Maryland Home Birth Advocates Seek Legislation to Minimize Midwife Restrictions

Women choose to give birth at home for a variety of reasons including the distrust of medical birthing procedures, the comfort of a familiar atmosphere, and the lack of intimacy in a hospital environment. After a steep decline during the 1950’s and 1960’s, home births have seen quite a resurgence in America over the past couple decades, with 24,970 births occurring at home nationwide in 2006. The state of Maryland has seen one of the greatest upsurges recently, with home births increasing by over 35 percent between 2003 and 2006. However, due to strict regulations in the state, the demand for midwives is exceeding the supply.

While Maryland permits certified nurse midwives (CNMs) who work in partnership with obstetricians to deliver babies in home environments, it does not allow other kinds of midwives, including certified professional midwives (CPMs), to do so. Twenty-six other states currently allow CPMs, who do not have nursing degrees, but are trained in childbirth and are credentialed, to be licensed for home deliveries. Even the state-sanctioned CNMs often are not available to deliver children in a home setting because the doctors they work with refuse to expose themselves to such a high level of legal liability. The small number of CNMs that are available for home births find themselves booked up quickly. Consequently, expecting parents seeking a home birth must either resort to a traditional hospital birth or illegally retain an alternative type of midwife.

Groups such as Maryland Families for Safe Birth are lobbying state legislators to develop legislation that will regulate the practice of midwifery and allow the licensure of CPMs to deliver babies in home settings. Advocates of such legislation maintain that regulation of the profession will allow more parents the option of a home birth and will ensure that these deliveries occur safely.

Opponents cite the safety of mothers and babies as their primary concern about legalizing the practice of CPMs and believe that childbirth is safest in a hospital where physicians, surgeons and modern medical interventions are available in the event of an emergency. In 2011, a joint statement opposing the legislation was issued by the Maryland nursing board, the American College of Nurse-Midwives, the Maryland Department of Health and Mental Hygiene, and a representative group of county health officials. Their position is that licensed doctors or nurses must attend home births and that patients must have immediate access to hospital care in the event of an emergency.

Ariana Kelly, a member of the Maryland House of Delegates, has drafted the legislation that she hopes to introduce during this year’s General Assembly session.