In states where midwifery is illegal, mid- wives run the risk of prosecution for practicing medicine without a license and for child abuse, manslaughter, or homicide if a mother or baby suffers injury or death. Yet research strongly suggests that home births conducted by experienced direct-entry midwives working with low-risk populations are as safe as or safer than doctor-attended hospital births, even taking into account the small number of midwifery clients who develop problems needing medical attention.
In states where direct-entry midwifery is legal, midwives typically must abide by regulations restricting them to “low-risk” clients (such as women younger than age 35) and restricting the techniques they can use (such as forbidding them from suturing tears after deliveries). These midwives typically must have a backup doc- tor and must transfer their clients to medical care if the doctor so orders. Thus, legalization has given midwives some degree of freedom to practice in exchange for limited subordination to medicine.
Despite evidence such as this, medical opposition to direct-entry midwifery remains strong and public support weak, although insurance companies do cover midwifery services in some states. Thus direct-entry midwives, even where legal, can’t claim to have achieved social acceptance even as limited practitioners.
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