Nebraska midwife fights to fix ‘glitch’ in laws limiting home birth to least-qualified attendants

July 26, 2024 | By BRITTANY HUNTER
homebirth midwife

Certified Nurse Midwife (CNM) Heather Swanson felt the calling to be a midwife as early as junior high, when her mother was a group leader with La Leche League—an organization of women dedicated to helping and supporting breastfeeding mothers. Women would gather in one of their living rooms once a month—the second Tuesday—for support and to share that momma wisdom about breastfeeding and all things natural childrearing.

One day, Heather was listening to them discuss birth experiences and frustrations about not feeling heard or respected by hospital staff. Some would discuss in hushed tones the possibility of home birth and the lengths some would go to for a different birth experience. It hit Heather like a flash.

“I want to be able to provide care to these women in my community,” she says.

Why would women in Heather’s community need to resort to those types of clandestine maneuvers to birth their babies the way they wanted? Because while home birth is legal in every state, Nebraska is unique in that it forbids CNMs like Heather from assisting in home births. For women who desire a home birth, the law effectively limits their choice of home birth attendants to the least-trained professionals.

Lay midwives and unlicensed doulas, neither of which are required to undergo any formal or certified training, are free to assist in home births as they please. But if a CNM like Heather were to assist a home birth, she would put herself at risk of a felony charge and potential jail time.

The law is completely outrageous and has absolutely nothing to do with safety concerns for laboring mothers and newborn babies. If it did, it wouldn’t penalize well-educated and well-trained professionals like Heather.

More than qualified

As part of her lifelong drive to provide birth care to women at home, Heather got the very best training (and lots of it) that she could get her hands on. She has an undergraduate degree from the University of Nebraska at Lincoln, a master’s degree from the University of New Mexico, a Certified Nurse Midwife (CNM) from the University of New Mexico, a Family Nurse Practitioner (FNP) degree from the University of Nebraska Medical Collage, a Doctor of Nursing Practice through the Frontier School of Nursing in Kentucky, and a Psychiatric Nurse degree from Liberty University, and she is now also studying functional medicine. She was also director of Holy Family Birth Center in Weslaco, Texas, for six years and has extensive experience working with the Indian Health Service. She also taught nursing at the university level for several years. Lay midwives, on the other hand, do not need any formal training—they need only apprenticeship-type training and a high school diploma.

To make matters worse, Nebraska is among three states that mandate CNMs practice only under a physician’s direct supervision and only in hospitals, public health agencies, or physician-approved settings. Home births are explicitly off-limits, even with a doctor present.

Heather feels led to care for women in rural environments where maternity care is sparse. She badly wants to serve families in Nebraska “so they don’t have to go across the border to Kansas, or go visit family in other states to have the birth they want, or try to have the birth they want but not be able to share about it or have good collaboration and a good transfer plan, if needed.”

She wants to give those women the dignity of the best formal training, the best she and modern science can provide. To her, that means absorbing every bit of education and knowledge she possibly can. The rigors of her years of schooling and childbirth experience means she is prepared for the twists and turns childbirth can throw at her. Being able to provide assistance at home would mean mothers who choose home birth can feel calm, safe, and in control while welcoming their newest little family members.

She doesn’t deliver babies, Heather insists. Moms do that. She “catches” them. Her favorite moments are when she sees fathers actively involved in a birth, whereas in hospitals, fathers are often pushed to the side—helpless, anxious, terrified spectators.

The law was nonsensical from its adoption in the 1980s and was always expected to be overturned.

Fighting back

Heather has been working through the legislative process for 21 years to do just that. She’s come agonizingly close to success, only to be stonewalled at the last minute. Is it protectionism from established medical interests? The continual turnover in the unicameral citizen legislature? Whatever it is, it is exhausting.

Moreover, many Nebraskan mothers that desire her services now don’t have unlimited birthing years left. Each year that goes by is more births overmedicalized, more women experiencing birth trauma, new mothers not being heard in their most vulnerable, critical hours. They deserve options—options that Heather is fantastically prepared to provide them but can’t, for no good reason.

Because birth has become so much safer over the past several decades, we now have the incredible luxury of worrying about the experience of birth, not just the outcome. The hospitalized, one-size-fits-most model of birth care often leaves new mothers feeling disconnected, disrespected, and divorced from one of their most spiritual moments—bringing forth new life. Some women feel a primal urge to reconnect with birth in ways the hospital model simply can’t accommodate. Today, only about 2% of women opt for home birth, and for the safety of them and their babies, we should avail them of the very best care they can get.

And that would be CNMs like Heather Swanson.

“I joke sometimes—I feel like we take better care of our cattle when it comes to providing people that can assist them than we do our women,” Heather says of current home birth attendant options in Nebraska. After all, a veterinarian has extensive medical training, unlike doulas and uncertified midwives.

Heather sums up the issue and why she is fighting:

It’s pretty unjust that women can have an out-of-hospital birth if they choose, and they can choose whoever they want as long as they are informed about who’s attending them, but I still can’t attend them. So now we have this growth of out-of-hospital birth by anybody, whether they’ve been formally trained or not, but someone who has been formally trained, who has out-of-hospital birth experience, who has attended home birth still can’t. I can go across the border [to South Dakota], but can’t do it here… in their home, which we know is the least risk for contamination of other viruses and bacteria and illnesses and things like that.

Pacific Legal Foundation is helping Heather fight to fix this Nebraska law, not only to fulfill her dream to serve her community, but also to protect a mother’s right to choose how to bring her baby into this world.