The certified professional midwife pressed the button on a handheld Doppler ultrasound machine she placed on Collins’ belly. “That’s her heartbeat,” she said to Collins’ 3-year-old daughter, who sat beside her mom as a whooshing sound filled the room. “I think Mommy’s baby’s right here.”

The midwife is not licensed as a nurse. In Georgia, that makes what she’s doing illegal. Â鶹ŮÓÅ Health News agreed not to identify her by name.

Georgia is one of seven states where delivering babies can earn non-nurse midwives, at minimum, a cease-and-desist letter requiring them to end their careers. In North Carolina, it’s a . In New York, .

Meanwhile, demand for their services is increasing. Intended home births rose by 42% nationally from 2020 to 2024, according to the National Center for Health Statistics, and those births are often overseen by certified professional midwives. In Georgia, they rose by 72%. Midwives who assist with home births typically see clients from prenatal appointments through after childbirth, providing more postpartum checkups than most new mothers receive.

Home births make up nationwide. In the eight states where they were most common in 2024 — Hawai‘i, Idaho, Montana, Pennsylvania, Utah, Vermont, Wisconsin, and Wyoming— they made up 3-5% of births.

As that number rises, midwifery advocates said, regulating the practice with licenses would allow home births to be safer. Free birth — without the help of a skilled professional before or after labor — can be .

“People are going to keep having their babies at home, and they deserve a trained provider,” said Missi Burgess, president of the Georgia chapter of the National Association of Certified Professional Midwives.

For decades, professional midwives have been advocating for laws to legalize and regulate their profession. More lawmakers have supported those efforts in the past 15 years, with 36 states and Washington, D.C., allowing them to get licensed to deliver babies. Last year, a wave of state lawmakers — in Georgia, Mississippi, Nebraska, New York, North Carolina, Ohio, and West Virginia — tried to add their states to the list, although none of their bills has become law.

Certified professional midwives deliver babies in homes or birth centers. Rather than attend nursing school — which many can’t afford — they earn a nationally recognized certificate by attending at least 55 births and demonstrating their knowledge. Nurse-midwives more often deliver babies in hospitals or clinics than in patients’ homes.

Some hospitals and doctors oppose midwife licensing proposals without certain guardrails. The American College of Obstetricians and Gynecologists showing that infants are twice as likely to die during planned births at home or in birth centers as in hospitals, while acknowledging that the data remains limited. It doesn’t account for several factors, including who assisted in the birth.

Still, prominent stories of home births with midwives gone wrong contribute to the skepticism around licensing laws. In 2023, The Washington Post of a licensed midwife who pleaded guilty to felonies in Virginia after an infant death and assisted with home births in Maryland in which two more babies died.

In Mississippi, a bill that would have regulated and licensed professional midwives died after a state senator blocked a vote in the committee he chaired. Democratic Sen. Hob Bryan he didn’t “wish to encourage that activity.”

But midwives said they have a sympathetic ear now in the Trump administration, with its Make America Healthy Again movement. Cassaundra Jah, executive director of the , said she has been on calls with midwifery groups pushing for the Department of Health and Human Services to provide legal protections for them, and some midwives have been in contact with the agency.

HHS spokesperson Emily Hilliard declined to comment on policy proposals but told Â鶹ŮÓÅ Health News that the administration “regularly meets with a wide range of stakeholders to hear input from the American public.”

Hospitals Want Guardrails

Advocates for the license say allowing certified professional midwives to provide care would help address a shortage of maternity care providers.

“Some midwives are leaving our state,” Rep. , a chiropractor who sponsored the Georgia bill, said during a hearing on the measure last year. “They’re being forced to quit. And now we have a shortage of these providers to take care of our pregnant moms.”

A by the March of Dimes found that 35% of counties in the U.S. have no birthing facility or obstetric provider. Georgia has the 13th-highest maternal mortality rate in the nation, according to the .

After the U.S. Supreme Court’s reversal of Roe v. Wade in 2022 eliminated federal protection for abortion, six-week abortion bans prompted more providers to leave states such as Georgia and Texas. Idaho lost by December 2024, two years after its abortion ban took effect. Doctors who left states with such laws cited fear of prosecution and an inability to provide the standard of care.

Of the 13 states with the fewest maternity care providers per capita, nine had a full or six-week abortion ban as of 2024, .

Licensing midwives won’t solve the larger maternity care shortage, but it’s a first step, said , a professor of midwifery and the principal investigator at the Birth Place Lab at the University of British Columbia. Certified professional midwives currently attend only about 1.4% of births in the U.S., according to federal data.

The would have granted certified professional midwives licenses through a state board, allowed them to administer lifesaving medications, and required their services to be covered by private insurance and Medicaid. They would not have needed a physician to supervise them. Without that mandate, giving birth outside of a hospital could be an option for more people.

