With the recent conviction of two Florida women for practicing "illegal midwifery" in a case where the mother died, I think it's worth sorting out exactly what is or isn't legal about home births and midwifery in this country.
First, it's not illegal to have a home birth, as Madeline Holler explained recently in her Babble story on her home birth. It's just often illegal to attend one acting as a medical professional (the question of whether the women convicted were acting as midwives was central to the case above).
In terms of the midwives, the first question that comes to most people's minds is that of licensing. There are two major midwifery credentials: the certified nurse midwife (CNM) and certified professional midwife (CPM). Both involve both written exams, proof of skills mastery, and clinical experience under supervision. CNMs also get a full nursing degree. CNMs are widely accepted throughout the country (though not nearly as widely as in other countries) and routinely see women for pre- and post-natal care and attend low-risk births in hospitals and birthing centers. CPMs are recognized and regulated in 24 states. Only CPMs are required to have experience in out-of-hospital birth
settings, so they are more likely to be the ones attending home births.
(As far as I can tell, the women convicted in the Florida case had no certification at all and it seems like their religious convictions may have kept them from seeking help as soon as they should have.)
Then there's the question about the legality of attending a birth at home even if you have the proper training. Many (if not all?) states require that a midwife wishing to offer home births be working in the practice of an OB that agrees to provide backup. Often this is what makes legal home births de facto unavailable—doctors are afraid for their malpractice premiums (or of the competition) and none in a given region will let home birth midwives join their practices. For a long time that was true up here in upstate New York.
Then there are those trained midwives who prefer to stay under the radar even where there are doctors who would work with them because the limits on what they can do as midwives (no breech deliveries, no delivery past 41 weeks, etc.) are so restrictive.
The potential effects of all this on home birth midwives—and therefore the availability of home birth for most of us who wouldn't want to go unattended—is pretty scary.
Brett Singer asked in his post about the Florida convictions a couple days ago whether someone could be prosecuted for an illegal home birth even if nothing goes wrong. Sadly the answer is yes. There is a case in Connecticut like that right now. The midwives responsibly transported the mother to the hopsital when a need arose, and it all went fine, but the ticked off doctor who received her filed a complaint. (This is why many home birth midwives have underground back-up relationships with friendly doctors who just can't afford to work with them openly.) You can just imagine what happens in the courts in those rare cases when something unavoidable does go wrong in a home birth, despite proper precautions.
And cases like the one in Florida certainly don't help any. Sigh.
Photo by freckle'sphotos.
Related Posts:
My Illegal Home Birth: Giving Birth at Home Was Weird, Magical and a Felony
