A group of Mississippi midwives is again advocating for regulations around their profession – a move they say will actually make it easier for midwives to practice in the state in the long run.
Under proposed legislation, midwives who want to practice in Mississippi would need to attain licensure from a board, and in turn would gain multiple privileges. As it stands, Mississippi is one of 13 states that has no regulations around professional midwifery – a freedom that hasn’t benefited midwives or mothers, advocates say.
“Tattoo artists have to apply for a license within our state, but yet someone who’s actually delivering a life and taking care of a mom, prenatal and postnatal – there’s no oversight,” said Rep. Dana McLean, R-Columbus, author of the bill. McLean has proposed similar legislation over the past few years.
This is the first year the legislation made it to a full floor vote. The bill specifically addresses professional midwifery – not nurse midwifery, which requires more extensive medical training.
House Medicaid Chair Missy McGee, R-Hattiesburg, proposed an amendment that would make it unlawful for licensed midwives to do homebirths for breech babies, but withdrew her amendment after other committee members voiced opposition to it. McLean said part of the purpose of the bill is to give women the opportunity to choose to give birth how they feel safest, and it would be the board’s responsibility to determine scope of practice.
Proponents of House Bill 927 say it builds value around midwives, protects mothers and babies, and strengthens the respect and collaboration between midwives and physicians.
“Consumers should be able to birth wherever they want and with whom they want – but they should know who is a midwife and who isn’t,” explained Tanya Smith-Johnson, president of the National College of Midwifery. “… Right now the way the law is, technically my husband could say ‘I’m a midwife,’ and there’s no one to say that you’re not.”
The lack of licensure, despite seeming inclusive, has rendered midwifery services inaccessible to poor women – and has also run some midwives out of business, Smith-Johnson explained.
Without licensure, insurance companies won’t cover midwifery services. Mississippi mothers have to pay out of pocket for the services and midwives end up undervaluing themselves to stay competitive in a market that doesn’t recognize them as licensed professionals.
“It’s hard for a midwife to be sustainable here,” Smith-Johnson said. “ … What is the standard of how much midwifery can cost if anyone and everyone can say they’re a midwife?”
The absence of licensure has also meant that midwives don’t get access to things like labor medication that those certified in states with licensure can access.
“It means that you’re kind of working just rogue … not being able to fully take care of a client, where you can order labs, carry oxygen, have medications a midwife would use for someone who is in labor – all of those things,” she said.
Smith-Johnson is part of Better Birth, a group that has been pushing for this legislation for five years. The group formed in response to an infant death that involved a midwife making questionable choices. The mother involved didn’t want to press charges – she just wanted reform.
“We formed because the mom had two options,” explained Erin Raftery, president of Better Birth. “She could either sue the midwife … but if she did that then it’s almost a guarantee that the profession would either be heavily restricted or outlawed, which is not what that mama wanted … So the other option her attorney gave her was to push for licensure.”
Anyone who practiced midwifery without a license under the bill would be fined $1,000.
In a state riddled with maternity care deserts, the last thing mothers want to see is birth workers leaving the state. But with no clear pathway to becoming a professional midwife, some birth workers are doing just that.
When Amanda Smith, originally from Jackson, was looking for a midwife to attend the births of her last three children, she and her husband couldn’t find a midwife with whom they felt comfortable working. Smith later discovered her calling for birth work while she was supporting her sister through labor, and she ended up getting her professional midwifery license in Colorado.
She returned to Mississippi in 2022 to serve her home state and now practices in Hattiesburg. However, she imagines there are midwives like her who leave the state and don’t come back – in no small part because of the liability risk that lack of licensure poses. While Smith has a Colorado midwifery license, she can’t become licensed in Mississippi because it doesn’t exist.
“It was one thing that really worried me about moving back,” Smith said. “I hired a lawyer to do a consultation and help me look over my paperwork and talk me through any scenario where I could potentially go to jail for being a midwife in Mississippi … I really look at this (bill) as a protection for midwives.”
If the bill becomes law, the board – comprised of nine members, including six midwives and the state health officer – will get to choose the kind of training midwives must undergo in order to attain a license.
In Texas, licensed midwives must complete a minimum of 1,350 hours of supervised clinical experience and pass an examination with NARM, the North American Registry of Midwives.
The bill seems to have more traction this year than it has in years past. Midwives say that in part, that’s due to a growing realization that they have the opportunity to regulate their profession as they see fit – before one too many risky situations causes physicians to impose regulations that don’t have midwives’ best interests in mind.
“I think there’s just been more iffy situations happening in the state, and it’s caused the midwives to realize that if we don’t do something now, it’s going to get done for us,” said Raftery.
The bill now advances to a full floor vote in the House.
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