Question

In Ohio, it is illegal for a midwife to birth in a hospital, and a nurse midwife cannot birth in a home or birthing center. Is this a policy that is standard across the country? It seems women aren't allowed many birthing choices.

Answer

There are a few different licensing classifications for midwifery in the United States, as there are different legal restrictions based on each classification. Both Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) are regulated on a state level, so licensing and accessibility change from state to state. For example, (CNMs) can practice legally in all 50 states, but some states require CNMs to be supervised by a physician or have ‘collaborative agreements’ with a physician. CMs are legally recognized to practice in New York, New Jersey, Rhode Island, Delaware, Maine and Missouri.

The major difference between CNMs and CMs is the method of training and certification. According to the American College of Nurse-Midwives, CNMs are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) as well as passed a national certification examination to receive the professional designation of certified nurse-midwife. CMs are individuals who have or receive a background in a health related field other than nursing and graduate from a midwifery education program accredited by ACME. This is primarily why CNMs face fewer legal restrictions in terms of practicing altogether, even though there are still regulations on how they must practice.

The restrictions for CMs make the practice of midwifery inaccessible for many in states where pregnant people may seek out providers who do not first train as nurses. Some families who have used midwives have been charged with child abuse or neglect due to the regulations based on nurse certification. And even while you may live in a state where midwives practice legally, there could be numerous insurance obstacles that block your access to these services. These gaps in accessibility may cause some people to give birth in circumstances they would not otherwise choose, such as delivering their babies in a hospital.

The amount of restrictions should not deter people considering midwifery services for their delivery. In a 2009 review of 11 studies regarding the topic, it was discovered that women who used midwives were more likely to be cared for in delivery by their primary provider and to have a spontaneous vaginal birth without epidurals, forceps, or vacuum extractions. Whether or not you choose to give birth in a hospital or at home, it is proven that there are several benefits to using midwives. Unfortunately, the state by state regulations can be confusing and restrictive, so before you make a decision about your own delivery, it is wise to check the legal status of midwives in your state.


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