A Public Health Ethics Analysis of the Criminalization of Direct Entry Midwifery

Abstract

Multiple types of midwives practice in the United States, but regulation of midwifery practice varies by state. In some states, direct entry midwifery practice is unregulated or criminalized. Because regulations are the most burdensome of the public health interventions, they require the most stringent ethical critique. This article uses the most recent Public Health Code of Ethics to analyze the ethics of regulations that criminalize direct entry midwifery practice. The Code establishes 8 criteria for ethical actions: (1) permissibility, (2) respect, (3) reciprocity, (4) effectiveness, (5) responsible use of scarce resources, (6) proportionality, (7) accountability and transparency, and (8) public participation. Laws that criminalize direct entry midwifery practice violate all of these criteria and therefore cannot be considered an ethical approach to the state's duty to safeguard public health. The remedy for this problem is for all states to license and regulate all types of midwives that meet international standards of education and training.

Expanding certified professional midwife services during the COVID‐19 pandemic

“…They also prevent pursuit of criminal action against midwives who were otherwise practicing without state‐recognized licenses. 19 Other states have eased restrictions on midwifery care during the pandemic, including expediting licensure of midwife‐led birthing centers and practice privileges for midwives licensed out of state. 3 , 20 , 21 Notably, the Governor of New York, after large midwife‐led advocacy efforts, issued an executive order to allow out‐of‐state licensed midwives to practice in New York.…”

“…These bills would increase access to community‐based birthing, particularly among low‐income families, and reduce the burden on hospital systems during successive waves of the COVID‐19 pandemic. They also prevent pursuit of criminal action against midwives who were otherwise practicing without state‐recognized licenses 19 . Other states have eased restrictions on midwifery care during the pandemic, including expediting licensure of midwife‐led birthing centers and practice privileges for midwives licensed out of state 3,20,21 .…”