Obstacles to the practice of licensed lay midwifery

Intensive interviews with licensed lay midwives in one of ten states that have recently reactivated and revised legislation legalizing such alternative practitioners for low risk clientele revealed a number of obstacles to their practice. The obstacles stem from the same rules and regulations developed by medical practitioners that made their homebirth service legal. Even after surmounting the difficulties of obtaining a license, the midwives find widespread unwillingness among private physicians to provide the required prenatal screening examination and medical back-up. The opposition of physicians to the licensed midwifery program is voiced in terms of concern about the safety of homebirths, particularly those attended by nonphysicians. Yet, the outcomes from the first 4 years of the program give no support for such concerns. Physician reluctance to cooperate with the legal program, combined with restrictions prohibiting the licensed midwives from suturing minor tears and administering a single dose of an antihemorrhagic drug in an emergency transfer, do compromise the overall quality of midwifery care. While accepting their subordinate position to medical practitioners, the midwives are struggling to establish the continuum of care for homebirth women implied in their licensure law.