If you are a home-birth midwife in Ohio, you may have very ambivalent feelings about licensure. You may be concerned that state regulation will seriously restrict your ability to practice according to your own protocols rather than guidelines imposed by a regulatory board. You may have strong feelings about midwifery as a spiritual calling, or believe that what you do in supporting normal, healthy birth is diametrically opposed to the paradigms of modern medicine and should not be equated with it. You may feel that state licensure and integration into the regulated health-care system will irrevocably change the nature of midwifery.  Or you may think that no law is better than a bad law -- and that any law likely to be passed in this state would include provisions that you would consider restrictive, ill-advised or unneccesary. You may believe that you cannot be prosecuted because midwifery is not explicitly prohibited in Ohio, because you do not carry restricted drugs, or because you exclusively serve a religious community. If you have been practicing for many years without problems, you may have come to feel quite comfortable with Ohio's lack of legal provision for midwifery.

The online book From Calling To Courtroom: A Survival Guide for Midwives documents the stories and struggles of midwives who have found themselves facing criminal charges -- even in states like Ohio, where midwifery is "not legally regulated, but not prohibited." According to Ida Darragh in the section "The Myth of the 'Alegal' Midwife,""For all practical purposes, for midwifery to be legal it must be licensed by the state."

If you are living in a state where midwives are not specifically regulated by law, you are not safe. Regardless of how quiet you are, how good you are, or how protective your clients are of you, you may still find yourself being prosecuted by the state in which you live. And the state really doesn't care how strong your calling is or how righteous your indignation.
(From Calling to Courtroom, The Illusion of Safe Practice)

If you are taken to court for practicing medicine without a license, what matters is not what you call yourself or consider yourself, but what you have done.  By providing prenatal, birth and postpartum care, you are encroaching on territory upon which the medical profession believes itself to have an exclusive right. Without laws specifically licensing direct-entry midwifery, the physician monopoly is in fact supported by the state. And while the state may have turned a blind eye to your practice in years past, there is strong evidence that this will no longer be the case in the future.

As more Americans struggling with the high costs of medical care or frustrations with the effectiveness and approach of conventional medicine turn to complementary and alternative health-care practitioners, and as rising health-care costs lead to more and more care being provided by non-physicians, the doctors' trade union has felt the bite in its pocketbook and is determined to fight to preserve the state-mandated monopoly that its profession has so long enjoyed. The Scope of Practice Partnership (SOPP) was created by a coalition of the American Medical Association (AMA) and several national medical specialty societies and state medical associations "to concentrate the resources of organized medicine to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public." The SOPP was "enthusiastically embraced" at the AMA's 2006 State Legislative Strategy Conference and has been incorporated as one of the AMA's "principal commitments" in their 2007 Strategic Plan. Consider what the SOPP has in mind (emphasis added):

RESOLVED, That it shall be the policy of our American Medical Association that state medical boards shall have full authority to regulate the practice of medicine by all persons within a state notwithstanding claims to the contrary by boards of nursing, mid-level practitioners or other entities (New HOD Policy); and be it further

RESOLVED, That our AMA, through the Scope of Practice Partnership, work jointly with state medical boards to assist law enforcement authorities in the prosecution of unlicensed medical practice by limited or mid-level practitioners (Directive to Take Action); and be it further

RESOLVED, That our AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state notwithstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice. (Directive to Take Action)

Direct-entry midwives in unlicensed states are far from being the only targets of the AMA's SOPP, but they are among the most vulnerable. The  SOPP's "assisting law enforcement authorities in the prosecution of unlicensed medical practice" has already begun. If we remain quietly content with the status quo in our unlicensed state, our midwives will be picked off one by one.

As the legal climate in Ohio grows more hostile toward direct-entry midwives, many will be unwilling to take the risk continued practice poses to themselves and their families. Midwives will transition to less risky professions or relocate to legal states, leaving families in Ohio with fewer and fewer options for out-of-hospital maternity care. This is the goal of the AMA-SOPP -- to completely eliminate the "competition." Who loses? The midwives who are forced out of practice or to leave their communities; the mothers who are forced into a choice between going to the hospital or birthing unassisted for lack of qualified midwives; the public who will increasingly see out-of-hospital birth as dangerous and radical and high-tech, high-intervention maternity care as normative.

By pro-actively banding together as families, professionals and consumers, we can seek to circumvent this outcome by working for licensure in Ohio. It is an idea whose time has come: by remaining unregulated, Ohio midwives may soon face extinction. State licensure is necessary to protect mothers, babies and the profession of midwifery.