ACOG supports an integrated maternity care system that facilitates collaboration among licensed and accredited clinicians across all birth settings, standardized safety, transfer and transport protocols, and risk-appropriate care at designated facilities. Safety concerns are greater in states where there is no requirement for midwives to work collaboratively with hospital-based clinicians or under common practice guidelines and transfer protocols.
ACOG respects a pregnant person’s right to make a medically informed decision about their birth attendant and place of delivery and believes hospitals and licensed, accredited birth centers are the safest setting for birth. ACOG supports the standards used by the American Midwifery Certification Board (AMCB) which credentials certified nurse-midwives (CNM) and certified midwives (CM). ACOG’s Joint Statement of Policy with the American College of Nurse-Midwives supports CNMs and CMs practicing to the full extent of their credential, training, and experience.
ACOG also supports the worldwide midwifery education standards set by the International Confederation of Midwives’ (ICM) in 2010—as a baseline for midwifery licensure in the U.S. All midwives—including certified professional midwives (CPMs), sometimes referred to as licensed midwives (LMs) and direct-entry midwives (DEMs), and others educated through non-accredited pathways—should meet the global standards. Birthing persons in every state should be guaranteed care that meets these important minimum standards.
A prior cesarean birth is one of several conditions indicating increased risk. For safety reasons, ACOG recommends that a trial of labor after cesarean be undertaken in facilities with trained staff and the ability to begin an emergency delivery. The availability of timely transfer and an existing arrangement with a hospital for such transfers are prerequisites for considering a home birth.
State legislatures are responsible for licensing and oversight of health care practitioners including midwives. Accredited education and training must be a prerequisite for state licensure and for reimbursement under public programs such as Medicaid and private insurance. ACOG supports national uniformity in midwifery licensure and scope of practice laws across all states. The standard birth certificate which every state uses should allow accurate recording of a planned home birth that is transferred to a hospital.
At the federal level, ACOG supports policy initiatives to address the shortage and maldistribution of maternity care clinicians including inter-professional education models that promote collaboration and team-based care.