Category: Pennsylvania Politics

HARRISBURG — Hidden deep in more than 600 pages of state budget documents, Pennsylvania lawmakers last month quietly repealed an unenforced 1929 law that allowed traditional midwives, the main group of midwives delivering home births, to practice.

Now, traditional midwives — who differ from midwives usually found in hospitals, are not medically trained, and often serve religious minorities like the Amish — are worried they have no legal standing to work in Pennsylvania and are challenging the repeal and a new law in state court.

The 1929 law had been on the books for nearly a century, asking traditional midwives to submit a paper application and a $10 fee to get a state certificate. But it had not been enforced for decades, and Pennsylvania, which has one of the highest rates of home births in the nation, was counted as one of 13 states that did not regulate the practice at all.

Meanwhile, other forms of midwifery — such as nurse midwives and certified midwives, who are medically trained and are formally affiliated with a doctor or health system — are highly regulated by the state and its medical board. But these affiliations often prevent nurse midwives and certified midwives from offering home births, as the health systems see them as possible risks for medical malpractice lawsuits.

The practice of traditional midwifery dates back to the Old Testament and has lived on through centuries of community knowledge and traditions. It can include Amish and Mennonite midwives, who are limited in the amount of education they are allowed to receive, as well as other unlicensed midwives who say they take only low-risk pregnancies.

Some Pennsylvania traditional midwives say their practice is more necessary than ever, citing the United States’ maternal mortality and morbidity rate and cesarean section rates that outpace most of the rest of the Western world. They see their work as more holistic and personal than the American medical system, offering more personalized care to the new parent and baby for weeks after birth, as well as an answer to maternity care deserts as more hospitals and birth centers close.

Medically trained midwives and physicians, who receive licenses from the state, argue the practice of traditional midwifery is potentially unsafe for mothers and babies, and requires little to no oversight in comparison to their medical training and licensure.

A new law, and legal uncertainty

There is no state law regulating home births — which are chosen by a variety of families for different reasons, from Amish who have religious beliefs about delivering at home to Black and brown women who have felt underserved or discriminated against by the modern healthcare system. But if traditional midwives — the primary group delivering babies in home births — cannot practice, some argue, home births will become inaccessible.

The legal fight over midwifery began earlier this year, when the General Assembly approved changes to a separate law to include another class of midwife: certified midwives, who have all the same education training as nurse midwives except the nursing degree. To receive a certification from the Pennsylvania Board of Medicine, nurse midwives and certified midwives must provide proof of education and a collaborative agreement with a physician or medical institution.

The law, the Midwife Modernization Act, was written to protect traditional midwives’ ability to practice, its author, Sen. Rosemary Brown (R., Monroe), said in a statement.

Kate McHugh, a nurse midwife who has worked for a decade with lawmakers on updates to midwife regulations, said stakeholders approached traditional midwives during earlier iterations of the bill to see how they would like to be regulated. The different groups of traditional midwives could not agree, so the nurse midwives and certified midwives moved forward on their own.

But the changes to Pennsylvania’s laws created a legal gray area, some midwives argued in a lawsuit filed last month.

An anonymous group of two traditional midwives, a nurse midwife, and an Amish man whose family utilizes traditional midwifery filed a lawsuit in a state appellate court, challenging Brown’s law as unclear about their ability to practice, and asking the state to enforce the 1929 law already on the books.

After the lawsuit was filed, legislators repealed the 1929 law as part of an overall state budget deal, creating more uncertainty for traditional midwives, according to their amended filing. Some lawmakers said they did not know they had voted to repeal the law, as the state budget is drafted in closed-door meetings among top leaders and fast-tracked through the legislative process with little time for rank-and-file members to review what they are voting on.

The law was repealed as part of a request by Democratic Gov. Josh Shapiro’s administration, according to a source briefed on budget conversations. The administration works closely on legal matters with Republican Attorney General Dave Sunday’s office, which is defending the state in the case. Shapiro’s office declined to comment.

