In a suburban Atlanta home where a chicken coop sits beside a playground, Madie Collins lay on an examination table while a certified professional midwife placed a handheld Doppler ultrasound machine on her pregnant belly. "That's her heartbeat," the midwife said to Collins' 3-year-old daughter, who sat watching as a whooshing sound filled the room warmed by a wood-burning stove. It was a scene of intimacy and care—one that is technically illegal in Georgia.
The midwife is not licensed as a nurse, which in Georgia means she is breaking the law. Georgia is one of only seven states where certified professional midwives (CPMs) who assist with home births face serious consequences: cease-and-desist letters ending their careers, misdemeanor charges in North Carolina, or even felony charges in New York. Yet across the country, demand for their services is surging.
Intended home births rose 42% nationally between 2020 and 2024, according to the National Center for Health Statistics. In Georgia, the increase was steeper: a 72% rise. These births are increasingly overseen by certified professional midwives, who provide continuity of care that extends from prenatal appointments through several postpartum visits—often more checkups than most new mothers receive in hospital settings. While home births represent only 1.5% of deliveries nationwide, they are more prevalent in states like Hawaii, Idaho, Montana, Utah, Vermont, Wisconsin, and Wyoming, where they account for 3% to 5% of all births.
Midwifery advocates say the solution is clear: legalize and license the profession. "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. Currently, 36 states and Washington, D.C., allow certified professional midwives to be licensed to deliver babies. Last year, lawmakers in Georgia, Mississippi, Nebraska, New York, North Carolina, Ohio, and West Virginia introduced bills to join them—though none have yet become law.
Certified professional midwives earn their nationally recognized credentials through rigorous training: attending at least 55 births and demonstrating their knowledge, rather than requiring the costly nursing school education many cannot afford. This distinction matters. Nurse-midwives more commonly work in hospitals and clinics, while certified professional midwives specialize in home and birth center deliveries.
Opposition remains, particularly from hospitals and medical organizations. The American College of Obstetricians & Gynecologists cites studies showing infants are twice as likely to die during planned home or birth center births as in hospitals, though the organization acknowledges the data is limited and doesn't account for factors like who attended the birth. Prominent cases have fueled skepticism: a 2023 Washington Post investigation revealed a licensed midwife in Virginia who pleaded guilty to felonies after an infant death and had assisted births in Maryland where two additional babies died.
Yet momentum may be shifting. In Mississippi, a bill to regulate and license professional midwives died after a state senator blocked a committee vote. The midwifery community, however, sees opportunity in the current political moment, sensing a receptive ear from the Trump administration's Make America Healthy Again movement.
For now, certified professional midwives like the one in Atlanta continue their work in legal limbo, serving women who have chosen home birth—and trusting that reform is coming.