In 1977, Oregon's attorney general held that midwives didn't require licenses to attend births without drugs or surgical procedures, says Maryl Smith, a historian with the midwifery council. Five years later, the midwifery council began a voluntary certification program that included an exam and experience requirements. By 1993, the Legislature established voluntary licensing, intending it to allow for reimbursement under medical assistance programs.
Licensing is a hot-button issue among midwives, Cheyney says. For starters, a license costs $1,500 a year, a fee some midwives struggle to pay. But most who avoid licensure do so because of their philosophical beliefs.
"They don't want to be part of this government body," Cheyney says. "They don't want somebody interfering with the art of midwifery. Then it's not mother-driven."
Viles says the move to licensure created rifts that took time to heal.
"I chose to be unlicensed because I felt it was the best way to uphold and affirm my belief and the Legislature's intent that birth is a natural body process and not a medical event," she says.
My stance on state licensure of midwives is that it should have a voluntary option, not mandatory. To mandate that all midwives be licensed only will further serve to alienate midwives, put them at risk for criminalization due to not licensing (for various reasons listed above), and severely restrict true freedom of choice for families.
I believe that every state interested in making midwives legal start with voluntary licensure, using Oregon as an example. There is no reason why any midwife should risk criminalization simply for attending families in birth.