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Iowa is facing a maternal health crisis including a severe shortage of OB/GYNs and family physicians who practice obstetrics along with labor and delivery units closing at hospitals and an increasing maternal mortality and morbidity rate. One solution to this crisis is expanding access to home birth certified professional midwives.

Last legislative session the Iowa House State Government Subcommittee chaired by Rep. Tom Moore considered HSB 522 to license certified professional midwives (CPMs) in Iowa, but it never made it out of the subcommittee due to misinformation from lobbyists of the nurse, hospital, and physician associations. 

The bill to license midwives, which will be re-introduced by Rep. Bobby Kaufmann during the upcoming session, models legislation in other states including South Dakota, which licensed CPMs in 2017. Currently, 36 states provide licensing for CPMs with Oklahoma being the most recent in 2020. Not providing licensing creates barriers to the CPMs currently practicing in our state and means fewer will enter the profession or will leave the state altogether.

The law in South Dakota was a long time coming with opposition from the state’s nursing association, but something changed in 2017 when now-former (SD has term limits which kept her from running for another re-election) state Senator Deb Soholt, R-Sioux Falls, a registered nurse and a former president of the South Dakota Nursing Association changed her position saying in a news article that midwives should be able to “practice in the sunshine instead of in the underground”. At the time the bill passed, former Sen. Soholt chaired the SD Senate Health and Human Services Committee and she said, “For 20 years I fought against [it]. Finally, I came to the realization that as a senator, if I believe in local control, and I know what it means to have a baby, who am I to say to another family ‘I am going to write your birth process for you?’ Families have the right to self-determination. If those families are willing to take that risk [of home birth], then we need to understand that risk. Let’s create a structure where we can see it.”

A study in the peer-reviewed Journal of Midwifery & Women’s Health (JMWH) confirms that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies and countless studies show midwives are proven to reduce the incidence of birth injury, trauma, and c-sections. Lancet Global Health just released a new modeling study estimating that even a modest increase in midwife-led care globally could avert a fifth of maternal and neonatal deaths and 14% of stillbirths globally by 2035. 

If midwives can help save the lives of Iowa’s mothers and babies, what is keeping our state legislators from providing a licensure path for CPMs? I know the answer and I hope the legislators that are still learning about the many challenges facing maternal-child healthcare will look at the evidence and see that licensing midwives to practice in their full scope is the right thing to do.

Some women in Iowa are having to drive hours to access care, something that is unaffordable and unsustainable. Homebirth is not for everyone and for families that want a hospital birth, midwives could provide quality prenatal and postpartum care closer to home in partnership with physicians or certified nurse-midwives. With the COVID-19 pandemic, CPMs are seeing increased demand for their services as the only providers trained in out-of-hospital birth.

Some may mistake my support for licensing of midwives for disapproval of hospital-based birth or physicians and that could not be farther from the truth (I have had two hospital-based births myself). Iowans need options and there is no risk-free birth setting, as detailed in this 2020 report from the National Academies of Sciences, Engineering, and Medicine which states, “Improving maternity care providers’ and birth centers’ ability to access state licensure and accreditation could also improve access to care.”

We need midwives more than ever to expand access to quality and evidence-based maternal health care. If Iowa legislators and Governor Reynolds want to improve maternal-child health they should fully support Rep. Kaufmann’s midwives licensing bill and ensure 2021 is finally the year Iowa joins the rest of the world in recognizing the critical role of midwifery-led care.

Author: Rachel Bruns

Rachel Bruns is a maternal-child health advocate and serves as a volunteer chapter leader for the International Cesarean Awareness Network (ICAN) of Central Iowa and patient advisor on the Iowa Maternal Quality Care Collaborative. Rachel works for a national nonprofit association promoting national service and volunteering. She lives in Des Moines with her partner Jordan and two children.