"I'm proud of the work that midwives and midwifery advocates have done over the decades," said Hannah Landis, certified professional midwife (CPM) and vice president of the Illinois Council of Certified Professional Midwives. "I'm proud we finally got something negotiated," said Landis of the law signed in December by Gov. JB Pritzker that allows the certification and licensure of CPMs in Illinois, making it the 37th state in the U.S. to recognize CPMs.
Typically active for home births, a CPM is a trained maternity care provider licensed through the North American Registry of Midwives. Not all states recognize the licensure, and Illinois ceased to do so in the 1960s, taking a further step in the 1990s to criminalize practicing as a CPM, making it a felony.
However, home births attended by CPMs never ceased during this time, causing providers to move underground. Despite Illinois' strong tradition of upholding a woman's right to choose her reproductive health care, the criminalization of CPMs greatly limited choice. Those who sought a CPM had to rely on word-of-mouth to find one, while women who were unsuccessful might choose to have an unassisted home birth.
Due to their underground status, CPMs were not allowed to carry oxygen or have access to life-saving clotting drugs. CPMs were also not able to accompany a woman to a hospital if an intervention were needed.
Women didn't stop choosing to have home births, but with licensure restored and CPMs able to operate again in the open once the law takes effect in October 2022, it will be much safer for everyone.
Landis, who has operated Beautiful Things Birth Services in Danville since 2018, said she originally got into birth work because of the lack of access.
"They shouldn't have made us have a gray market. It's unethical. I've fought against that for 14 years, since I got pregnant and couldn't find what I was cultured in. My mom, my aunts and my sister-in-law all had home births. It's very normalized to me.... Only having a hospital option felt disorienting to me and influenced my rite of passage into motherhood.
"I'm mad, I'm bitter. I'm annoyed the state intervened in something it had no business getting into. That's why I got into birth work. I felt it was my battle to fight, to serve women in their way and in their choice," Landis said.
There are many reasons a woman may prefer a home birth, such as a cultural norm or trauma from a previous hospital birth experience. Some women simply want to avoid unnecessary interventions and have more autonomy throughout labor.
In the U.S., about one in three women who give birth in a hospital have a cesarean, much higher than the World Health Organization's recommended rate of 5-10%. Hospital births often lead to a cascade of interventions, which in turn can lead to greater risk of infection, complications and longer recovery times.
Leah Williams (a pseudonym used to protect privacy) is a traditional midwife operating in central Illinois who gained entry into the craft through apprenticeships. She said the most common reason someone seeks her out over a hospital birth is "having control over the situation, and not having to fight over what they want." Though many women write a birth plan, those preferences are often ignored or disregarded during the birth, resulting in what Williams describes as a "combative atmosphere in the hospital," whereas "just having the things they would put in a birth plan should be routine."
However, Williams is unsure if she will seek CPM licensure to work legally. Part of her concern is the cost and time required to do exactly what she is already doing – three years of formal education and roughly $50,000 in expenses.
Another reason Williams cites to stay underground is that, although the CPM licensure is now recognized, it is legally limited in scope. For example, a vaginal birth after cesarean (VBAC) is not deemed within the scope of CPM licensure, and is also rarely available in a hospital setting.
"The thing I love is that I can work for the mom directly without a third party telling me what to do," said Williams. "I can support a mother wanting a VBAC, and I can support her without the government telling me I can't."
"That market will persist," agreed Landis. "There are midwives that will help someone give birth at home despite a risk factor."
Landis expects more women to seek out home birth because the new law "allows midwives to market themselves and consumers can make up their minds, based on options. What we've seen in other states, it's not a huge percentage of people choosing home birth, but it can get up to 5%."
Many activists feel the home birth midwifery model may also help provide more equitable outcomes for women, especially women of color. Currently, American women die of childbirth at a higher rate than in any other developed country, with women of color dying at two to three times the rate of white women. The infant mortality rate for babies of color is several times higher than for white infants.
Now that CPM licensure is recognized in Illinois, the next piece of the puzzle will be getting home births covered by Medicaid, which will increase access to home births for women of color and women who live in poverty.
Carey Smith is thankful for the underground midwife who attended the home birth of her youngest child.