Saint Louis University Journal of Health Law & Policy

Document Type



As COVID-19 spread throughout the United States in early 2020, many pregnant people sought alternatives to delivering in a hospital. Midwifery practices offering services at home or in a freestanding birth center reported record numbers of inquiries, including from people looking to transfer care near the end of pregnancy. Whether due to fear of COVID-19 exposure in health care settings or out of a desire to avoid restrictive hospital policies regarding support people and newborn separation, people who had not previously considered home birth were newly drawn to midwifery care and others who had considered a midwife-attended birth redoubled their efforts to find an available provider. The turn to community birth—birth in a freestanding birth center or at home, usually with the support of a midwife—is a reasonable and understandable development, given the strong health and safety record of midwifery care, midwifery’s focus on holistic and individualized care, and the generally smaller caseload size of midwifery practices relative to obstetrics practices, which can minimize the number of people to whom providers are exposed during a health crisis. Midwifery care is especially attractive for some pregnant people of color—and Black women in particular—who have experienced bias and discrimination in health care settings and who have higher rates of both provider mistreatment and adverse health outcomes than White women in mainstream maternity care. But many pregnant people who sought midwifery care during the pandemic discovered they lacked access to non-hospital-based alternatives, as the supply of local midwives could not meet demand or legal restrictions meant there simply were no midwives in the area.

This Article examines the turn to community birth during the COVID-19 pandemic and argues that various legal and regulatory restrictions on midwifery practice unfairly interfere with access to this important, health-promoting model of care, especially for people of color, who disproportionately bear the burden of poor maternal health outcomes and hospitalization or death from COVID-19. In particular, this Article examines how lack of licensure for direct-entry midwives in some jurisdictions, along with non-evidence-based restrictions on scope of practice for all types of midwives and burdensome regulatory hurdles to establishing freestanding birth centers, impedes the growth of midwifery as a profession and limits access to community birth. This Article concludes with several recommendations that draw on the experiences of pregnant people during the pandemic to advance a pro-midwifery reform agenda that will tackle inequities in access to community birth and improve maternity care for all.