Midwife Licensure in Georgia: Answers to Frequently Asked Questions
The Georgia Birth Advocacy Coalition is partnering with the Georgia Midwifery Association, doulas, childbirth professionals, and parents across the state to ask our state legislature to finally license certified professional midwives (CPMs). Learn more about licensure by clicking here.
Your legislators work for you! Please contact them or come to Midwife Day at the Capitol on February 6th. As you talk with your elected officials, you’re likely to hear some difficult questions. You may also find some inaccurate information on social media. Here are the most commonly asked questions about CPM licensure in Georgia.
Why should CPM midwives be licensed?
Licensure accomplishes a number of important goals. It regulates the practice of midwifery such that CPMs no longer have to worry about facing sanctions for practicing medicine or midwifery without a license. Although rare, midwives who attend births and who remain unlicensed can be threatened with prosecution and even face jail time.
Licensure also integrates CPMs into care systems. This makes it easier for them to work with doctors and hospitals, to refer patients to other providers, and to be covered by insurance. Cigna recently announced that it would provide insurance coverage for licensed home birth midwives. This means that, if CPM midwives become licensed in Georgia, families would have a new option to pay for care. This reduces health care disparities, opens up new birth options and choices, and could potentially reduce the costs of giving birth.
All other medical professionals in the state—from dental hygienists and therapists to doctors and dentists—are licensed. Licensure protects medical providers and confers a number of rights and responsibilities. It treats midwives as the dedicated, educated professionals they are.
Isn’t this the state intruding on family decisions?
The state is already intruding on families’ decisions. CPMs are nationally certified, but they remain unregulated and unlicensed in Georgia. This means that, by doing what they are trained to do, they are at risk of facing legal sanctions.
That interferes in families’ ability to make decisions. When midwives are unlicensed:
A midwife can be forced to quit practicing if she receives a cease-and-desist letter, leaving her clients without a provider.
Doctors and other medical professionals may be reluctant to work with them.
If a client must transfer to a hospital, the transfer can be difficult.
Licensure recognizes that families are entitled to choose home birth, and provides a legal route through which they can do so. Home birth is legal now, and will remain so. The only difference is that licensure extends more protections to families and midwives.
Does this mean the government would be endorsing home birth?
No. Home birth will always happen, whether it is regulated or not. Licensure is an acknowledgment of the reality that some women will always choose home birth. By licensing midwives, the state creates a regulatory framework that ensures birthing people can get quality care. There is no evidence that licensure increases the rate of home birth, or that it will in any way harm doctors or hospitals.
But really, isn’t home birth dangerous?
For low-risk women, the answer is no. CPMs are trained to assess risk, and are only certified to care for women for whom home birth is safe. Studies consistently show that home birth can be safe. In fact, an analysis of previous studies found that maternal outcomes are actually better with planned home births. In a state that has the highest maternal mortality rate in the nation, licensing CPMs is one route to improving outcomes.
However, home birth is less safe when CPMs are not integrated into care systems. Licensing CPMs makes it easier for them to work with doctors and other health care providers, thereby ensuring safe and comprehensive care.
What do doctors think of this legislation?
Different doctors have different opinions. Some doctors have long worked with CPMs. Some medical organizations oppose CPMs. That opposition is rooted in neither research nor fact. There is no evidence that licensing CPMs harms families or babies. Indeed, research shows that integrating CPMs into systems of care offers better outcomes. CPMs cut the rate of preterm labor and low birth weight in half. Licensing CPMs reduces needles interventions and improves infant safety.
Doctors who oppose CPM licensure do so because they see CPMs as competition. That’s not a valid reason for legislators not to vote for this legislation. Even if it were, CPMs are not in competition with doctors. In many areas of Georgia, CPMs fill important care gaps. Some counties in Georgia lack a single obstetrician. In those regions, CPMs aren’t an alternative care option. They’re the only care option. Even in large metropolitan regions, CPMs are not a source of competition. Less than 1% of births are at home. People who choose home birth will continue to do so whether or not CPMs are licensed.
Are there other types of midwives?
Yes. Certified nurse-midwives, who primarily attend hospital and birth center births, are already licensed by the state. There are also other midwives who are not currently licensed. Traditional midwives, sometimes called granny midwives or grand midwives, have served communities across the state for centuries. They are the original midwife. Some may choose to seek certification and licensure as CPMs if legislation opens that path. Others may opt not to become licensed. The choice is up to them. Licensure will not affect those who wish to remain unlicensed. Instead, it merely extends additional protections to those who wish to seek those protections.
Isn’t this forced licensure and intrusion on midwives’ rights?
Some midwives might feel that way, but that is due to a misrepresentation of the legislation. This law will not force anyone to become licensed who does not want to. It merely opens a new path to midwives who wish to follow that path. And in so doing, it extends care options to more birthing families. Licensure may mean that some families can get their home births covered by insurers.
The overwhelming majority of CPMs support this legislation, and believe it will help them provide better and more comprehensive care.
The Georgia Birth Advocacy Coalition supports this legislation because consumers want another option, and they do not want their midwives to face legal sanctions for offering that option.
Do you have questions or concerns about midwife licensure? Do you need help talking to your legislators? Share your questions in the comments!
To support this legislation, please attend Midwife Day on February 6th. Click here to RSVP.