Midwife Licensure

Access to safe, legal home birth is in danger. Licensing direct-entry midwives (CPMs) ensures Georgia parents have access to home birth. Most states already license CPMs, 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 (CPMs). The time for licensure has come. The Georgia Birth Advocacy Coalition stands with The Georgia Midwifery Association and other professional bodies to ask the Georgia Legislature to finally license and regulate home birth midwives. Thirty-one 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

There are two midwife certifications in Georgia. Certified nurse-midwives (CNM) often practice in hospitals or birth centers. Certified professional midwives (CPMs) attend home births. Georgia licenses CNMs. It does not license CPMs. CPMs who practice in Georgia are typically licensed in other states. So even though they have medical training and have apprenticed under another home birth midwife, Georgia does not acknowledge their existence.

This means that CPMs are not subject to regulatory oversight by any board in Georgia. It also means that Georgia does not recognize CPMs as medical professionals. This can be catastrophic for CPMs and the mothers they serve. CPMs 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 CPMs.

How CPMs 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 for CPMs, 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 CPMs.

Georgia faces another issue that CPM 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.

CPMs and other 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 CPMs, 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 CPMs and home birth sometimes tell people the choice is between giving birth in the hospital or at home. That’s not true. Some women have always chosen home birth. They will continue to do so whether CPMs are licensed or not. The only question is whether home birth happens in the shadows. Licensure empowers CPMs to provide excellent care. Further, licensure expands access to quality care by:

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

  • Making it safer and easier for CPMs, CNMs, and doctors to collaborate.

  • Ensuring hospitals can accept CPMs’ medical records.

  • Mothers and CPMs will no longer have to fear legal sanctions for choosing home birth.

  • The state will be able to set clear standards for CPMs 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

The Georgia Midwifery Association has introduced legislation to license and regulate CPMs this legislative session. Here’s what you can do to support this legislation:

  • Attend Midwife Day at the Georgia Capitol. You don’t have to be a midwife to attend! This is a day for birth activists to network, share ideas for passing this legislation, and lobby our legislators. We need a strong showing to show Georgia’s legislators how important this bill us. If you can’t attend, please share the event with people who might be interested.

  • Contact your legislator to tell them you support this legislation. This is a state law, so only contact your state senator and representative. You can find them here.

  • Follow the Georgia Birth Advocacy Coalition page on Facebook. We will post frequent updates on this legislation, as well as calls for help when we need it. Legislation moves quickly, and things can change fast. Our Facebook page offers the most updated information.

  • Contact the bill’s legislative sponsors to thank them for their support and ask what you can do to support this current legislation. Karen Mathiak and Timothy Barr are currently sponsoring this legislation in the Georgia House.

  • Educate yourself about the many issues in Georgia’s maternity care system, particularly maternal mortality and racial inequities. More than 60% of maternal deaths are preventable. Direct-entry midwives play a key role in preventing maternal deaths.

  • Buy a t-shirt and other gear at the Georgia Moms Deserve Midwives store. All proceeds benefit the Georgia chapter of the National Association of Certified Professional Midwives (NACPM).