Each year, hundreds of Utah women give birth at home with only a lay midwife to help. The actual number of such births is unknown, but it is significant. Now there is nothing inherently wrong with home births or midwives as such, but the lack of any training or certification of lay midwives is troubling.
As things now stand, anybody can become a lay midwife, without training, without background, without licensing, even without a basic education. All one has to do is give oneself the title and spread the word.There are no state laws governing midwives, and while their legal status has shifted back and forth, the most recent attorney general's opinion - in 1986 - said that midwifery is not the practice of medicine and therefore is not illegal in Utah. But that's an opinion, not a court verdict. Because their position remains unclear, many midwives function in a shadowy off-the-record world and word-of-mouth advertising.
This situation has the state Health Department deeply concerned, as it should be. While aiding at a birth may not meet the legal definition of the practice of medicine, it can have medical consequences. There are times when the health of the mother or the newborn baby may be at risk.
At the very least, midwives ought to be registered and licensed, so people know who they are and what they are doing, even if special training is not required. Yet some minimal training would seem to make a great deal of sense as well.
Some states require licensing or registration. Others have outlawed the practice of midwifery altogether. Some, like Utah, are simply silent.
Unfortunately, the chance of legislative action to regulate midwives is not bright in Utah.
Those who use the services of midwives - according to a 1986 study - tend to be secretive, and are not pushing for any oversight of midwives. Yet users could benefit by having midwives registered; it would at least help in choosing an experienced person and pinpoint those who may have problems.
The midwives themselves are opposed to any form of registration or regulation. And, strangely enough, the medical community also opposes the idea. This is because it feels any program of registration or licensure would give official recognition to midwives.
A 1986 task force did an extensive study of midwifery in Utah. The members included licensed nurse midwives, lay midwives, lawyers, Health Department officials, University of Utah faculty members, and representatives of the public.
This task force made many recommendations to provide more oversight of lay midwives. But none of the proposals were adopted. The work of that task force ought to be dusted off and considered once more.