“It’s not fair the way [the budget] is done,” said Rep. Dave Zimmerman (R., Lancaster), who said he unknowingly voted in support of the bill that repealed the 1929 law in an omnibus bill. “It concerns me a little bit that we repeal something in the fiscal code rather than right up front where it’s transparent.”

“You have people in the Amish and Mennonite community that this is what they do. We have midwives that have been doing this for 30 and 40 years, They’re probably as good as anyone else doing it, certified or not,” Zimmerman added.

The lawsuit

The group of traditional midwives filed the lawsuit anonymously out of fear of retribution from the state for continuing to practice, said the group’s attorney, Jonathan Goldman, of the Goldman Law Team, based in Fort Washington. The midwives spoke with The Inquirer on the condition of anonymity for the same reason.

One of the midwives, who serves south-central Pennsylvania with a largely Amish and Mennonite clientele, said she has delivered 1,600 home births over 38 years. She had practiced traditional midwifery in other states, before similar certifications were required there. At one point, she said, she was arrested and charged with a misdemeanor for continuing to practice home births in New York.

Unlike medically trained nurse midwives and certified midwives, traditional midwives are prohibited from practicing medicine, which could mean dispensing medication or conducting medical procedures as simple as stitches. They have historically been investigated by state boards of medicine if this is called into question, making the group even more distrustful of state oversight.

One of the anonymous traditional midwives, who has delivered an estimated 600 births around eastern parts of Pennsylvania, said her clients are often religious and want traditional models of care, such as no lab work and one ultrasound — a very hands-off approach compared to the highly surveilled pregnancies in modern medicine.

The midwife, who delivered four of her 10 children in the hospital before finding an interest in home births, said her faith as a born-again Christian drew her to the “completely different model of care” that does not rely on pharmaceuticals, with a comfortable home setting and few restrictions like in a hospital.

“In the hospital, it’s a fractured system. There are several midwives and physicians, you never know who you’re going to get, who is going to be on call,” said the midwife, who works with Amish and Mennonite populations in south-central Pennsylvania. “We are the community midwives. We know the secrets, we know the stories, we know what kind of care works. We know the family intimately. And it improves outcomes because knowing them intimately and emotionally allows us to provide that kind of specialized care.”

Sunday’s office, defending the state in the suit, said in a July 24 filing that the midwives’ claims are a “misreading and misunderstanding of the current law,” and that traditional midwives “can continue to practice as lay midwives without certificates.” Sunday’s office did not respond to a request for comment.

The case is scheduled for a preliminary injunction hearing to block the law from going into effect on Wednesday, where Brown and other lawmakers may be called to testify and a judge is expected to rule whether current laws prevent traditional midwives from practicing.

Outside the medical system’s framework

Obstetricians in hospitals and birth centers routinely work with certified midwives, who have an advanced degree in midwifery, and nurse midwives, who have a nursing degree in addition to specialized midwifery training.

“As an OB-GYN physician, I absolutely respect somebody’s right to make a medically informed decision about how they take care of themselves in their pregnancy, and who they request assistance from in birth, and where they give birth to their babies,” said Holly Cummings, an OB-GYN in Philadelphia and chair of the Pennsylvania section of the American College of Obstetrics and Gynecology, a leading physician organization. “But I do also believe a hospital or an accredited birth center is the safest place to give birth. I don’t think in the U.S. in 2026 we can currently safely, uniformly support home birth.”

ACOG does not support traditional midwives, who can also be known as lay midwives.

But traditional midwives maintain they should be able to continue their work outside the medical system’s framework, citing it as a religious tradition and safe practice, and hope the judge rules in their favor.

“Pennsylvania has a rich history of midwifery,” said the midwife listed in the lawsuit who serves parts of eastern Pennsylvania. “We have some of the highest home-birth numbers in the country. … It would be sad to see Pennsylvania not acknowledge the heritage in midwifery that we have here.”

Staff writer Sarah Gantz contributed to this article.