News Story

New Licensure Mandate And Fees Make It Harder To Be A Midwife

If fewer enter the profession, expectant mothers may have fewer choices

Starting Aug. 1, midwifery will become the latest profession whose members are subjected to a state occupational licensure requirement.

Michigan’s medical service licenses include a category of nurses called licensed certified nurse-midwives. Another group of individuals, certified professional midwives, are not nurses and have not previously been subject to a full licensure regime. Their training is focused on normal deliveries and home births.

That will change. Certified professional midwives will be able to legally deliver babies, but they will be subject to the burdens of a full licensure regime. These requirements include:

  • An application fee and a one-year licensing fee of $650.
  • A $400 renewal fee every two years.
  • Completing an educational program accredited by the Midwifery Education and Accreditation Council or another organization approved by the state.
  • Completing at least 30 hours of continuing education, which includes one hour in pain and symptom management and two hours on cultural awareness, every two years.
  • Training in identifying human trafficking.
  • A criminal background check.

Katie Lavery, a certified nurse-midwife and legislative liaison for the Michigan affiliate of the American College of Nurse-Midwives, was involved in developing the new law. She said licensing certified professional midwives is needed to promote safety and consistency in care. Lavery said that the high fees may be a barrier to entry for some prospective midwives. But she said she hopes aspiring midwives will see the value of licensing and make it work.

“Our organization feels strongly that the women of our state deserve safe, seamless care for birthing,” Lavery said. “This means that women should be able to seek the provider of their choice in a safe and consistent manner and that their chosen provider should have open access to transfer and emergency services when needed. This has not always been the case in Michigan and we hope that recognizing these providers [through licensing] will improve this.”

Lavery added that licensing will also lend credibility and “raise the bar so that women who are choosing a CPM know that this licensed provider meets the minimum standards of education and safety.”

But Dick Carpenter of the Institute for Justice pointed out that 12 other states and the District of Columbia do not require a license for certified professional midwives. This, he said, strongly suggests that licensing is unnecessary. Instead, Carpenter said, a professional’s reputation is a far more credible indicator of quality and trustworthiness.

“We have at our fingertips in the form of actual consumer reviews voluminous information about service providers,” he said. “These reviews provide more information about a potential service provider than any licensing scheme will ever offer. If a mother-to-be wants to find a midwife, she will be better informed by the experiences of other mothers than licensing bureaucrats in Lansing.”

The real reason for occupational licensing, Carpenter went on, is job security.

“This is a classic example of industry leaders and associations seeking to erect a fence around their own occupation,” he said. “This is, in fact, how most licenses are created — industry leaders going to the legislature and asking for a license of their own industry.”

Jarrett Skorup of the Mackinac Center for Public Policy analyzed Michigan’s occupational licensing requirements in a 2017 study.

“There are benefits to be gained by current workers in an industry if barriers are erected that keep others out, and occupational licensure serves as one of those barriers,” Skorup wrote. “Fewer workers in the industry, means less competition among themselves, higher demand and more customers for each licensee and thus higher prices, and, ultimately, larger profits for those in the industry. The regulations that exist for this purpose and produce this type of effect are considered ‘captured,’ because, instead of serving the interest of the public, as government regulations are meant to do, they are serving the narrow interests of a particular group, at the direct expense of the public.”

Skorup said that if new regulations cause fewer candidates enter the profession, the result could be fewer options for expectant mothers, harming the very group licensure advocates promise to help. He notes that hundreds of thousands of people in Michigan live in the 25% of counties in the state with no obstetric care, and these new mandates will further limit birthing options for women.