Reality Check: There is no evidence to suggest that mandatory licensing will increase safety. There is some evidence that limiting choices increases risk in certain situations. We don't know what would happen if Oregon made licensing of midwives mandatory.
The question is: If licensing of midwives became mandatory, what would happen to the families who previously chose unlicensed midwives?
We can look to other states where midwifery is illegal, or only CNMs can legally practice, to see what has happened there. In those states, the families who previously chose unlicensed midwives do 1 of 3 things:
1. They still choose an unlicensed midwife, who is now practicing illegally. If the mother or baby requires transfer to a hospital, the midwife usually does not come in to the hospital or provide records to the hospital. This makes the hospital less able to provide good care, and increases risk. There also may be situations where transfer is delayed because the midwife and family do not want to bring light to their illegal arrangement. This greatly increases risk.
2. They choose an unassisted homebirth or "freebirth." While those who are in support of unattended homebirth will argue that it can be done safely, I cannot imagine that anyone arguing for mandatory licensing would argue that no monitoring and no skilled attendant increases safety.
3. They choose a legally practicing midwife, if available, or to go to the hospital. THESE CHOICES ARE ALREADY AVAILABLE, should they desire them.
So here we have two options that are more dangerous, and a third that already exists. The total population affected by these changes is very small, so the overall impact on public health is also very small.
Those who care about improving birth and health outcomes for mothers would have more of an impact on public health by focusing their time and energy on reducing preterm birth or increasing breastfeeding support.
Reality Check Verdict: When it comes to increasing safety, mandatory licensing is a waste of time and money.
