Indianas 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 midwifes training, and that in some rural areas, a midwife is as well equipped as a small hospital.
Its 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 Controls 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.