Better Birth
Volume 93, No. 2, Winter 2021
By Elizabeth Kukura [PDF]

This Article provides a critical analysis of restrictive regulations that exclude midwives or prevent them from practicing to the full extent of their training. It offers a brief history of the relationship between midwives and physicians since colonial days, showing how interprofessional cooperation and respect waned as physicians became increasingly professionalized and sought to advance obstetrics as an independent specialty with preeminent expertise in childbirth. These efforts established the conditions that have led to modern-day hostility towards midwives by the medical profession.

Because physicians oversee a majority of the relevant state licensing boards — and their professional organizations have strong political influence on state legislatures — doctors in many states have resisted competition from midwives by regulating them to the margins of maternity care. The Article highlights recent research showing that greater integration of midwives into mainstream maternity care is associated with better maternal and infant health outcomes and argues that current restrictive regulation is both unlawful and impedes progress on improving outcomes at a time when the United States is facing a maternal health crisis.