Metro

Midwives debate bill that could regulate home births around the state

DCR Ranger Captain Stephen Owens greeted 1-year-old Desmond Ziolo of Hopkinton. His mother, Rachael Ziolo, and others, who mostly wore green "Support Birth Choice" T-shirts, oppose a bill on regulating midwifery.
Pat Greenhouse/Globe Staff
DCR Ranger Captain Stephen Owens greeted 1-year-old Desmond Ziolo of Hopkinton. His mother, Rachael Ziolo, and others, who mostly wore green "Support Birth Choice" T-shirts, oppose a bill on regulating midwifery.

Dozens of midwives and mothers with babies in slings and toddlers in strollers gathered at the State House this week to offer their take on a bill that, if passed, would require home-birth midwives to be licensed by the state.

Out-of-hospital midwives currently have no state oversight in Massachusetts, according to proponents of the legislation.

In addition to licensing, the bill would create a board of registration to regulate those who perform home births.

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Midwives who spoke before the Joint Committee on Public Health were split on the bill’s effectiveness.

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Supporters believe it would improve the safety of home births and increase access to maternity care.

Opponents fear it would limit the number of midwives allowed to perform home births around the state and tie up the enterprise in red tape.

The bill is sponsored by Representative Kay Kahn of Newton and Senator Anne Gobi of Spencer, both Democrats, and was drafted by the Bay State Birth Coalition, a consumer group.

“Licensing midwives who practice in out-of-hospital settings will ensure consumers who choose to have a home birth will receive their care from a licensed professional midwife,” Khan said.

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The popularity of home births across the nation has increased in recent years, according to a 2014 report from the Centers for Disease Control and Prevention, but they still account for a tiny fraction of deliveries.

Only 1.36 percent of US births took place outside a hospital in 2012, up from 1.26 percent in 2011.

Massachusetts averages 500 home births a year, according to state birth certificate statistics.

The bill would require home-birth midwives to obtain a credential to become a CPM, or certified professional midwife. CPMs are expected to go through three to five years of training and apprenticeships for national certification from the North American Registry of Midwives, according to the registry’s website.

An estimated 94 percent of out-of-hospital midwives in Massachusetts already have a CPM credential, so the requirement would affect only a small number of providers.

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(The state’s Board of Registration in Nursing provides oversight for certified nurse midwives, who work in hospitals. They are licensed as registered nurses.)

Ann Kilroy, a CPM for 26 years, said many midwives around the state have been in support of such a bill for decades. A registration board, she added, would consist of other certified professional midwives. “We’re not going to make strict regulations that are unfair,” Kilroy said.

Not everyone is so sure. Joyce Kimball, a certified professional midwife for 17 years, said she’s concerned that regulations would drive some out of the profession.

“Yes, in other states midwifery is licensed,” Kimball said. “The concern is that many midwives are licensed out of practice.”

In addition, Kimball and others with her group said they were worried that women who decide to have a home birth would not be allowed to choose who they want as a birth attendant.

They wore bright neon-green T-shirts that said “Support Birth Choice.” They also spoke against the wording of the bill, which calls for fines and potential jail time for unlicensed midwifes.

“I’m concerned a board tasked with deciding what is safe at home and what is not would exclude women who may otherwise choose to give birth at home,” said Newton resident Nicole Chamoy, 36, who gave birth at a hospital twice before trying a home birth.

“Risk is in the eye of the beholder,” she said. “It’s not up to anyone else to tell that woman what she can and cannot do.”

And yet supporters of the bill maintain that not all women can choose to have a home birth, as they are often not covered by insurance.

The cost of a home birth averages between $3,000 and $5,000, Kilroy said.

“I turn people down every week because their insurance won’t cover a home birth,” Kilroy said.

“I end up serving people who can afford to pay out-of-pocket, and that’s the part I would like to see changed. But also to be able to have regulations for midwives so we have to practice within protocols, just like anybody else, for the safety of the clients.”

Cristela Guerra can be reached at cristela.guerra@globe.com. Follow her on Twitter @CristelaGuerra.