But the Georgia Department of Public Health and the Georgia Hospital Association opposed the licensing bill, primarily because they wanted more regulations than the midwives were willing to accept — including physician supervision.

Anna Adams, a spokesperson for the hospital association, suggested establishing transfer agreements that required all women planning to have a home birth to register at the hospital first. When a laboring woman is transferred to a hospital, which happens in about , “we have no prior knowledge of this patient,” Adams said. “It’s a tricky situation to inherit when you’re trying to save the mother and the baby without any background.”

Georgia midwives said they planned to bring the licensing proposal back next year.

In early April, three midwives for restricting their ability to practice, arguing that the rules violate the state constitution.

“Every pregnant person should be able to choose where they give birth and with whom,” said Jamarah Amani, a plaintiff in the lawsuit and co-founder of the .

Black women are three times as likely to die during or after childbirth as white pregnant patients. In January, a prominent Black nurse-midwife in South Carolina died after unexpected complications from childbirth.

Today, midwives and their clients are predominantly white, but the home birth rate among Black women rose 42% nationally from 2019 to 2024, according to the Centers for Disease Control and Prevention.

“Ultimately the system has failed us as a people,” said Tina Braimah, a Black nurse-midwife who attended home births for a decade. She then opened a in North Carolina, allowing her to see more clients from a variety of backgrounds. “When the system consistently fails you, you look for other options.”

Becoming Part of the System

Many maternal health researchers say mothers fare better when midwives are a key part of the health system. In 2018, researchers at the Birth Place Lab published a study of all 50 states showing that integrating midwives was associated with better outcomes for moms and babies, including lower rates of infant deaths. Integration involves collaboration among all kinds of midwives and doctors so that patients can easily transfer to or from a hospital. It also involves giving all midwives the authority to practice the full range of their skills, including prescribing lifesaving medication.

A by the National Academies of Sciences, Engineering, and Medicine states that data from other countries suggests home births can be as safe as hospital births for low-risk women who are part of an integrated, regulated system.

Washington state has one of the highest rates of in the U.S., according to the . Its home birth rate is consistently higher than the national rate, while its remains lower than the national average.

One in 5 women report being mistreated during maternity care, according to a . Pregnant patients tend to be more satisfied when midwives lead their care, whether at a hospital, a birth center, or home.

Hannah Haynes gave birth to her first three children in a hospital near her home in Jefferson, Georgia. During the third labor, which was induced, she received a catheter that led to a urinary tract infection and then sepsis, a life-threatening condition. She was separated from her newborn for four days while receiving treatment.

“Something has to change,” Haynes said.

Haynes regrets electing to get induced when it wasn’t medically necessary. She gave birth to her fourth child at home, with the help of a certified professional midwife she trusted. She’s pregnant with her fifth and plans to use the same midwife. She said she won’t deliver at a hospital again.

“I was a little nervous,” Haynes said, because she had heard rumors that midwives didn’t know what they were doing. But after meeting the midwife, “I just felt so confident in her.”

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Before giving birth to her second child, Heidi DiLorenzo was anxious. She worried about her blood pressure, and the preeclampsia that prompted her to be hospitalized twice during the pregnancy. She worried that some terrible, unnamed harm would come to her 3-year-old daughter. She worried about her ability to love another baby as much as she loved her first.

But DiLorenzo, an attorney in Birmingham, Alabama, did not worry about taking Zoloft. She had used the medication to treat anxiety before she had her first child, and she continued it throughout that pregnancy and this latest one.

And since having her second daughter, in September, she credits an increased dosage with pulling her out of the “dark hole” of sadness she felt postpartum. “I wouldn’t be as good of a mom to my girls if I didn’t take it,” DiLorenzo said. “I wouldn’t have the energy.”

She is among the estimated 20% of women in the U.S. who during or after pregnancy. Yet only half of those mothers receive adequate treatment, according to , who runs the perinatal mood disorders program at the University of Florida. And just 5% take a selective serotonin reuptake inhibitor, a class of medications commonly used to treat both conditions.

Now medical experts are concerned that a July panel discussion convened by the Food and Drug Administration could lead to more cases of untreated depression. Many of the 10 members of the panel expressed concern about the use of SSRIs, such as Zoloft, during pregnancy. They included Josef Witt-Doerring, a psychiatrist who owns clinics aimed at helping people wean themselves off antidepressants, and Adam Urato, an OB-GYN who recently petitioned the FDA to put stronger warnings on SSRIs.

While the discussion did not represent any official FDA guidance, the panelists — in claims the American College of Obstetricians and Gynecologists called “” — linked the drugs to increased risks of miscarriage, birth defects, and autism in children exposed to them in utero. The Society for Maternal-Fetal Medicine said its members were “alarmed by the made by FDA panelists.”

