Indiana’s ban on midwifery is aimed at protecting newborn babies and their mothers. But in practice that ban results in an unregulated system without standards where midwives still help with births – making them criminals.
State law permits midwifery only if the midwife is also a registered nurse. Indiana is one of just 10 states that prohibit trained women from assisting with home births.
Midwifery is legal – and regulated – in about half the states, while the remaining states neither outlaw nor regulate the practice.
The Indiana House voted 63-32 last week to allow trained, nationally certified midwives who lack a nursing degree to assist women with pregnancy and childbirth. If the bill becomes law, Indiana will find that it starts to save a considerable amount of money, said Jana Studelska, spokeswoman for the Midwives Alliance of North America and a midwife in Minnesota.
A Washington state study found that from 2001 to 2004, home births saved the state nearly $500,000 in Medicaid costs. Savings to all payers, including private insurance, amounted to $2.7 million.
More important than money, legalizing but regulating the practice should better ensure that practicing midwives are well trained.
Unquestionably, midwives who are not nurses are assisting with a number of Indiana births, despite the law. In 2010, slightly more than 1,000 women intentionally gave birth at home, yet only about a third did so with the legal assistance of a nurse/midwife. At least some of the remainder – more likely most – were attended by midwives who lack a nursing license.
And some Indiana prosecutors have been aggressive in enforcing the law. Last year, LaGrange officials charged two women with practicing midwifery without a nursing license.
For many, the idea that women would prefer to give birth at home rather than in the security of a hospital – where many resources are available if the birthing proves complex – is unsafe. But Studelska argues that emergency care is a key part of a midwife’s training, and that in some rural areas, a midwife is as well equipped as a small hospital.
It’s a very personal choice, Studelska said. The kind of care a midwife provides is fundamentally different than medical care. It offers a level of service and support that people crave.
The Centers for Disease Control’s National Center for Health Statistics found that women who choose homes births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer pre-term, low birthweight and multiple births.
Home births, the CDC reports, are more common among women aged 35 and over, and among women with several previous children.
The bill may face a tougher time in the Senate, but Indiana lawmakers are right – at the very least – to seriously consider the issue.
As Studelska said, It is time for regulation, not persecution and prosecution.