Understanding Midwifery Laws: What They Mean for Your Care in Pennsylvania

If you’re exploring out-of-hospital birth, you may be surprised to learn that not all midwives are treated equally under the law—and not all midwives carry licenses. In Pennsylvania, where lay and traditional midwifery exists in a legal grey area, families still have access to excellent care—but it’s important to understand the landscape.

Let’s walk through what the laws really say, how they affect your midwife’s ability to serve you, and what protections (or risks) exist for both you and your provider.

Licensed vs. Unlicensed Midwifery: What’s the Difference?

  • Certified Nurse Midwives (CNMs)
    CNMs are licensed medical professionals—registered nurses who go on to receive graduate-level training in nurse-midwifery. In Pennsylvania, CNMs are licensed and legally recognized. They work under physician supervision or within hospital systems and must follow state-mandated protocols. While this sounds protective, it often limits their ability to support truly autonomous, physiological birth. CNMs face institutional restrictions and transfer requirements that prioritize liability over trust.

  • Certified Professional Midwives (CPMs)
    CPMs are nationally certified for out-of-hospital birth through the North American Registry of Midwives. However, Pennsylvania does not license CPMs. This means that although a CPM may be trained and credentialed, she holds no state-recognized legal status. She works with the same risk as a lay midwife under PA law.

  • Lay or Traditional Midwives
    Lay midwives are trained through apprenticeship, mentorship, and years of hands-on work—not through institutions. In Pennsylvania, lay midwifery is not licensed or regulated. We operate in a legal grey area—not prohibited, but not protected either. Still, we are able to offer full-spectrum care with the same skill set as a labor and delivery nurse, and often more, with the added benefit of deep relationship and continuity.

Felony States vs. Grey Area States

It’s critical to know that some states go beyond lack of licensure and actively criminalize traditional midwifery.

  • Felony States like New York and New Jersey consider the practice of midwifery without a license a criminal offense. Midwives in these states have been arrested, charged, and even jailed. Simply attending a home birth without state credentials can be classified as practicing medicine without a license—a felony.

  • Pennsylvania is a grey area state. CPMs and lay midwives are not licensed or recognized, but the state does not actively prosecute or criminalize traditional midwifery. This provides room for private, autonomous practice—though with no legal immunity or official protection.

What Lay Midwives Can Still Do in Pennsylvania

Despite the lack of licensure, midwives in Pennsylvania can and do provide full, skilled maternity care—including clinical services that support both safety and autonomy:

  • Write orders for labs and diagnostic imaging (We do not need physician approval to order prenatal labs or ultrasounds.)

  • Facilitate newborn screening (including metabolic screening/PKU, hearing screen, and critical congenital heart defect testing)

  • Complete official state paperwork including:

    • Filing of the birth certificate

    • Applying for the baby’s Social Security card

  • Provide full prenatal, birth, and postpartum care with monitoring of vitals, fetal development, and maternal wellness

  • Respond to emergencies and provide skilled support during labor and delivery, including:

    • Fetal heart tone monitoring

    • Hemorrhage management

    • Neonatal resuscitation (NRP-certified)

  • Refer to specialists or physicians when needed

Scope of Practice & Risks for Lay Midwives

Even in Pennsylvania, lay midwives can still be sued in civil court, and can be arrested if a county DA or local agency pursues prosecution. These cases are rare—but they are possible. Without licensure:

  • There are no legal protections in the event of a poor outcome

  • There is no malpractice coverage, even if consent was thorough

  • A midwife can be prosecuted or sued, even if she provided excellent care

That said, most traditional midwives choose to serve anyway—believing that your right to choose how and where to give birth matters more than their legal safety.

Pros of Practicing Without Licensure

  • Freedom from state-mandated protocols and transfer triggers

  • Deeper trust in birth physiology without fear-based oversight

  • Longer, relationship-based prenatal visits

  • Spiritual, faith-based, or culturally aligned care

  • Continuity of care from a single midwife through the full childbearing year

Cons of Practicing Without Licensure

  • No official legal recognition or protections

  • No access to liability insurance or malpractice coverage

  • Risk of civil litigation or criminal accusation

  • No backup from the state in emergencies

  • Burden of responsibility falls heavily on both midwife and client

What Does This Mean for You as a Client?

When you choose a traditional midwife in Pennsylvania, you’re choosing personal responsibility, deep autonomy, and a care model rooted in trust—not bureaucracy. Your midwife may not carry a state license, but she is likely trained, experienced, and spiritually grounded. She knows how to care for you—physically, emotionally, and holistically.

At Cardinal Birth Midwifery, we believe you deserve care that honors your body, your faith, and your right to birth in safety and peace. We operate in integrity, walk in wisdom, and serve with our hands open and our hearts submitted to the Lord. We are not licensed—but we are called, qualified, and committed.

If you’re ready to reclaim your birth on your terms, with a midwife who truly sees you, we’re here to walk that path together.