North Carolina Advocates Fight Back Against Midwife's Arrest

Earlier this month, Emily "Amy" Medwin, a Certified Professional Midwife (CPM), was arrested in North Carolina for practicing in the state without proper certification. Although Medwin is educated in home and out-of-hospital births, authorities say she was not licensed to practice midwifery in North Carolina, only in Virginia.

But the problem isn't hers alone. CPMs are only legally recognized in 27 states, so even if she tried to obtain the proper licensure in North Carolina, she couldn't. The state doesn't license CPMs, so they can be criminally prosecuted for unlicensed health care practice, despite their legality in neighboring states.

The threat of criminal prosecution has led many advocates and mothers to speak out on her behalf, including Lindsay Fisher, who started a petition calling on the state legislature to legalize midwifery in North Carolina. Advocates in the state are also part of the "The Big Push for Midwives" campaign, a larger effort aiming to pass legislation to license CPMs in all 50 states.

For many, the fight over midwives pits a woman's choice to have her child at home against the medical establishment. According to Katie Prown, Campaign Manager for the Big Push for Midwives, "the medical lobby spends millions of dollars all over the country each year to defeat pro-midwife legislation and to keep CPMs, who are specially trained as experts in the provision of out-of-hospital maternity care, illegal and underground."

The medical establishment sees it differently. A white paper on the North Carolina Medical Society's website states that "a top priority ... is to defeat any proposals where patient safety could be at risk," including a 2009 proposal to license CPMs in their state. The American College of Obstetricians and Gynecologists (ACOG) takes the position that hospitals and birthing centers are the safest places for labor and delivery and does not support planned home births.

ACOG does concede that the "absolute risk" of planned home births is low, but they cite research that shows it carries a higher risk of newborn death compared to planned hospital births. They also find that home births in low-risk women are associated with fewer medical interventions.

Lack of medical intervention is one reason Arielle S., a North Carolina mother-of-three, chose to deliver at home with a midwife for her third child.

"I was treated like a human being with my midwife. I was allowed to birth gently. There was a reverence about the entire labor that wasn't present with my first two children. I was able to give birth without any wires attached to my body, needles shoved into my skin, bright lights, screaming."

Her concerns over the U.S.'s high cesarean rate -- 32 percent of all births, an increase of over 50 percent in the past few decades, according the CDC -- also played a role in wanting a more natural delivery. "Pregnancy and birth are not a disease and don't need to be pathologized. It happens as naturally as the process involved in getting pregnant in the first place -- if you have a midwife that will let it be that way."

But the process of finding a midwife isn't always easy and the licensing situation can make it harder. According to Arielle, she and her husband nearly gave up on the search for one in North Carolina. She is on Medicaid, and although it would have paid for her labor, it would not cover home birth with a midwife. So, they paid for the midwife out-of-pocket.

Many insurers cover midwives, but only if they are licensed in the state and work in a hospital or approved birthing center. Because midwives are traditionally less expensive than hospital births, advocates say that greater certification will lower medical costs, while also allowing women to give birth the way they want.

North Carolina isn't unique in its lack of licensure, but according to Prown, they are a hold-out among neighboring states that have moved to make changes. "Throughout the South, other states—including Virginia, South Carolina, Florida, Louisiana, and Texas—have embraced the region’s historical legacy as one of the last remaining bastions in the country where families have had continued access to midwives able to legally provide maternity care in all settings, including private homes and freestanding birth centers."

To advocate for CPM legislation, the North Carolina Friends of Midwives are organizing a Birth Freedom March in Raleigh on March 2. You can also sign your name to the petition calling on North Carolina Senate and House to pass legislation that would license and regulate CPMs.

Photo credit: eyeliam