Antidepressants are a safe, “lifesaving” tool, given that mental health issues such as suicide and overdoses are the leading cause of maternal death in the country, ACOG President Steven Fleischman said in a statement on the group’s website.

, a nurse practitioner who in 2011 helped found the nation’s , in North Carolina, said SSRIs are “probably the most well-studied medicine in pregnancy.” In long-term studies of children exposed to the drugs in utero, she said, researchers haven’t seen problems.

It’s too soon to know whether the panel discussion has affected prescribing rates — or whether those who are pregnant are avoiding the drugs more. But Raines, who teaches at the University of North Carolina-Chapel Hill School of Medicine, said she’s already fielding questions from patients. She said the misinformation the panelists spread — along with President Donald Trump’s about taking Tylenol during pregnancy — is making her job harder.

Dorothy DeGuzman is a family medicine physician who treats high-risk pregnancies in California. “There’s already so much stigma around taking antidepressants in pregnancy,” she said. “This will just add to the fear.”

The Panel

The July panel discussion was one of four the FDA has convened since May. In the past, the agency vetted members of advisory committees to avoid conflicts of interest. Yet these panels were chosen in private and the events were held with scant public notice. In a July investigative report by MedPage Today, researchers and consultants the events’ ethics and legality.

Department of Health and Human Services spokesperson Emily Hilliard did not directly answer when asked about the panelist selection process. She called the panel events “roundtable discussions” in which experts review the latest scientific evidence, evaluate potential health risks, and “explore safer alternatives.”

The July panel appeared to be following an Trump issued in February establishing the Make America Healthy Again Commission and directing it to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors” and other medications.

Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the FDA, is a frequent critic of such drugs. He , without evidence, that they might be contributing to school shootings.

In opening remarks at the July panel discussion, FDA Commissioner Marty Makary also voiced concerns about the medications. “From a national standpoint, the more antidepressants we prescribe, the more depression there is,” he said.

‘Not a Luxury’

The sole member of the panel who was both a board-certified psychiatrist and an OB-GYN — the University of Florida’s Roussos-Ross — raised a different concern. “Research shows that in women who stop their medications in pregnancy, they are five times more likely to experience a relapse,” she said.

Mothers with moderate to severe depression and anxiety during pregnancy are more likely to , she added. If they don’t receive treatment, she said, they are and are at risk of suicide. They can have with their babies, Roussos-Ross said, and those children are at higher risk for problems such as , depression, or anxiety — due to their mother’s mental health challenges, not the SSRIs.

“I want to stress that treating mental illness in pregnancy is not a luxury,” she told the panel. “It’s a necessity.”

Overall, about 19% of U.S. women in their 20s and 30s experience depression, according to the latest data from the Centers for Disease Control and Prevention, and roughly 10% take SSRIs. But studies show that half of women decide to stop taking antidepressants before or during their pregnancies.

One reason so few expectant mothers receive depression treatment, doctors say, is that they are already afraid to take any medications during pregnancy. The majority of DeGuzman’s patients rely on Medicaid, the government health coverage for those with low incomes or disabilities. Half are Latina. She often prescribes SSRIs, she said, but her patients rarely take them.

The issue is especially urgent for Black and Latina mothers, who experience than white, non-Latina mothers but are . Many factors contribute to this disparity, including systemic racism, exposure to violence, misdiagnosis, and a lack of access to care.

Shanna Williams, a perinatal mental health therapist who treats African American mothers in Philadelphia, said many of her clients were already more likely to trust friends and family over their doctors when it comes to whether antidepressants are safe to take while pregnant or breastfeeding. The FDA panel is “one other voice that’s saying you shouldn’t do this,” Williams said. “And that does not help.”

, who studies perinatal mental health in women of color, said universal child care and paid parental leave would help. “My research showed that the most important thing we can offer is social support,” said Blanc, an assistant professor of psychiatry at the University of Miami Miller School of Medicine. “We need the village to step up.”

Kellyn Haight experienced debilitating depression after she moved to the mountain town of Brevard, North Carolina. The former labor and delivery nurse had no child care for her then-2-year-old daughter and no family or friends nearby as her husband was traveling for work.

Her doctor prescribed Prozac — it didn’t help. She called her husband to return home, but her insomnia just got worse. One morning, she begged him to end her suffering. He took her to the emergency room, and staffers sent her to the psychiatric unit of a local hospital. She said she was stripped of her clothing and put in a locked room. “I felt like a creature, like an animal,” said Haight, now 37. “One of my biggest fears is that happening again.”

After she was released, Haight found a psychiatrist and started taking Zoloft. She built a community of friends and began to feel stable.

Now that her daughter is 5, she’s trying to have another child — and plans to keep taking Zoloft throughout the pregnancy. “I would rather be safe and present for my child,” she said. “I’m OK with assuming the risk, because I know what the alternative looks like, and I’m not going there.”

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