Home Birth in Nebraska: Overdue for Change
Photo credit: Ardyce Blooms
“Nebraska families deserve safe and supported births. We deserve to have the same options afforded to other American families.”
Every year, thousands of American families choose to have their babies at home. Nebraska families, however, have very little choice in the matter. The privilege and sacred right for parents to choose the location of their baby’s birth has been steadfastly denied to Nebraskans for decades. Midwifery is highly restricted in Nebraska, which is even more troubling when you account for the major lack of maternal health care in rural Nebraska.
Lifting restrictions on midwives can improve birth satisfaction and safety for Nebraska families. New proposed legislation could lead to exciting changes in Nebraska’s home birth landscape. Read on to find out what’s going on – and how you can help!
Midwife: a Title Behind Red Tape
A midwife is a trained professional who cares for women during pregnancy and childbirth, somewhat like an obstetrician. Unlike obstetricians, midwives are not surgeons, and they typically handle low-risk pregnancies and births. Many families choose a midwife because they want a birth experience that is more autonomous and family-centered, with fewer medical interventions. In other states midwives attend births in hospitals, birth centers, and in families’ homes. There are many types of midwives, typically separated by their method of training. For our purposes today, we’ll just focus on two: CNMs and CPMs.
Certified Nurse Midwives (CNMs) first become nurses, and then take additional training to become midwives. Nebraska is one of three states where CNMs are required to practice under the supervision of a physician, which limits midwives’ ability to practice independently. This ensures that Nebraska families can only receive care from physicians, even when it comes through the hands of a midwife. Additionally, CNMs are forbidden from attending home births in Nebraska, the only state in the US to hold such restrictions.
Certified Professional Midwives (CPMs) go through midwifery training to become certified midwives. CPMs are not recognized in this state. Nebraska is one of only 12 states that does not authorize CPMs to practice. Because they are not recognized in this state, they do not have access to life saving medications. They are also not able to collaborate easily with other medical providers. This leaves a large gap in maternal health care — especially when a higher level of care is needed — and puts mothers at risk.
Nebraska’s Rural Maternal Healthcare Gaps
Over half of Nebraska counties are considered maternity care deserts, meaning they have no obstetric providers or birthing hospitals. For rural families, this often means driving a long distance for obstetric care. Longer travel time can increase risks to both mother and baby, and also increase financial strain and stress leading up to the birth. There are midwives living in Nebraska’s maternity care deserts that could be supporting families in their communities right now if not for our state’s seemingly arbitrary limitations.
Lifting the legal restraints on midwives would likely increase the number of available midwives in rural and urban communities. Currently, CNMs cannot operate autonomously or attend home births as they do in other states, and out-of-state CPMs would lose their livelihoods or risk legal persecution by moving to Nebraska. Nebraska residents who want to become midwives need to travel out of state for training. There is currently very little incentive for midwives to come here.
Home Birth Restrictions Increase Risks
The lack of options for Nebraska families has led many to seek alternatives, such as hiring an “underground” midwife. Though they exist, it can be very difficult to find one of these providers, as they cannot widely advertise their services, and the home birth community is very protective of its midwives. If parents do manage to find a midwife willing to attend their home birth, Nebraska’s restrictions prevent those providers from being able to access important medications. If an emergency arises and a quick hospital transfer is needed, midwives and families risk being met with hostile hospital staff and even calls to DHHS. This is partially due to the inability for homebirth midwives to professionally collaborate with medical providers as they do in many other states.
Call to Action!
Nebraska midwives and families have fought for decades to create legal paths to home birth, with little to show for it. However, at the time of this writing, a bill is progressing through Nebraska legislature, which has the power to make big changes. LB676, dubbed the “Momnibus” bill, would permit CPMs to practice in the state and lift the limitations placed on CNMs, allowing them to practice autonomously (without a supervising physician) and attend home births.
If you believe, like we do, that Nebraska families deserve options, we encourage you to help the cause. Here are some things you can do!
Talk to your state senator (or if you’re like us, ALL the state senators). Ask them to support LB676.
Follow Nebraska Certified Nurse Midwives and Nebraska CPM Alliance on Facebook for updates and further calls to action.
Tell your friends to do the same!
Nebraska families deserve safe and supported births. We deserve to have the same options afforded to other American families. We are so hopeful that with enough support, we can see BIG changes happen here.
