Pregnant mothers in Nebraska fight back against restrictions on birth freedom
Emily Tvrdy has given birth four times. Now, as she prepares for her fifth, she knows what type of birth experience she wants—and what type she wants to avoid.
Three of her four children were born in a hospital. The first she describes as traumatic, involving complications, pain, and a long separation from her infant son. Medical decisions were made without her input, without her consent, and, sometimes, without even her knowledge. She expresses a sense of powerlessness that was, in her words, “really, really hard for me.”
Her second hospital birth was a breeze. Emily arrived at the hospital at 2:30 a.m., and her baby was born shortly after 3 a.m. In fact, the labor was so quick that the doctor didn’t make it in time.
“The nurse and myself caught the baby,” Emily recalled.
That time, she left the hospital feeling empowered, realizing how smoothly things could go when a low-risk birth could occur with minimal intervention. When she got pregnant for a third time, she decided to labor at home. As a devout Christian, she wanted a birth experience that was spiritual as much as medical, where she would be trusted to make her own decisions rather than having to fight for them.
According to Nebraska law, this would force her to give birth unattended.
Giving birth in Nebraska
Home birth is legal in Nebraska, as it is in all 50 states. But Nebraska is alone in its restrictions on who can attend home births.
Giving birth alone? No problem. With an unlicensed attendant? Sure. With a certified midwife? Felony, according to the State of Nebraska.
Certified nurse midwives, or CNMs, are among the most highly trained childbirth providers, but Nebraska intervenes the minute they arrive in the delivery room. Because physicians rarely make house calls, Nebraska mothers seeking a safe out-of-hospital birthing experience are left with very few options.
When Emily decided to give birth at home, she knew she had a hospital just a few blocks from her house. She felt comfortable with the knowledge that, if a complication arose, she could access medical care quickly.
Forced to labor unattended
Emily’s home birth went well. At the time, she had been an OB nurse for several years. She had a hospital down the street and an emergency plan in place. And she felt at peace knowing she wouldn’t have to play defense against a medical staff that may or may not take her birth plan seriously.
After an eight-hour labor, Emily’s daughter arrived safely at home. She was nine pounds and 10 ounces—a big baby, a long labor, but a healthy mother and infant. For Emily, it was further proof that she could trust her body’s natural timing.
“So often, the interventions that we’re doing are because we’re impatient or because we are fearful as a system,” she said.
Still, Emily knew firsthand that complications could arise. Although she felt safe and comfortable at home, she also reported an uneasiness toward the end of her labor, due to the lack of medical care.
“I knew that I was coming to the end of the labor and she was going to be born, and I had support, but I also did not have a midwife with me,” Emily recalled. “And so I was trying to kind of shut my thinking brain off and really get [instinctual], because you have to with birth. And I find it to be kind of hard to… shut off my thinking brain and really get into the spiritual part of it, that instinctual part of it, when I know that there wasn’t someone… to help if need be.”
Without a midwife, Emily had to act as her own medical provider while trying to stay present as she brought new life into the world. Nebraska’s law forced her into a bind. She had to choose between her faith, her safety, and the law—a burden the First Amendment forbids.
By the time she was pregnant with her fourth child, the hospital down the street from her home had closed for deliveries. The next-closest hospital was about 15 minutes away, too far for Emily to feel comfortable laboring at home in the event of a true emergency. So, for her fourth child, she delivered in a hospital. It was another quick labor—so quick that, for the second time in Emily’s life, the doctor missed it.
The mothers who decided to fight
Emily has filed a lawsuit challenging the State’s ban, but she’s not the only Nebraska mother who seeks a midwife-assisted birth option. Midwives often have the flexibility to forge personal relationships with mothers that hospital schedules rarely allow—and they typically cost less, too. For mothers who want minimal interventions and a provider they know by name, midwife care is often a better fit.
Kate Ternus, another Nebraska mother, filed a parallel lawsuit challenging Nebraska’s ban under the Fourteenth Amendment. She gave birth to her first child in South Dakota with the assistance of CNMs and wanted the same experience for her second.
But Kate had since moved to Nebraska and couldn’t access any professionally supported out-of-hospital option. So, she drove across state lines—while in labor—to give birth to her second child in the home of a CNM. It was three hours round-trip.
Like Emily, Kate acknowledged the possibility of complications that require hospital care. Driving through rural farmland, far from the nearest medical facility, while in labor, added undue stress to her pregnancy. But it was a calculated risk—she was still more relaxed in a van, in the middle of nowhere, than in a hospital.
“I felt just so much more comfortable that I wouldn’t have to fight the doctors against doing things that I wasn’t comfortable with,” she said.
Nebraska’s safety argument doesn’t hold up
Courts have time and again protected individuals’ freedom to make intimate decisions free from governmental interference. Fundamental rights recognized by the Supreme Court include the right to marry, the right to use contraception, and the right to raise and educate one’s children in the manner of one’s choosing. The right to choose the circumstances of giving birth fits squarely within this framework.
Although hospital births are now the norm, midwife-assisted home birth is a practice deeply rooted in American history. For the government to assume it knows better than generations of mothers when it comes to the health and safety of their children—and go so far as to restrict women’s freedom to decide for themselves—is a violation of the Fourteenth Amendment to the U.S. Constitution.
A state that claims to protect maternal health while banning some of the nation’s most extensively trained and cost-effective midwifery professionals from attending home births faces an uphill battle in trying to justify its restrictions in the name of public safety—especially when the data points the other way.
Birth centers have been proven to lower costs and improve health outcomes for low-risk pregnancies, especially in rural states like Nebraska, where access to maternity care is not a guarantee. More than one-third of U.S. counties are “maternity care deserts”—areas with no birth facilities or obstetric clinician services available—but Nebraska is the only state to impose such burdensome restrictions on qualified providers.
Research shows that midwife-led care is associated with fewer preterm births, episiotomies, and epidurals. One study found a 7.5% reduction in C-section rates in states where CNMs have independent practice authority, with potential nationwide savings of more than $101 million a year. And multiple systematic reviews found no significant differences in perinatal mortality between birth centers and hospitals for low-risk women.
The path forward in Nebraska
Earlier this year, another Nebraska mother, Hope Lindstrom, filed a similar lawsuit for the right to give birth at home under CNM care. The law did not change, but the State agreed to grant her a religious accommodation. And on April 26, she made state history by giving birth to a healthy baby girl at home, under the care of certified nurse midwives.
Kate and Emily are now fighting the same battle—one that will likely extend well beyond their due dates. For the sake of the Nebraskan women who will come after them, they believe the fight is worth it.
