The Double Edged Sword of Licensed Midwifery

Right now there are changes going on in laws regulating the practice of midwifery around the US, changes that will impact the future of home-birth in this country. One of the ones that is always on my mind is the move for state and national licensing and certification of midwives.

When you think of the term “licensed midwife”, it sounds good. It sounds like it means “safe”, “well-trained”, “qualified”, “accountable”, “responsible” midwife. But, in my journey into midwifery I am starting to wonder how true that is.

On the positive side, maybe licensing will bring a certain respectability to midwifery. Maybe people will see that we have something to offer the community on a wider level. There are countries where lay-midwives even have hospital privileges if they are licensed. And, maybe if Doctors saw that we had worked to gain the knowledge we have and we had some title to prove it they would listen to us if we had to transfer a patient, much like they would listen to another Doctor giving over a patient to their care. But, would gaining respect in a more mainstream system require assimilating yourself into it?

I think that the real crux of the issue lies in regulating midwives more then licensing them… And the two things go hand in hand. When a state decides to license midwives, they also hand them a set of rules and guidelines to follow in order to keep that license. This becomes a problem for moms like me, mom’s who have more than one c-section in their history and know their best chance at having a normal birth is with a midwife at home. Or, a mom carrying twins. Or a mom past the magic 42 weeks gestation. But, the midwife operating within the confines of her license is sometimes forced to turn away these mothers whether she feels able to help them on their path to a normal pregnancy and birth or not.

So, the midwives with the most freedom to exercise their judgment end up being those in areas where midwifery remains un-regulated. And, assuming that they are in a state where midwifery is not illegal… I would say these midwives might be in a pretty good situation. “But, without a license how will I know she is a competent midwife?” mothers may ask. Talk to her and ask as many questions as you can. Do your homework. Talk to her clients. Look into public record and see if there is anything about her. Ask other midwives in your area their opinion. Be an informed consumer. And I hope if you have to be referred to a physician at any point during your care you will check his credentials the same way.

When I first started researching midwifery I thought that I would want to be licensed, and that I would never practice unless I was. Now, I am starting to feel differently. I don’t think a license will make me a better midwife. And I don’t think that passing an exam to get licensed will teach me anything more than how to pass the exam and get licensed. I am not interested in that. I will do it if I feel it is the right choice, but I am no longer locked into the idea that it will help me or protect me to have a license.

You come to a point when you are learning about midwifery that you realize midwives are really sticking their necks out no matter what their license status is. There is no way to prevent it. And I hope everyone sees that a license is not a guarantee that you are choosing the right midwife. I know that some people are soothed by the license. They feel like it is a way to reassure themselves that the midwife they have chosen is capable. And, there may be some truth to the idea that licensing could weed out some under-qualified midwives… But it might also keep some really great ones from doing things they know are right.

I guess in the end if I get a license (and I just might) I will try to remember that it is only a piece of paper and I am only doing it to get midwifery out there in the mainstream. But, I will not let it dictate my practice. I will not let the fear of losing it keep me from doing what I know is right. And I will remember that some of the organizations making these licenses are still living in the past and using antiquated information to form their standards most of the time.

So, next time you hear a midwife tell you she is not licensed, remember this and ask her why.