required to carry malpractice insurance
3) Defined scope-of-practice: OOH births attended by midwives should be limited to low-risk only
4) Integrated system of care: Midwives should be integrated into the health care system through authority to treat, prescribe and admit patients and/or through collaborative agreements with physicians
5) Education: the minimum level of education for midwives should be at the graduate level. The American Midwifery Certification Board sets standards for graduate level training of Certified Nurse Midwives, (CNMs) and the direct-entry equivalent, Certified Midwives (CMs).
Safer Midwifery for Michigan's position on the practice of OOH midwifery:
1) Licensing: a license should be mandatory in order to practice midwifery
2) Malpractice insurance: all midwives should be required to carry malpractice insurance
3) Defined scope-of-practice: OOH births attended by midwives should be limited to low-risk only
4) Integrated system of care: Midwives should be integrated into the health care system through authority to treat, prescribe and admit patients and/or through collaborative agreements with physicians
5) Education: the minimum level of education for midwives should be at the graduate level. The American Midwifery Certification Board sets standards for graduate level training of Certified Nurse Midwives, (CNMs) and the direct-entry equivalent, Certified Midwives (CMs).
How do other states meet Safer Midwifery for Michigan’s criteria for safe OOH midwifery?
State and year licensed or legalized
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License required to practice midwifery
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Requires malpractice insurance
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Limits OOH birth to low-risk only
(no VBAC, twins, breech)
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Requires integration into health care system/
collaboration
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Minimum standard of education is AMCB program
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
| NO |
NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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NO
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Links:
Arizona Health Department, Midwifery scope of practice of by state, VBAC, multiple, breech in non-hospital settings. http://www.azdhs.gov/als/midwife/documents/committee/additional-resources/state-laws-chart-vbac-br-mg.pdf
The Big Push for Midwives, CPM legal status by state. http://pushformidwives.org/cpms-by-state/
Lansing State Journal, Midwife Laws state-by-state, http://www.lansingstatejournal.com/interactive/article/20120503/NEWS01/120502001/Midwife-laws-state-by-state?nclick_check=1
Midwives Alliance of North America. About Midwives: State by State. http://mana.org/about-midwives/state-by-state
Safer Midwifery for Michigan, State Laws and Licensing. http://www.safermidwiferymi.org/issues/state-laws-licensing
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