When Missi Burgess received her national certification to become a midwife two years ago, she didn’t set out to break the law.
In 2015, the Georgia Board of Nursing banned midwives without a nursing degree from practicing midwifery and publicly calling themselves midwives.
Burgess said many midwives in Georgia didn’t know about this change in legislation at the time.
“No one let us know,” Burgess said. “Someone stumbled upon it. For a little while, everyone (midwives were) like, ‘Well, what does this mean?’”
She said the ramifications didn’t become evident until Debbie Pulley, who has been a certified professional midwife since 1995, received a cease-and-desist order from the nursing board in June.
When that happened, Burgess said the Georgia chapter of the National Association of Certified Professional Midwives turned its focus toward a legislative effort. The group of midwives sent a proposal advocating for the licensure of certified professional midwives.
Burgess, president of the association’s Georgia chapter, said the difference between a certified professional midwife and a nurse midwife is clinical training.
Instead of earning a nursing degree and practicing in a hospital, she said certified professional midwives are required to have experience in home births. This apprenticeship process takes around four years and involves working at a midwifery practice.
Burgess describes midwifery as a “system of shared decision-making.” Midwives work with parents, so they can make informed decisions before and after their child’s birth.
“It’s never us saying to them, ‘This is what you should do,’” she said. “We definitely have guidelines and safety parameters.”
Instead of earning a nursing degree, Burgess said most midwives in Georgia have either stopped practicing or have cut back.
“We feel pretty strongly that we don’t want to be nurses,” she said. “But, we’re definitely not trying to say that nurse midwives aren’t vital. We love nurse midwives and work together with them a lot but have different environments that we want to work in.”
Burgess has taken her website down and decreased the number of home births she attends.
“It doesn’t seem safe to continue to put myself out there as a midwife when the state is saying I’m not allowed to,” Burgess said.
She fears the legislation barring midwives from practicing without being registered nurses will hurt Georgia’s maternal mortality rate.
According to the Centers for Disease Control and Prevention, there were 16.9 pregnancy-related maternal deaths in the U.S. per 100,000 live births in 2016. Georgia’s Department of Public Health report in 2016 showed a rate of 37.2 maternal deaths per 100,000.
Many midwives assist home births in rural areas where obstetrical services are limited. Burgess, who lives in Lilburn, serves mothers in Hall, Jackson and Gwinnett counties.
“We’re able to jump into Georgia’s battle against maternal mortality,” Burgess said. “We’re able to get into these rural areas to provide maternal care. The postpartum time is vital — having someone to come check on you — and we do that.”
During the 2019 legislative session, Burgess and members of her chapter went before the Georgia Occupational Regulation Review Council at the Georgia State Capitol. The committee reviews all legislation that proposes to license or certify occupations that are unregulated.
Burgess said the Georgia chapter gave the council a lot of information about the midwifery education process.
“Throughout our work of advocating at the Capitol, what became clear is that the issue is not with our licensure,” Burgess said. “But more with lawmakers' discomfort with choosing to have out-of-hospital births. What wound up being discussed the most was, ‘Is it even safe to have your baby at home?’ It is well established in scientific literature that it is a reasonable decision for low-risk women.”
Requiring midwives to have a nursing degree isn’t the norm in the U.S.
As of 2019, certified professional midwives are legally authorized to practice in 35 states.
“It’s widely accepted,” she said. “Georgia is really behind the ball here. They’ve got some catching up to do.”
For more information about midwives in Georgia, visit nacpm.org.