Hayli Netterlund’s first home birth went well.

The 27-year-old mom from Reinbeck wanted to use a midwife, rather than go to a hospital to give birth, after she saw the U.S. ranking when it came to maternal mortality, which has increased substantially, according to the Center for Disease Control. Death rates have grown in the U.S. from 7.2 deaths per 100,000 live births in 1987 to 16.9 deaths per 100,000 live births in 2016, according to the Center for Disease Control.

But while her first birth was easy, the birth of her second child in December 2019, was not. He was in a difficult position for her to give birth, and so, at the recommendation of her midwife, Netterlund went to the hospital.

While Netterlund said she’s thankful the staff at her hospital listened and spoke with her midwife, she said she’s heard from other Iowa moms who have not had the same experience because hospital staff were concerned about licensing and liability concerns.

She wants to see that change and have the state create a pathway toward licensure for midwives, which she said would allow for easier communication between midwives and doctors.

“I really love the care I get from her and the trust she builds and the education she shows me she has,” Netterlund said.

Under a new bill proposed in the Iowa House, midwives would be required to get a state license to practice, opening a pathway for them to get access to Medicaid dollars, administer prescription medication and refer patients to other medical professionals.

House Study Bill 522 would require all midwives who are seeking a license prove they’re over 21, graduated from high school and earned a professional midwife certification. It also establishes a professional state board for midwifery.

Currently, midwives are not regulated by the state of Iowa and there are no licensing requirements, according to the Midwives Alliance of North America. Medical providers, including the University of Iowa Hospitals & Clinics, MercyOne and Unitypoint Health offer Certified Nurse Midwives on their staff. They are trained registered nurses who have a graduate-level certification in nurse-midwifery.

Working midwives and doulas at a subcommittee meeting on Monday said the bill provides a safe option with oversight for moms, particularly as rural hospitals close their maternity wards.

They also said that it will allow midwives to administer certain drugs, like Pitocin for postpartum hemorrhage, which requires a license.

“Women are entitled to give birth wherever they want to,” said Megan Day Suhr, a professional doula and longtime midwife advocate. “But having access to a qualified, educated midwife across the state increases good outcomes.”

Major medical groups, including The Iowa Clinic, UnityPoint Health, Iowa Medical Society and Iowa Nurses Association have registered in opposition to the bill. Lobbyists expressed concerns over midwives’ abilities to handle complications like a breech birth, as well as the possibility to waive liability insurance in the bill’s language.

David Adelman of the Iowa Osteopathic Medical Association said a license would make it appear that the state endorses midwifery as a safe practice. He said his organization supports certified nurses, instead.

“We believe nurse midwives have adequate training,” Adelman said.

The State Government Subcommittee tabled the conversation until the organizations can agree upon bill language.

“There are issues with this,” Rep. Tom Moore, R-Griswold, said. “I want to further the conversation and I want it to go on.”\