After years of hard-fought advocacy, Michigan midwives, expectant parents, and families started the new year celebrating. That’s because in early January the governor signed a bill allowing Certified Professional Midwives (CPMs) to become licensed by the state.
Compared to a Nurse Midwife who attends births mostly in hospital settings and is licensed as a nurse, a CPM is a midwife who practices in out-of-hospital settings and has received training outside of nursing. This could include completing a midwifery school degree or an apprenticeship followed by CPM exams.
For CPMs who have, out of necessity, practiced their profession without a license up to this point, the new law means increased legal protections. It also ensures standards of care for pregnant families who choose out-of-hospital births.
Continuing to practice despite the risks
Stacia Proefrock advocated for the law in the Michigan legislature. As the primary midwife and owner of Trillium Birth Services, she knew all too well the risks of performing home births without the safety net of licensure. “The laws in Michigan have always been vague about midwifery, but the threat of getting prosecuted for practicing without a license was constant,” says Proefrock. She sits cross-legged on the couch in her Ypsilanti office, a bright, charming space where expectant mothers come for labor support services and midwives attend trainings.
Despite the risks, Michigan midwives continued to practice and families continued to seek out their services. Michigan advocates long desired a consumer protection law that ensured midwives had the proper training and credentials. Before the law passed, anyone could call herself a midwife and could practice however she chose. Advocates understood that CPMs, just like any other maternity care providers, needed more than a certification; they would benefit with a state-issued license and an oversight board.
The long road to licensure
The Coalition to License Certified Professional Midwives formed during the years of advocacy. Made up of state midwifery organizations, consumer organizations, and individual parents and midwives, the group had support from national midwife and consumer networks. The coalition worked hard to pass a bipartisan bill led by State Representative Ed McBroom from the Upper Peninsula.
“It is the responsibility of the state to protect public health. This means ensuring health care providers meet minimum standards. And midwives are no different,” says Deborah Fisch, a parent and attorney who spent years advocating for the new law. She approaches the issue from a reproductive justice framework, which supports the right to have a child, to not have a child, and to raise that child in a healthy and safe environment. Being able to choose quality prenatal care is an important piece of this framework.
A lifetime activist, Fisch became passionate about how women give birth in the United States after having both her children at home. “I really enjoyed giving birth. And that’s not what a lot of women say who give birth in hospitals,” says Fisch. “But I felt like I had done something extraordinary, like I had done it, not that it had been done to me.”
Like Fisch, Proefrock describes her own home birth as empowering: “The care was amazing. My midwife spent more time with me, and she gave me social and emotional support. I felt she treated me, the patient, as a whole person.”
With this level of care, both women felt that the medical community as well as the state should recognize the status of non-nurse midwives within the healthcare community. Michigan lagged behind other state’s licensure laws but has finally become the 31st state to enact licensing.
Writing the rules of the law
“This is a case where a law was made because a lot of people in Michigan wanted it and spoke up,” says Fisch. Now that the law passed, many Michigan midwives are asking how it will affect their practice. To allow time for the specific rules to be drafted, no licenses will be granted until at least 2018. The first step is to establish a state midwifery board composed mostly of licensed midwives who will play a major role in writing the regulations. The licensure act also imposes an initial license cost of $450, with an annual renewal fee of $200.
“We actually got the [licensure] costs down quite a bit,” says Proefrock. “I don’t think the costs will deter midwives from seeking a license. In fact, I think this law is going to attract a lot of new midwives to Michigan because they know we’re now a regulated state that is safe to practice in.”
According to Fisch, one of the most important things licensure will do is to provide a protocol for transfer of care from the home or birth center to a hospital setting when necessary. This will provide better interaction between midwives and medical professionals. It may also allow midwives to seek reimbursement from Medicaid.
“Home births shouldn’t be just for wealthy families,” says Fisch. “Families give birth at home for all kinds of reasons. It doesn’t matter why they do it; everyone deserves access to quality care in whatever setting they choose.”