Legal Issues in Homebirth Midwifery

Okay, so let me try to explain a convoluted issue  as simply as possible:

Here in North Carolina, only certified nurse-midwives are legally allowed to attend homebirths. Those certified nurse-midwives have to have back-up (sponsorship, essentially?) by a doctor. Most doctors do not want to support a nurse-midwife attending homebirths, for various reasons: the doctor thinks homebirth is not safe; the doctor does not want the nurse-midwife taking clients from him; the doctor’s malpractice doesn’t allow homebirths without a huge cost; or the hospital where the doctor works doesn’t allow him to support homebirth. In North Carolina, there are either 11 or 12 certified nurse-midwives who attend homebirths. Most of them are supported by Dr. Henry Dorn, who has written against about the over-medicalization of childbirth.

My Masterpiece, born in a birth tub in our bedroom in Arizona with a certified professional midwife.

There is a national credential for non-nurse midwifery — the certified professional midwife — and yet midwifery is regulated state-by-state, with states like North Carolina who don’t recognize the cpm credential. Some states require another credential, a licensed midwife, which is like a cpm+ a few other things. Some states have other requirements, like less or more — did I mention it’s a mess?

Last year near Charlotte NC, a well-known non-nurse-midwife who was a certified professional midwife was arrested, and North Carolina Friends of Midwives held a rally. (Ironically, the rally was here in Raleigh — little did I know I’d be living here a year later. Sigh.) Recently another Charlotte midwife was arrested after a baby died. This midwife was not a certified professional midwife; she was a direct-entry or “lay” midwife.

All of these leads me to the following conclusion: midwifery in North Carolina — and probably in other states where non-nurse midwives are not legal — is a mess.

My Masterpiece and I are checked by a certified professional midwife. Later I transported to the hospital for a retained placenta and postpartum hemorrhage.

certified professional midwife checks My Masterpiece and me. Later I transported to the hospital for a retained placenta and postpartum hemorrhage.

On one hand, I believe that women should be allowed to choose their provider. Whether that means a certified professional midwife who isn’t a certified nurse midwife, a midwife licensed in another state, or just a direct-entry midwife who isn’t certified, I think a woman should be allowed to choose. Without the government having a hand in that decision!

However, I also believe that the midwife owes the client an accurate portrayal of her credentials and her experience, or lack thereof. I think she needs informed consent. Also, that informed consent needs to include the risks of choosing a provider who might be in legal trouble if she has to transport a client (which happens if there is a situation that the midwife cannot handle, either before, during or after the birth). Such a situation might lead a provider to either (a) not transport even if the client is in need or (b) transport and dump the client so she avoids legal issues. (I’m assuming worst-case scenarios here. I would like to hope that most midwives wouldn’t do either.) So in that respect I want some legal intervention, for lack of a better word. I want some requirements.

Porcelain, born at home in Charlotte on the toilet. Her birth went perfectly.

This is a very complicated issue. I think it’s also a feminist issue; the skeptic/pessimist in me wonders if this would be so convoluted if it involved mens’ bodies?

I don’t think this issues is going to be solved anytime soon. What do you think?


2 Responses

  1. We have faced many of the sames issues at our Charlotte midwife Center (, but the struggles are diminished by the lovely work we carry on doing. If anyone has questions about Midwifery in Charlotte, NC, feel free to get in touch!

Comments? Thoughts? Streams of Consciousness?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: