Nebraska has home delivery for everything but babies
A couple of generations ago the vast majority of Nebraska babies were born at home. But today the views of Nebraskans on home births are polarized, shaped by the state’s restrictive laws, cultural values and concerns that put safety over personal autonomy. Currently Nebraska is the only state in the U.S. where certified nurse midwives (CNMs) are legally prohibited from attending home births. In fact, it is a felony for them to do so. Midwifery was common and legal in Nebraska until 1993, when then Attorney General Don Stenberg issued an opinion stating that lay midwifery was the “unauthorized practice of medicine and surgery.”
I have spoken with many groups, including organizations like Nebraska Friends of Midwives, who support home births. They argue women should have the right to choose where and how they deliver their babies. I have also had many conversations with midwives who are highly trained in their field, but are unable to practice their art because Nebraska statute doesn’t recognize their credentials simply because they are not also registered nurses. They emphasize the comfort and control of home environments, especially for low-risk pregnancies, and cite hospital risks and unnecessary interventions such as cesarean sections. (The incidence of C-sections performed in Nebraska hospitals in 2008 was 31 percent.) Nebraskan Kate Sorensen, a home birth advocate, is an example of the lengths women go to in order to have this option. She had a home birth with an out-of-state midwife to get around the legal barriers.
Despite the objections from some in the medical community, home births are actually safer than some options currently available in Nebraska. Advocates say legalizing trained midwives could reduce risks from unassisted births, which some women choose due to the state’s restrictions. Many see home births as a return to natural, community-based practices. This resonates, especially in areas where hospital access is limited. Many in rural Nebraska face so-called “maternal health care deserts,” as hospitals like the Howard County Medical Center have ceased offering birthing services due to low demand and high costs. This pushes some toward home births out of necessity. For those who desire a “home-like” feel to the birthing process, some hospitals have begun offering specialized birthing rooms with certified nurse midwife support. Other facilities, like those supported by Central Nebraska Doulas, seek midwife care in hospitals or birth centers to balance safety and personal preference.
On the other hand, many Nebraskans, including a number of medical professionals and the Nebraska Medical Association, oppose home births, citing safety risks. Doctors argue that hospitals are better equipped for emergencies, such as placental abruption or hemorrhage. Hospital births are said to be safer, due to modern equipment and staff. Adding fuel to the public skepticism about home births have been several high-profile incidents which have been covered by the media. The corresponding dire statements from health officials have warned of the dangers of untrained or unlicensed individuals attending births, swaying opinion against home deliveries to the point that in 2017, only 90 home births occurred in Nebraska.
Just because Nebraska offers no license for midwives, however, does not necessarily mean they are untrained, and the absence of licensing creates a barrier to gifted and trained midwives moving to our great state. In fact, 37 other states offer professional licenses which are not reciprocated or recognized in Nebraska. Almost every year a bill comes before the legislature which would harmonize licenses with other states, making it easier for medical professionals or teachers to move into Nebraska without a significant educational burden or requirements for them to continue working. Without that reciprocity, we keep certain needed trades and professions from our state.
The Nebraska Supreme Court even entered into the home birth fray with its 2024 review of lay midwife regulations. The question at hand is whether midwifery is actually “practicing medicine” under state law.
The Legislature is currently considering LB 374 which would establish the Licensed Midwives Practice Act in Nebraska, creating a formal regulatory framework for professional midwifery. Thirtyseven other states have already recognized and licensed these caring professionals without requiring them to have credentialing as nurses. It’s time we joined them.
Loren Lippincott represents Legislative District 34 in the Nebraska State Senate. Read his column in the Nance County Journal.