NORTHAMPTON — With the arrival of a royal baby on Wednesday, out-of-hospital births dominated headlines amid speculation that Meghan Markle had chosen to give birth at home. But for months before the Duchess of Sussex brought out-of-hospital births into the spotlight, midwives in Massachusetts had been debating the effects of a bill that would legally recognize those who typically attend home births — certified professional midwives.
Currently, Massachusetts does not legally recognize certified professional midwives (CPMs), who obtain their licenses through the North American Registry of Midwives (NARM). As of this month, CPMs have a path to licensure in 33 states, not including Massachusetts, according to the National Association of Certified Professional Midwives.
Legally recognized midwives in the state instead have received certification through the American Midwifery Certification Board (AMCB) and are known as certified nurse-midwives (CNMs).
The proposed legislation, H.1948/S.1332, “An Act Relative to Out-of-Hospital Birth Access and Safety,” would legally recognize CPMs and create an accompanying board of registration. Although similar legislation has been proposed before, this particular iteration was introduced in January 2019.
Midwives who spoke with the Gazette expressed mixed opinions on the bill.
Tanya Rapinchuk, a certified professional midwife at Sacred Birth Midwifery Care in Northampton, said that she is “not opposed to licensure in theory,” as it can help consumers understand the quality of care they will receive, but feels that the current bill is “imperfect.”
Rapinchuk said she is concerned that the legislation narrows the acceptable avenues toward certification. NARM allows midwives to either complete an apprenticeship program or graduate from a program accredited by the Midwifery Education Accreditation Council (MEAC). The bill states that, beginning in 2020, “an applicant must obtain certification by completing a program or pathway accredited by the MEAC.”
“It doesn’t support the apprenticeship model of education,” Rapinchuk said, “which I think is one of the most powerful and important ways of having a really solid understanding of how it feels to be a midwife — having lots of hands-on experience.”
But Katharine Green, a UMass professor, certified nurse-midwife and co-affiliate legislative chair for the state American College of Nurse-Midwives, said that she sees the bill as an opportunity to increase public safety standards in Massachusetts.
“CPMs are currently not licensed in this state, and that also means that they are not regulated particularly well in this state,” Green said.
“Women deserve choices,” she added, “and we have gone to a much more medicalized form of labor and delivery in recent years in this country. Women are still going to do what they’re going to do. I would much rather have it be safe.”
While recent reports suggest that the Duchess of Sussex may have given birth in the hospital after all, a small but growing number of Americans choose to have out-of-hospital births, according to the National Center for Health Statistics. For both advocates and opponents of the bill, creating access to home births remains a top priority.
Ryan Pryor, a CPM and family nurse practitioner living in Northampton and currently working as a nurse in Connecticut, believes the bill would allow people to have greater access to out-of-hospital births, which he described as “ethically imperative” for those who have had negative experiences in a conventional hospital setting, in particular.
Pryor, who identifies as transgender, said that this issue often arises for trans and other LGBTQ individuals who give birth: “Very often, a trans person or nonbinary person may feel more comfortable birthing outside of a hospital because you have more control outside of a hospital.”
Although Pryor and Green see the increased regulation as an improvement, others, including Rapinchuk, feel that similar licensure requirements in some states have set overly restrictive measures. Rapinchuk said that other states have “systematically” ruled out certain people giving birth from the list of who’s eligible for a home birth — for instance, people opting for a vaginal birth after cesarean or those who do not meet hemoglobin levels.
Rapinchuk acknowledged that a home birth is not best for everyone. Together, parents and midwives can gain a better idea of the individual’s situation, she added.
“My main goal for this is access,” Rapinchuk said. “Quality access and choice for families. And I guess, for me, (the bill) limits some of that.”
“I’m aware that there needs to be compromise on all sides of how to get there,” she continued, “because I believe we’re going to get there at some point, but I would like more people to be included in the conversation.”
Joyce Kimball, a Worcester-based CPM and volunteer with the advocacy organization Support Birth Choice, expressed a similar concern.
“Once you place legislation and choices into the government realm,” Kimball said, “you lose control of what’s allowed and what’s not allowed.”
Emily Anesta, a founder and board member of the consumer advocacy group Bay State Birth Coalition, said that the bill was created in accordance with international and national standards for midwife certifications, such as United States Midwifery Education, Regulation and Association regulations.
When Anesta was looking for a midwife for herself, she recalled that the process was somewhat confusing.
“It took a lot of work for me to understand the credentials,” she said. “I still had no independent way of verifying the credentials.”
Through the proposed legislation, Anesta said, parents would have “more consumer transparency and protection about that.”
One of the main reasons why Anesta said she supports the bill is because she thinks it would facilitate easier collaboration between hospitals and midwives, which can sometimes be complicated due to misunderstandings about licensure and the hospital’s liability in working with the midwife.
The bill also would increase access to midwifery care by allowing more midwives to take insurance, Anesta said. While home births are typically less expensive than hospital births, she continued, they are often not covered by insurance.
Pryor said that he also sees easier collaboration between midwives and other health care professionals as a crucial component of the bill.
“One of the real issues currently is, because CPMs are less recognized and less known in the state, there can be challenges to facilitating a smooth transfer of care into the hospital,” Pryor said. “I think when that doesn’t exist, it really creates continuity of care issues for clients.”
But Kimball said she doesn’t agree “that this legislation will compel private insurance to cover home births,” and she doesn’t believe that midwives have poor relationships with hospitals and birthing centers under current practice.
Kimball took a negative stance on the proposed legislation as a whole, saying she sees “no benefit to this bill.”
“It only harms,” she added.
In addition to possibly creating measures she sees as overly restrictive, Kimball said that the bill also could create financial barriers to becoming a midwife, which in turn would decrease consumer options around home births.
“We’re trying to grow more midwives,” Kimball said. “This bill says only midwives who can afford an expensive university program can become licensed as midwives in the state of Massachusetts.”
The bill has received support from local legislators such as Lindsay Sabadosa, who said that it “ensures that patients have more of an option and brings more respect to the profession.”
Jacquelyn Voghel can be reached at firstname.lastname@example.org.