Bill Highlights

There are nine things that you really need to know about Senate Bill 1208, the Michigan Midwife Bill. This bill . . .

1.)  Defines a "Licensed Midwife" as a registered professional nurse who is licensed as a midwife. The bill further states that anyone who does not hold a license would not be allowed to refer to, or advertise herself as a “midwife” in the state of Michigan.

2.)  Ensures that every midwife in Michigan is educated, trained, and prepared according to accredited programs of study. To obtain a license in the state of MI, a midwife would need a minimum of a registered nursing degree, have attended at least 50 births with another licensed midwife in the previous 24 months, and pass the written examination approved by the Task Force.

3.) Defines a midwife's scope of practice as delivering a baby, nursing services performed in connection with delivering a baby, or providing health care related to pregnancy, labor, delivery, and postpartum care of a mother and her infant. “Licensed midwife” does not include the practice of medicine, osteopathic medicine, or surgery…meaning a midwife cannot perform functions that would require a physician’s expertise. Example: Vacuum extraction, cesarean, etc.

4.) Provides specific guidelines for transfer of care to make sure women choosing out of hospital birth remain low risk. High risk situations that would require transfer of care to a physician include:
preterm labor, preterm rupture of the membranes, abnormal fetal heart rate, breech or other malpresentation of the fetus, delivery that is excessively overdue, low or high amniotic fluid volume, a mother with heart disease/blood disease/or any other significant medical condition whereby the treatment of the condition is outside the scope of practice of a Licensed midwife, any other condition or circumstance that indicates to a reasonable medical professional that a physician should attend the birth.

5.) Ensures that midwives carry malpractice insurance, up to $100,000. Insurance is another layer of accountability. A midwife must comply with safety protocols and function within her scope of practice in order to obtain insurance. Insurance also helps pay for medical bills in instances of negligence causing injury or death.

6.) Provides oversight by a balanced Task Force. The proposed task force would consist of 2 nurse (licensed) midwives, 2 OBs, 1 pediatrician, 1 hospital administrator, and 2 citizens. This is the group that would be responsible for researching acceptable - accredited programs of study, collecting and publicly publishing data on outcomes, promulgating and overseeing rules of practice, and reporting such findings to the board of nursing.

7.) Ensures that collaborative care actually happens between midwives, obstetricians, birth centers, and hospitals by requiring them to have a contract of consultation. (Note: This is not the same as requiring an OB to sign a midwife's license in order to practice, like in North Carolina.) It simply means that midwives working outside the hospital have a written agreement with a physician or hospital, should the need for consultation arise.

8.) Requires all Michigan midwives to report their outcomes. Midwives would report outcomes to the proposed task force, who would put together an annual report that will be accessible by the public.

9.) Defines "freestanding birth centers"  and ensures they employ only """"licensed midwives who have insurance and follow the above stated protocols for transfer of care and collaboration. This would eliminate the fact that anyone, anywhere in MI can open a “birth center”. This aspect of the bill would require all “birth centers” to be facilitated by midwives who provide educated, licensed, insured, accountable care.


  1. Hi guys! I am very excited about this bill, but I do have a question. Where does the "have attended at least 50 births with another licensed midwife in the previous 24 months" number come from? Is that reasonable and attainable? And if this bill is passed, is anyone grandfathered in? Wouldn't it be difficult for a midwife to become licensed if there are only a handful of licensed midwifes in the state to attend births with?

    I hope my questions are taken as negative. I am fully supportive of preserving choice while improving safety! I guess my concern is that for those responsible midwives who want to become licensed, that the process is one that is reasonably attainable.

    1. I couldn't agree more that reasonably attainable and balanced regulation is key. I believe that the bill itself addresses this by saying that currently practicing midwives would have 180 days to apply to be "Licensed Midwives" if they've met the minimum standards for education. That would be the grandfathering in phase that you mentioned, and would afford for more options for apprenticing opportunities. As far as 5o births in the previous 24 months, I'm not sure exactly where the number came from or how obtainable it really is within that time frame. A midwife would better be able to assess whether or not that was realistic. I wish I had a better answer on that one. I also think that once standards are established, more qualified midwives will be drawn to our state.

    2. Any RN attaining a CNM would be getting her 50 births as part of her training

  2. Ooops, I meant I hope my comments AREN'T taken as negative!

  3. So, based on the above information, if this bill passes, then current midwives who are NOT RN's would have to become RN's to continue practicing? I'm just trying to be clear... if there is a midwife who is NOT a registered nurse right now, then when this bill passes, she would be no longer able to legally practice or call herself a midwife till she became an RN? Are there other requirements? Would she have to become a CNM? or just any RN could become a licensed midwife, if she attended 50 births?

    1. I believe the bill indicates that if a midwife is not an RN, she would need to become one to reach the minimum educational practice standard, and call herself "midwife" according to the state's definition. I don't think she would be able to practice as a "midwife" once the bill passes without having furthered her education. She would NOT have to become a CNM (bachelors degree, plus graduate school in midwifery). The added requirements would be 50 births in the last 24 months under the supervision of a Licensed Midwife, and passing a state approved exam.

      I think the intention was to include more training with courses like pharmacology, physiology, and clinical experience. The RN requirement is aimed at setting a minimum standard for education that surpasses the inconsistency of NARM's lacking requirements. Some disagree with that bar, but some bar for educational standards (other than NARM) has to be identified. Being a "midwife" in MI has to mean something, whereas now, it means a million different things in terms of training and practices. Some have suggested international standards as a compromise. The bottom line I suppose is that we, as a state, need to define what that minimum standard should be, noting that NARM is not enough.

  4. To be reasonable, the malpractice insurance should be at least $1M. The RNs should have master's degrees in OB.

    But homebirth is still seriously risky, no matter how trained, educated, and experienced the attendant is, simply because of the distance to emergency care.