Legal Status of Direct-Entry Midwives
Where and how a woman chooses to give birth should be a very personal decision, chosing midwifery is also a practical one:
According to Dr. Frank Oski MD, [the Country] could save $13 to $20 billion a year by developing midwifery care, demedicalizing birth, and breastfeeding. Frank A. Oski, MD, Professor and Director, Department of Pediatrics, John Hopkins University School of Medicine, Baltimore. Contemporary Pediatrics, Nov., 1993, p9.
The following was obtained by folowing the chart compiled by the Midwives Alliance of North America (MANA), the Midwifery Education and Accreditation Council (MEAC) and the North American Registry of Midwives (NARM), found here: Direct-Entry Midwifery State-by-State Legal Status-Last Updated 5-22-2002
and also by doing key-word searches for each state on Yahoo!. with some additional help by http://www.motherstuff.com/
. I started work on this in January, and have put many hours into this, though I remain unsatisfied with the incompleteness of this work, (I hate to put something out that is so incomplete) but since times-a- wastin', I figured I have just got to get this out there, what I have.
Ranked by seemingly most free to least free. . . ( with quotes from the various websites regarding the legal status).
- Legal by constitutional interpretation. North Dakota
(unknown status, though by some accounts, it seems identical to Maine).
Legal by Judicial Interpretation or Statutory Inference
- license, private accredited training acceptable. Under a 1991 law, direct entry midwives are licensed by the Alternative Health Care Board, which also licenses Naturopathic Physicians. Direct entry midwife apprentices also pay an annual licensing fee to work with a preceptor. About 11 midwives, including 8 Certified Professional Midwives (CPMs) are currently licensed and attend home births. The NARM written exam (part of the CPM requirement) is used as part of the licensing process.
- permit, accept permits by other states through reciprocity only nurse-midwives may practice, because licensing is performed by medical authorities(1)Direct Entry Midwives (DEMs) are legal by licensure. CPM with NARM Exam not required. No MEAC Accredited Schools of Midwifery. No Medicaid reimbursement. Delaware Friends of Midwives is actively working to pass a Rules and Regulations change that would make it possible for all midwives (CPM's and CNM's) to attend births in all settings in this state. (1)
- license required by law. Recip not offered. Direct entry midwives are licensed and practice in homes and birth centers. The law that permits direct entry midwives to practice was extended in April 1999, granting CDM licenses (Certified Direct-entry Midwife) and uses the NARM exam as part of the credential process. There are some restrictions to the care that direct entry midwives can provide, for instance, a CDM cannot assist a woman with a prior C-Section.
6. New Hampshire
- Certification recip recognizes at least one private training, accepts Medicaid reimbursement. After 20 years of being regulated under the Depaartment of Health and Human Services, New Hampshire enacted legislation in 1999 creating an independent Midwifery Council, a regulatory agency with rule-making authority. The council is currently drafting rules for the practice of midwifery.
by licensure, accepts ACCS and MEAC training by private means. Vermont- license On May 5, 2000 International Midwives Day, the entire Senate passed the bill licensing CPMs in Vermont, the final legislative step. The licensing act went to the Governor as part of an omnibus bill, and he allowed the bill to go into effect without his signature. He was opposed to a section of the bill unrelated to midwives, but did not veto it. The bill will go into effect July 1, 2000. Creation of the rules will take place over the summer with the Director of Professional Regulation, two midwife appointees and a physician with home birth experience. This is a public process that allows input, but not final say by all concerned parties (Medical Society, nursing etc.). Law mandates that state Medicare pay for midwifery.
illegal, prohibited by statute
. Midwives may attend births in Wyoming, but are restricted from practicing prenatal or postpartum care and a midwife in Wyoming may not deal with a pregnant woman until contractions begin.
9. South Dakota
no legal status, specifically prohibited to non-licensed individuals, otherwise unknown.