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Midwife Licensure

Access to safe, legal home birth is in danger. Licensing direct-entry midwives ensures Georgia parents have access to home birth. Most states already license homebirth midwives, and doing so improves birth outcomes while protecting midwives and families.

Access to safe home birth in Georgia is continually threatened. This is because Georgia does not currently license or regulate direct-entry midwives. Direct-entry midwives are midwives who undertake an apprenticeship and other training to attend homebirths. They have practiced midwifery for millennia. The time for licensure has come. The Georgia Birth Advocacy Coalition stands with The Georgia Midwifery Association, Citizens for Community Midwives, and other professional bodies to ask the Georgia Legislature to finally license and regulate home birth midwives. Thirty-five states already do, and many others are currently working toward licensure. It’s time for Georgia to join their ranks.

Access to safe home birth is in danger

Homebirth midwives are already practicing in Georgia. Licensing them helps them practice more safely. Not licensing homebirth midwives does not end homebirth, but it does make it less safe.

Midwives who attend homebirths cannot currently be licensed in Georgia, unless they are certified nurse midwives (CNM). Homebirth midwives who are not CNMs often have significant training and experience, and have attended thousands of births. Some have contributed to textbooks or worked alongside obstetricians for decades. Yet their lack of a license means:

  • They cannot usually carry malpractice insurance. This means if they harm a patient or baby, suing them is virtually impossible.

  • They cannot usually accept insurance coverage.

  • They are not integrated into systems of care, which can make it difficult for them to refer patients for additional testing or get hospitals to accept their patients’ medical records.

  • There is no statewide standard for who can and cannot practice. Anyone can call themselves a homebirth midwife.

These, and many other, shortcomings can be catastrophic for midwives and the mothers they serve. They can be accused of practicing medicine or midwifery without a license, and threatened with lawsuits or even jail time if they keep practicing. Hospitals may not accept their records, which puts their patients in danger. Doctors may refuse to work with them.

There is a simple solution to this problem. Georgia must join the rest of the country and license homebirth midwives.

How Homebirth midwives Lower Maternal Mortality, Improve Care Outcomes

Georgia leads the nation in maternal mortality, and is 49th in infant mortality. Numerous studies show that midwives improve care outcomes and offer more patient-centered care. A 2018 study found that greater integration of midwives into care systems, including full licensure, improved care outcomes, reduced needless birth interventions, and improved infant safety. Research published by the CDC found lower rates of preterm labor and low birth weight among infants cared for by certified professional midwives, one type of homebirth midwife. Midwives offer culturally competent care that many women, particularly Black and indigenous women, struggle to access.

Georgia faces another issue that midwife licensure can solve: a critical shortage of obstetricians. Some counties lack even a single OB. There are only 75 labor and delivery units remaining in the entire state—far fewer than is necessary to serve the state’s families. Most are concentrated in Atlanta and other metropolitan areas, leaving women to travel long distances or face the prospect of getting no prenatal care at all.

Direct-entry midwives have served rural and low-income women for generations. Licensure doesn’t change that fact. It doesn’t create competition for doctors or cause women to choose home birth who would not otherwise do so. It acknowledges the role of midwives, and ensures they have the skills and tools they need to tend to their patients.

What Happens When Women Can’t Access Home Birth?

Opponents of home birth sometimes tell people that licensing homebirth midwives will lead to more unsafe births, or a much higher rate of homebirths. That’s not true. Some women have always chosen home birth. They will continue to do so whether midwives are licensed or not. The only question is whether home birth happens in the shadows. Licensure empowers midwives to provide excellent care. Further, licensure expands access to quality care by:

  • Allowing midwives to openly serve rural women who might otherwise have access to no provider at all.

  • Making it safer and easier for midwives and doctors to collaborate.

  • Ensuring hospitals can accept midwives’ medical records.

  • Protecting mothers and midwives from legal sanctions for choosing home birth.

  • Ensuring the state will be able to set clear standards for midwives and hold them to those standards.

Is regulation really a good idea?

Some patients worry that regulating home birth gives the state too much power. Others worry that it means that the state has lent its support to home birth. Neither is true.

Licensure accomplishes one thing, and one thing only: it allows midwives who want to be licensed to seek a license. This requires them to follow the safety and other guidelines the state puts in place.

Licensure does not make it such that patients can’t choose their own providers. It is not an endorsement of home birth. It is merely an acknowledgment of a reality that is already happening.

what you can do to help

Senate Bill 111 would license and regulate a group of highly qualified homebirth midwives including, but not limited to, certified professional midwives (CPM). This inclusive legislation promotes diversity in midwifery, and provides several paths to a career as a midwife. There is a very real chance this bill could pass, but only if the citizens demand that their legislators support it.