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Who can be licensed as a midwife in Illinois is likely to expand soon, but critics say lack of Medicaid coverage is a problem

Who can be licensed as a midwife in Illinois is likely to expand soon. But home births attended by midwives under this new law would not be eligible for Medicaid coverage, at least for the time being.

Advocates say that’s a big problem for parents who can’t afford to pay for a home birth out of pocket — who are also some of the parents most likely to benefit from alternatives to hospital births.

Currently, only midwives with nursing degrees are legally permitted to practice in Illinois. The new measure would allow some certified professional midwives who are not nurses to apply for licensure, a move that would allow them to provide more comprehensive care without fear of criminalization, while opening up more options for parents seeking home births.

Midwives in Illinois have been fighting for such recognition for more than two decades.

The bill passed both houses of the state legislature in the fall session. If Gov. J.B. Pritzker signs it into law, licensing will go into effect in October 2022, according to Sen. Cristina Castro, D-Elgin, who sponsored the bill in the Senate.

“This is all going to make everything so much safer in Illinois,” said Barbara Belcore, a midwife based in Evanston who is the legislative chair of the Illinois Council of Certified Professional Midwives, which worked to pass the bill.

The bill would give certified professional midwives in Illinois access to lifesaving medications during births and allow them to openly collaborate with physicians before, during and after a birth, Belcore said. Demand for home birth had increased steadily for several years, even before the pandemic, she said. The hope is that the bill creates more providers to meet that demand.

Belcore, like many Illinois midwives, is licensed in a neighboring state — in her case, Wisconsin. In Illinois, she can take doula clients, meaning she can legally provide parents with comfort measures and patient advocacy, but not with medical services. This bill will allow her to practice as a midwife here.

“Illinois is taking an amazing step in addressing the maternal health crisis,” said Castro. She pointed to the work of advocates who recognize the importance of women — especially women of color — having access to maternal care.

But the bill does not allow licensed midwives to be covered by Medicaid.

In Illinois, many parents who use Medicaid to cover medical care for pregnancy and births are people of color who are often at higher risk from pregnancy-related complications: In Illinois, Black women were eight times as likely to die of a pregnancy-related medical condition as white women, when excluding mental health-related deaths, the state’s 2021 maternal mortality report found.

And midwives say those parents are some of the most likely to benefit from alternatives to hospital care. The Centers for Disease Control and Prevention says racial disparities in maternal health outcomes result from a number of factors, such as quality of health care and underlying conditions. The agency also names structural racism and implicit bias as contributing factors for the disparity. Advocates hope that increased access to home births — particularly access to home births facilitated by culturally competent midwives — could be a boon to maternal health for women of color, and particularly for Black women.

Castro said she is committed to pushing for Medicaid coverage when the legislature is back in session in the spring.

Until that happens, advocates say, the lack of coverage is a big problem for parents who can’t afford to pay out of pocket for a home birth.

“We really need to make sure that this is something that’s equitable and fair to everybody, and is not just going to continue to affect the status quo of those who can pay for it,” said Star August, co-founder and CEO of the Holistic Birth Collective, a Chicago-based nonprofit.

August was the president of the Illinois Council of Certified Professional Midwives until Oct. 23, when she resigned.

Earlier this year, after she took on the role of president of the midwives council, August and Holistic Birth Collective co-founder Callan Jaress began to push for a second bill, one that would create a pilot program allowing midwives in Illinois to be covered by Medicaid over a five-year period. That bill stalled in the fall session.

“I chose to resign because I will not publicly support a politician who believes it is acceptable for the liberation of my daughters to come even one moment after the liberation of a wealthier person’s daughters,” August wrote in a statement to the Tribune. “These people were tokenizing ‘Black and Brown families,’ at the exact same time that a bill that would have created access for at least some of those families was knowingly left behind.”

A representative for the board of the Illinois Council of Certified Professional Midwives did not return a request for comment regarding August’s resignation.

Castro defended the bill and the progress it represents.

“As a Latina woman myself, I understand the importance of making sure communities like mine who have been disproportionately affected by maternal morbidity and mortality have equitable options for getting the care they need in the time surrounding pregnancy,” she said in a statement to the Tribune on Thursday. “This landmark legislation recognizes and certifies midwifery as a unique health care profession and opens the door for future work to expand options for expecting mothers.”

Bukola Bello, a lobbyist who worked on both bills, said the two-part approach makes sense.

“You have to take care of the licensure aspect first,” Bello said. “Inserting that into the bill, I don’t believe the General Assembly had the appetite to do that when the focus, essentially, is on making sure that licensure is handled and dealt with, first and foremost.”

The licensure bill is a “great first step,” Jaress said. “But for our organization, our work’s really just getting started.”

Editor’s note: This story has been updated to specify that the bill will allow midwives without nursing degrees to be licensed. Certified nurse midwives are currently licensed in Illinois.