What Good Midwifery Looks Like

Midwifery should be safe, respected, and integrated into the healthcare system. That’s already the case in countries like Canada, the United Kingdom, and the Netherlands—and it can be true in the United States as well.

We don’t need to eliminate home birth. We need to ensure it’s practiced by qualified, accountable midwives who are part of a functioning, well-regulated system of care.

The Certified Nurse Midwife (CNM) model already meets these standards. No one attending births should fall below this level of preparation, training, and professional oversight.

1. Require a Graduate-Level Midwifery Education

No provider should attend births independently without a graduate-level education.

CNMs, physicians, nurse practitioners, and physician assistants all complete advanced academic and clinical training. Even registered nurses with bachelor’s degrees are not authorized to independently manage maternal and newborn care.

In countries where midwives hold only a bachelor’s degree, they practice within highly integrated systems—with required physician backup and strict referral protocols. In the U.S., where care is often provided outside hospital systems, a graduate degree should be the minimum requirement for any provider managing birth independently.

2. Require AMCB Certification as the National Standard

All midwives who attend births should be certified by the American Midwifery Certification Board (AMCB). AMCB certifies both Certified Nurse Midwives (CNMs) and Certified Midwives (CMs)—the only U.S. midwifery credentials that meet international education and clinical standards.

This national standard provides:

• Rigorous academic and clinical training

• Hospital-based experience

• Emergency skills certification

• Oversight by a nationally recognized certifying body

Unlike other midwifery credentials, AMCB certification ensures consistency, transparency, and patient safety. We don’t need multiple training routes. We need one national, high-standard path—just like every other health profession.

3. Protect the Title “Midwife”

The title “midwife” must be legally protected, just like the terms “doctor,” “nurse,” or “attorney.” Only individuals who are certified by AMCB—Certified Nurse Midwives (CNMs) or Certified Midwives (CMs)—should be allowed to use the title.

Currently, in many states, anyone can claim the title “midwife”, regardless of education, certification, or clinical training. This loophole creates dangerous confusion, allowing undertrained individuals to appear equivalent to licensed professionals.

Title protection ensures:

• Clarity for families about who is truly qualified

• Accountability for those who attend births

• Respect for the profession of midwifery

If we would never allow someone to call themselves a surgeon, lawyer, or pharmacist without meeting national standards, we should not allow it for birth care either. This isn’t about exclusion—it’s about public safety.

4. Limit Home Birth to Low-Risk Pregnancies

Out-of-hospital birth should be limited to clearly defined low-risk pregnancies, in line with guidance from:

• The American College of Obstetricians and Gynecologists (ACOG)

• The American Academy of Pediatrics (AAP)

• The College of Midwives of British Columbia (Canada)

• The Royal Dutch Organisation of Midwives (Netherlands)

At minimum, home or birth center care should exclude:

• Breech or non-cephalic presentation

• Multiple gestation (twins or more)

• Prior cesarean birth (VBAC)

• Gestational age under 37 or over 41+6 weeks

• Maternal illness or pregnancy complications (e.g., hypertension, diabetes)

Midwives must also be trained and certified in neonatal resuscitation and newborn emergency stabilization. You cannot separate care for the mother from care for the baby.

5. Require Integration with Hospitals and Physicians

Midwives must not practice in isolation.
Safe care requires full integration with the broader healthcare system, including:

• Access to lab work, imaging, and prescriptions

• Clear consultation or shared care agreements with physicians

• Hospital transfer protocols with local facilities

• Admitting privileges wherever possible

When complications arise, patients deserve continuity—not delays or abandonment. Integration ensures midwives can escalate care quickly and effectively.

6. Require Public Reporting of Outcomes

States should mandate transparent, standardized reporting of midwifery outcomes, including:

• Neonatal, fetal, and maternal mortality and morbidity

• Emergency transfers to hospital

• Intended birth setting and provider type

These reports should be reviewed and published by an independent public agency, such as a state health department. Oregon provides a strong model for outcome tracking that protects families while supporting quality improvement.

Transparency builds trust. Without it, families are left in the dark—and unsafe practices are allowed to continue.

7. Require Malpractice Insurance

Malpractice coverage must be required for all midwives attending births.

Malpractice insurance:

• Holds providers financially accountable

• Compensates families for preventable harm

• Shields Medicaid and taxpayers from avoidable costs

Any state that allows midwives to practice without malpractice insurance must ensure that families are fully informed in writing—before care begins. Even then, many legal experts question whether consent alone is enough to waive the right to safe, regulated care.