ANY bill to legislate birth and birth workers should include the following criteria:

1. Protect bodily autonomy: make your own choices without being forced or coerced.
2. Licensure should be optional. 
3. Protect the rights of a woman to choose to birth at home with the attendant of choice (regardless of culture or tradition).
4. Licensure should not force a woman to see a doctor or force a birth worker to discharge a woman based on a list of conditions.

HELPFUL BACK GROUND KNOWLEDGE

1. There were 202 home births in 2021 (1.2%)
2. There is already a licensed midwifery option in WV, the Certified Nurse Midwife (CNM).  
3. Direct Entry and Lay Midwives defined in WV: (these could be certified professional midwives (CPM) or traditional midwives) attended 211 births in 2021 (there is a discrepancy between the number of homebirths and number of births attended by an unlicensed midwife).
   
   1. CPM – completed study or apprenticeship with licensed individual and passed a test
   2. Traditional or Lay Midwife: various methods of attainment, often apprenticed with experienced midwife, and various amounts of self study.  Other titles include Birth Attendant.
4. Certified Professional Midwives (CPM’s) in WV want licensure. 
5. Some licensed midwives and CPM’s feel that unlicensed midwives are a threat, or that every midwife should be licensed to gain legitimacy in the medical system.
6. Midwifery is a very old profession, and it historically has been attended by direct entry midwives who have learned the art from other experienced midwives.  Many in the home birth community view birth as a normal function of the body, not a medical event or illness, and therefore works best in a safe and unobserved environment.  Too often hospital birth means painful intervention, drugs to speed labor or reduce pain, care from unknown individuals, and difficulty advocating for one’s own choices. 
7. Many home birth clients do not want to interface with the medical system, and therefore do not want the medical system to be in their own homes.
8. The medical associations will not allow passage of laws regarding midwifery without their own input and control.

Current bills in the WV legislature as of 2025:

1. SB 84
   
   1. Senate Bill 84 aims to license Certified Professional Midwives (CPMs) in West Virginia. However, in doing so, it seeks to criminalize direct entry midwifery, labeling it as a “public nuisance” and “inimical to public health and welfare.” 
   2. Additionally, SB 84 imposes excessive restrictions on licensed midwives, forcing them into physician oversight and bureaucratic mandates that limit their ability to provide care. These government controls do not enhance safety—they reduce the ability of midwives to make informed, professional decisions in real-life birth scenarios.  This language carriers over into the next bill (see number two).
2. SB 482
   
   1. Senate Bill 482 seeks to license Certified Professional Midwives (CPMs).  The current bill 482 lists conditions that require consulting a doctor including: complete placenta prevue, partial placenta previa (after 32 weeks), HIV infection, cardiovascular disease (including hypertension), severe psychiatric illness, pre-eclampsia/eclampsia, intrauterine growth restriction, known potentially serious anatomic fetal abnormalities, any type of diabetes not controlled by diet and exercises, labor prior to 37 weeks, substance use disorder with current or recent use, or any other condition or symptom which may threaten the life of the client or fetus.  And if the client does not want to consult with a physician the midwife must drop them from care. 

1. 1. 1. Some of these conditions have gray areas, or rely on flawed technology such as ultrasound.
      2. Some of these conditions may happen toward the end of pregnancy, in which case the midwife is likely to retain the money collected, which may be greater than $5,000.
      3. This is forced medical care.  A person should be able to make these decisions with a responsible midwife, regardless of type, without it being written into law.
   2. Bill 482 also lists how a midwife must handle a transport.  Sometimes transports happen emergently after a long birth, during which time it may be difficult to fulfill all aspects of the bill as written, and I think it is wrong to legislate such an occasion.  Again, most midwives would do their best to accompany the client and act in the most supportive manner possible.  Why does it need written into a law?
   3. Bill 482 mentions the following “The Board may deny, revoke, or suspend any license to provide midwife care issued or applied for in accordance with the provisions of this article, or to otherwise discipline a licensee or applicant upon proof that he or she…(4) Is guilty of conduct derogatory to the morals or standing of the profession.” 
   4. Who is determine what the “morals” are?
   5. Political agendas may impact the meaning of morals depending on the views that a particular person holds.
2. HB 2455 “Birth Freedom Act”
   
   
   1. This bill shows some promise in securing protection for choosing to work with a midwife, choose a home birth, have control over medical care, and limit the impact of licensure. 
   2. My issue is with the following statement: “(e) Nothing in this act shall prohibit a birth attendant from providing midwifery services without a license if the birth attendant has cultural or religious traditions that include the attendance of birth attendants at birth, and the birth attendant serves only women in that distinct cultural or religious group.”
   3. I feel like the above statement should be true regardless of cultural or religious group.  A birth attendant should be able to provide midwifery services without a license to any woman wishing to work with an unlicensed birth attendant or midwife.
   4. I would like to suggest that community midwives should have “qualified immunity” like the police officers.  Too often midwives (licensed or unlicensed) are criminalized for a bad outcome, despite providing competent care.  The same outcomes in a hospital are seen as “no one’s fault” because of the assumption that a doctor will “do everything possible,” and such an outcome could not be prevented.  We need to decriminalize midwifery in order to truly protect birthing women and their choices.   Midwives are experts in physiologic birth and should be treated with respect. 
3. HB 2174
   
   
   1. Bill regarding birth centers in WV. 
   2. Things to note:
      
      1. Does not allow breech delivery.
      2. Does not allow twin delivery.
      3. Does not allow pregnancy to go beyond 42 weeks and use birth center.

1. More Background
   
   1. Some midwives seeking licensure believe the following: they will be seen in a higher standing by the medical field, which would improve treatment when interfacing with the mainstream medical system; birth centers would be a possibility in West Virginia; insurance including Medicaid would pay for births; midwives who do not pursue the CPM title are inferior and should not practice.  My rebuttals:
      
      1. Licensure will not help improve treatment during transport situations.  The medical community views home birth as unsafe and irresponsible. 
      2. Birth centers are expensive and often cannot remain in business in states that have already legalized them.
      3. Medicaid does not reimburse well for births with Certified Nurse Midwives in the home birth setting, therefore these midwives do not take many clients with Medicaid.  It is doubtful that reimbursement would be adequate for CPM’s. 
      4. Many home birth clients do not have insurance and are self-employed.  These changes are driving up the price of midwife care to nearly $5,000 or above.  Many traditional midwives keep their prices intentionally low and potentially half the price of a CPM/CNM.  The out of pocket costs are likely similar if an insurance covers out of network costs at 40%, for example. 
      5. Most traditional midwives have a strong sense of duty to their clients and the community.  They have invested heavily of their time and money to be well trained, safe, and responsible.  They deserve to be protected by the law.
   2. Many of the schools teaching CPM’s do not support Christian values or are in complete disagreement with them.  They are forcing inclusive language and other political agendas, and therefore often unattractive to Christian midwives.  There are midwives that have surrendered their titles due to these facts.
   3. Finally, birth is risky and the outcomes cannot be guaranteed.  Licensing midwives is not going to change this fact, and it does not protect any midwife from legal action.  Most midwives cannot afford malpractice insurance.  Supporting community birth comest with potentially huge financial, emotional, and physical risk to the midwives involved.  If CPM’s are licensed there should be direct wording included in the bill that protects the rights of traditional (unlicensed) midwives and the clients in their care.