Common Arguments—and Why They Fall Short

Supporters of Certified Professional Midwife (CPM) licensure and deregulated out-of-hospital birth often rely on emotionally persuasive but logically flawed arguments. These talking points may sound appealing, but they collapse under scrutiny. Here's why:

“This is about equity and access.”

Why it falls short:
Equity should never mean offering lower-quality, riskier care to poor, rural, or underserved families. Yet that is exactly what happens when states license midwives with lower educational standards and no integration into the healthcare system. Historically, underserved communities have been harmed by being offered less, not more. This is no different.

What equity really requires:
Ensure that all families—regardless of ZIP code—receive high-quality care from trained, licensed professionals. Support the expansion of physicians and Certified Nurse Midwives (CNMs) into birth centers, clinics, and underserved areas. Don’t create a two-tiered system where the lower quality goes to those who need care the most.

“It’s a feminist issue. Women deserve birth choices.”

Why it falls short:
True feminism is about protecting and empowering women—not abandoning them to unsafe systems. Using feminist language to justify substandard care is not empowerment—it’s betrayal. Throughout history, harm has often been done to women under the guise of protecting their freedom. This is no different.

A better feminist vision:
Women deserve real choices, grounded in transparency, informed consent, and clinical safety. That includes access to home birth that is regulated for safety, hospital-based midwives, safe birth centers, and accountable providers—not underregulated care masked as liberation.

“We need more providers. This helps fill a gap.”

Why it falls short:
We do not lower the bar for physicians, nurses, or teachers just because we need more of them. We invest in training and infrastructure to meet demand without compromising safety. Creating a shortcut midwifery credential doesn’t solve a workforce crisis—it creates a public health crisis.

A better solution:
Strengthen the CNM pipeline. Expand training programs. Pay midwives competitively. Remove unnecessary practice barriers for AMCB-certified midwives. Address the shortage without lowering the standard.

“Hospitals are unsafe too.”

Why it falls short:
Hospital care in the U.S. needs improvement—but the solution isn’t underqualified care outside the system. Hospitals have accountability, emergency capacity, and oversight—none of which exist in isolated home birth settings with CPMs.

As some argue, “Babies die in hospitals all the time, and that doesn’t make the news.”
This is a deeply mistaken assumption. The death of a full-term, otherwise healthy baby born to a low-risk mother in a hospital is vanishingly rare. Most hospital newborn deaths involve premature infants, severe congenital anomalies, or high-risk pregnancies—not the typical cases seen in out-of-hospital birth.

What actually helps:
Improve hospital maternity care. Hire more CNMs. Integrate midwives into hospital teams. Create safer options within the system, rather than promoting unsafe alternatives outside of it.

“Home birth is a valid choice.”

Why it falls short:
It can be—in the right circumstances and with the right provider. It is not a valid choice for high risk births or being led by someone without appropriate education. But CPMs are often not transparent about their credentials, lack of hospital privileges, or high-risk client load. Many families don’t know that their midwife couldn’t practice legally in most other developed countries.

How to protect choice:
Support evidence-based home birth—with licensed, insured, AMCB-certified providers working in collaboration with the health system. Choice without safety is not choice—it’s risk disguised as freedom.

“Women trust their midwives.”

Why it falls short:
Trust is important—but trust must be earned through standards, transparency, and accountability. In an unregulated system, trust becomes blind. Many families learn the truth about their midwife’s credentials or disciplinary history only after a tragedy.

What builds real trust:
Let women trust that the licenses a state provides are only provided to midwives who meet national and international standards, who are integrated into care teams, and who can manage complications—and confidently send women to the hospital when out of hospital birth is no longer appropriate.

A Better Way Forward

We can support:

• Midwifery autonomy

• Community birth access

• Informed decision-making

• Respectful care

But only if we insist on minimum standards.

Let’s not create a system where those with fewer resources are offered lower standards. Let’s create a system where every mother is protected, every baby is valued, and every midwife is accountable.