Arkansas Midwives Face New Regulatory Restrictions

Nov 22, 2016

More than 250 babies were delivered by Certified Professional Midwives in Arkansas last year.
Credit Deb Phillips

Home birth advocates claim the medical rights of childbearing women in Arkansas will be compromised by proposed new rules and regulations being considered by the Arkansas Department of Health, which licenses lay midwives in the state.

“Arkansas’s midwifery regulations are already some of the most restrictive in the nation,” says Tanya Smith, a midwifery advocate who serves on the Arkansas Department of Health’s Midwife Advisory Board. “The Arkansas Department of Health is planning to make them more restrictive by outlining certain tests, procedures and treatments that Arkansas women must consent to, otherwise they will lose their midwife.”

That an expectant mother would give birth at home was unquestioned until roughly the 1930s, when more hospitals began to offer obstetric and maternity care.  Today, not even two in 100 American babies are born outside of a hospital.

But interest in midwifery — a highly educated class of health professionals specializing in home-based prenatal,  delivery and post partum care — continues to rise. CNM's, or Certified Nurse Midwives, are allowed to practice in medical centers and homes in every state in the country, but fewer than 30 states license CPM's--Certified Professional Midwives.

There are just 27 CPM's, also referred to as licensed lay midwives, practicing in Arkansas. They delivered 250 babies in 2015.  

Arkansas Certified Professional Midwife, Deb Phillips, based in North Little Rock.
Credit Deb Phillips

Deb Phillips, among the first to be licensed in Arkansas in 1987, has delivered more than a thousand babies in central Arkansas. She says if the new stricter regulations pass and her pregnant clients don’t comply, she is legally bound to withhold services.

“That’s the worst part of the changes that they are trying to enact,” Phillips says. “Women may have to leave the care of their midwife. And if she is 36 weeks along, who is she going to go to?”

Phillips is referring to patient quotas. Obstetricians have to limit the number of patients they accept, and require women to enroll for care early in their pregnancy to assure sustained treatment.

Phillips says the rules will also expand requirements for women seeking a home birth in Arkansas. They'll have to submit to three medical risk assessments either with an obstetrician or health department clinician. Currently regulations prevent licensed midwives from contracting with mothers who’ve previously experienced a multiple or breach birth, or a surgical delivery.    

Tanya Smith, facilitator of the advocacy group Arkansas Birth Matters,  says the growing number of regulations governing midwifery strips women of their medical birth rights.

“It is our hope,” Smith say, “that the Arkansas Department of Health will balance their interest in making home birth safe for mothers and babies with protecting the rights of women to make their own medical decisions and choices.”

Elizabeth Harris, Deputy General Counsel for the Arkansas Department of Health, declined commenting on the proposed changes, but welcomes informal public comment.

“We are asking consumers and midwives to let us know their concerns,” she says. “We are not done, basically, drafting these rules. We are still in that process.”

The Arkansas Department of Health posts a list of Certified Professional Midwives on line, as well as current rules and regulations

The draft rules can be read here: ADH Midwife Draft Regs.pdf

Once the Midwife Advisory Board approves the draft rules and regulations, a final draft document will be made available on the Health Department’s website for official public review and comment, early next year.  

Correction: The Midwife Advisory Board-approved draft rules and regulations first must go before the Arkansas Board of Health--after approval from the Governor’s office and filing with the Secretary of State. The document is then posted for public comment.