What Midwifery Licensure and Certification Means for YOU as a Pregnant Mama

I’ve noticed that certification/licensure status is becoming a key factor in vetting and selecting a midwife to attend a home birth.

I suspect this is largely due to the influence of a couple of prominent voices, like Free Birth Society and Indie Birth, who have done an incredible job raising awareness about the pitfalls of certification and licensure. I’m grateful for them for this. I mostly agree with their stance on the subject.

But as with all things, one can take an idea too far.

We may become too quick to automatically write off midwives with such credentials without considering the whole picture. We have demonized certification and licensure and lost all sense of nuance around the subject.

Here’s the thing: certification and licensure are tools. Some midwives choose to use them, and others do not. Like all tools, they can be employed in problematic or beneficial ways.

Let’s explore this together so that you can make wise, informed choices about your choice in birth attendant.

First, a story. My 5th baby was a wild pregnancy (with a few non-compulsory a la cart prenatal check-ins). When we got pregnant with our sixth baby, my husband had no desire to repeat the free birth experience and so I agreed to prayerfully seek out a midwife to attend us whom I felt I could trust not to interfere. The unlicensed options in our area were incredibly scant and either unavailable or too “green” for my preferences, so I started considering the pool of certified, licensed midwives. In the end, the Lord led me to an old-school CPM who reluctantly held a license and whose incredibly chill nature and respect for my autonomy (even if I was 42! Even if I gestated beyond 42 weeks! Even if I declined every single test!) spoke volumes to me. I experienced peace and consolation when I imagined her in my birth space. So we hired her — a CPM/LM — and she was exactly the midwife that I needed.

This could be true for you as well, and it’s important to remain open to that possibility. If you write off every midwife with letters after her name, you might miss out on your best fit midwife.

Here are some things to consider beyond her credentials or lack thereof:

1. How is the midwife oriented toward her credentials? Does she hold them in high esteem, believing they provide the only path toward being a skilled/legitimate midwife? Or does she hold them with humility (maybe even reluctance!!), recognizing that it isn’t the only way?
2. What are the licensure laws/parameters in your state? Do you live in a state where licensed midwives cannot support breeches, twins, and VBACs or where the second you hit 42 weeks they are required to transfer you out of care? Or does your state — like mine — have more lenient laws, allowing a midwife to support any of those types of births according to her level of comfort and competency and requiring an OB consult at 42 weeks while retaining the patient’s right to remain the care of the midwife?
3. Does she acknowledge and declare allegiance to Jesus or the board/state that issued her credentials? When push comes to shove, if the requirements of her certification or licensure collide with your unique needs as a birthing mother, is she willing to listen to and obey the Holy Spirit and be responsive to your needs even if that leads her to act in ways that her license/certification frowns upon?
4. What do you sense the Holy Spirit saying to you when you sit across from her? As she answers your questions and shares about her practice and her heart, how does that land in your Spirit? Keeping an ear open to your Good Shepherd’s voice, what do you sense He’s saying? Since He knows the future in ways you never can, He knows how/whether her credentials will pose problems in your unique pregnancy/birth journey and you can trust that.
5. When, how, and under which influences was she trained? Her age, the mode/road she took (e.g., apprenticeship vs. a MEAC education) to get to where she is now, her mentors/teachers, her philosophy of birth, and her personal experiences all impact the way she will practice. Not all CPMs operate in the same way. There is lots of room for variety within that credential. Same is true for licensure.

Some CPMs will be less medical and more trusting of birth than unlicensed ones, believe it or not!

It’s true that my own choice has been not to pursue certification or licensure, and our birthkeeper/pre-midwifery training program also steers clear of that. Yet I also recognize that some sisters in Christ have been led down other roads and to differing conclusions and I trust that they too are serving in the way and place that God has purposely positioned them.

I hope this helps you in your discernment process, sister. Trust that if the Father is leading you to have a home birth with a midwife, He has one out there that will be just right for you.

PS: You might also be interested in this short video in which I discuss the pitfalls/downsides of licensure in general.