The Herald Bulletin

June 5, 2013

New law legalizes midwifery in Indiana

By Maureen Hayden
CNHI Statehouse Bureau

INDIANAPOLIS — A new law that legalizes midwifery in Indiana has been a long time coming for women like Mary Ann Griffin, a certified professional midwife and longtime advocate of home births.

Her first trip to the Indiana Statehouse to lobby legislators to repeal an old state law that made her work a felony crime came the same year she gave birth to twins.

“They’re seniors in high school now,” said Griffin. “That’s how long it’s taken us to get here.”

On Tuesday, Griffin was at the Statehouse again, this time to join Gov. Mike Pence in a ceremonial signing of House Enrolled Act 1135. It’s the new law that, when it goes into effect July 1, will make Indiana the 28th state in the nation to legalize and regulate midwives who attend at-home births.

“It’s a huge step forward for families in Indiana who choose home births and for the midwives who provide those services,” said Griffin, now president of the Indiana Midwives Association. “It increases accountability and transparency for our profession and increases access to the medical community when needed.”

Up until now, it’s been illegal for midwives to be involved in home births in Indiana unless they were certified nurse-midwives licensed by the state. But most of those certified nurse-midwives work exclusively with hospitals or obstetric practices and attend few home births.

House Enrolled Act 1135 creates a mechanism for the state to now recognize an additional group of midwives who routinely attend home births and who’ve been certified by a national midwifery organization recognized by other states.

Supporters of the new law say it recognizes the reality of home births in Indiana and sets new safety standards for a practice that’s been going on, outside the law, for years.

About 1,000 women give birth at home each year in Indiana, according to state health officials and others who testified on the bill. Some of the strongest support came from the Amish communities in Indiana, who for religious reasons, shun hospital births.

“There needed to be a system in place that would both increase the professionalism and accountability in midwifery,” said Tuesday Lach, a Muncie-area midwife who worked legally in other states. “Having the profession unregulated doesn’t provide that.”

That was also the thinking of Rep. Ed Clere, a New Albany Republican who took over this year as chairman of the House Public Health Committee. Similar legislation to legalize midwifery had died in the committee in past years, killed by opposition from the Indiana State Medical Association.

“This is not creating a new practice of midwifery,” Clere said. “The practice has been going on in Indiana since the frontier days. All this does is make it safer and more transparent.”

The new Indiana law may be one of the toughest in the nation; it’s more stringent than what the Indiana Midwife Association originally wanted.

The new law creates a new designation of “certified direct entry midwife” rather than recognizing the standards set by the National Association of Certified Professional Midwives. It gives the job of licensing certified direct entry midwives to the Indiana Medical Licensing Board, which will adopt rules and standards with feedback from a midwifery committee that includes both midwives and doctors.

The law increases the oversight of the certified midwives by physicians and requires expectant mothers who plan a home birth to be seen at least twice — in the first and third trimester — by that supervising physician.

The provisions requiring more physician supervision came after the Indiana State Medical Association opposed the original midwifery bill. Association members have repeatedly expressed concerns about the safety of home births unsupervised by physicians.

As it reads now, only about a dozen midwives practicing in Indiana would likely qualify to be certified, Griffin said.

But Griffin and others see the law as a significant first step toward gaining recognition for their profession. One piece of the new law requires the state health department to collect much more information about home births.

“We’re hoping that will show there are good outcomes for families who chose home births attended by trained midwives and who have access to good prenatal care,” Griffin said.

Maureen Hayden covers the Statehouse for the CNHI newspapers in Indiana. She can be reached at maureen.hayden@indianamediagroup.com