At 5 a.m., Amanda Visel experienced her first contractions at her home in Northern Illinois. As the morning progressed she communicated intermittently with the two midwives in Southern Wisconsin who would attend her birth. By mid-morning, they all agreed it was time to go. Visel and her husband then drove one hour and ten minutes over country roads to a birthing center in Mineral Point, Wis.
“Every single bump we would hit would stir up a contraction,” Visel says. They had discussed the plan ahead of time, if things were progressing too rapidly, the midwives would meet her at the Wisconsin border. Six hours after her first contraction, Visel made it to Mineral Point and gave birth to a healthy baby boy.
For Illinois parents to be, finding a midwife with a state-recognized license to attend a homebirth has long been challenging. This is in large part because until recently the state did not license Certified Professional Midwives (CPMs). The CPM credential is awarded by the North American Registry of Midwives, a national certifying organization. In 2006, after two decades of midwives advocating to have their profession recognized as a safe alternative and legalized, Wisconsin became the 25th state to license CPMs. Today, only 36 states license CPMs, and those who practice midwifery without a nursing degree in states that don’t license CPMs risk substantial fines, forcing the practice underground.
Midwives in Southern Wisconsin, meanwhile, have grown accustomed to receiving inquiries from families in Illinois. In fact, some birth centers and midwifery practices —like Stateline Midwives— market themselves specifically towards Northern Illinois families seeking midwifery services in Southern Wisconsin. Other midwives are focused on the communities around them in Southern Wisconsin, but find that Illinois families seek them out, desperate for an alternative to a hospital birth.
Initially, Visel — a nurse — had planned to deliver in a hospital. But at 39-weeks pregnant her obstetrician informed her that she would have to wear a mask while she delivered. Not only that, the obstetrician said, but if she tested positive for Covid-19 when she went into labor, her newborn could be removed from her care. “I was horrified,” she says.
Determined to find an alternative, Visel emailed Valerie Atkinson, a midwife at Faith in Birth Midwifery, a midwifery practice that she co-runs with Moriah Post-Kinney.
Even before the pandemic midwives in Southern Wisconsin like Post-Kinney and Atkinson, the midwives who attended the birth of Visel’s son, were receiving several inquiries a year from Illinois residents. Since the start of the pandemic, though, midwives who practice on the Wisconsin side of the border have noticed an uptick in interest in their services from families in Illinois.
Overall, non-hospital births make up a tiny fraction of all births nationwide. In Wisconsin, around 2% of all births take place at home, and around .6% take place in a clinic or birthing center according to the Wisconsin Vital Records Office. Altogether less than 2,000 births in Wisconsin take place outside a hospital annually. Illinois does not make similar data available, but midwives in the state estimate around 1,000 births take place outside of a hospital setting.
The number of midwife-attended births has long been on the rise in Wisconsin. In 2011 just 679 births were attended by a licensed non-nurse midwife. By 2020, the last year for which data is available, that number had more than doubled, even as the total number of births in the state decreased, according to the Wisconsin Vital Records Office. Based on anecdotal evidence from midwives in Wisconsin and nationwide, that trend appears to have accelerated during the pandemic.
Before the pandemic, Atkinson and Post-Kinney, had at most one patient per year from Illinois. In the last year they have had seven. Gena Reitano, a midwife who also works in Southern Wisconsin, used to see one patient from Illinois at most, per year. Since the start of the pandemic, she’s had six patients from Illinois. Other midwives in Southern Wisconsin report receiving more inquiries from Illinois families about their services as the pandemic progressed and report attending more births.
Many of those referrals come through word of mouth. Since giving birth in Mineral Point, Amanda Visel has referred several friends and acquaintances to Atkinson and Post-Kinney’s practice, including her sister-in-law, Jessica Cummins.
Cummins was already interested in an alternative to a hospital birth when the pandemic began. As the pandemic progressed, though, Cummins, who works as a physical therapist in Rockford, Ill., saw firsthand how understaffing was affecting patient care. “I didn’t want to be on the receiving end of that,” she says.
Throughout the pandemic both nationwide and in Illinois, hospitals and medical clinics have been chronically short-staffed. Not only that but Covid-19 safety policies and protocols were changing daily. “I didn’t want to get to the point where I was about to give birth and all of the sudden my husband couldn’t be there,” Cummins says.
Like Visel, Cummins traveled around an hour to give birth at Atkinson’s birthing center in Mineral Point.
Given the distances some Illinois residents, like Cummins, must travel to give birth in Wisconsin, midwives have to consider the risk that labor will progress more quickly than anticipated. For a first or second pregnancy, labor tends to be more prolonged, and most midwives consider travel of one or two hours of travel safe. For subsequent pregnancies though, some midwives will decline to provide care to Illinois families if they are concerned that the family wouldn’t be able to reach them in time.
Reitano evaluates the medical history and previous labor experiences of her patients before deciding how far she thinks they can safely travel. Her primary objective is to avoid a situation where a pregnant person is in the latter stages of delivering and still traveling, or even worse, delivering a baby in the car.
“Nobody wants to have babies in cars,” Reitano says. “It’s rough.”
In both Visel’s and Cummins’ cases, they had discussed the possibility of rapid labor and delivery ahead of time with Atkinson and Post-Kinney. If labor was progressing too quickly, they agreed, the midwives would meet them at the Wisconsin-Illinois border to either escort them to the clinic or assist with a car delivery. In both cases, they made it to the birthing center with plenty of time to spare.
Still, Visel wishes there were more options for pregnant people like her in Illinois. “I would have loved to find a midwife closer to me, and I would have loved to deliver in my home,” Visel says.
A nearby midwife has historically been hard to come by in Illinois because the state has not permitted non-nurse midwives to practice until recently, thereby limiting the pool of midwives who can practice legally. But the state took an important step towards addressing its midwife shortage this month. On October 20th the Illinois state senate passed the Licensed Certified Professional Midwives Practice Act. And on October 28th, the Illinois House of Representatives approved the latest version of the bill, making Illinois the 37th state to recognize Certified Professional Midwives.
The passage of the Midwives Practice Act represents the culmination of nearly 43 years of activism and advocacy in the state. Christine Sheets, the president of the Illinois Friends of Midwives, an organization that advocated for the passage of the bill, was jubilant that the bill finally passed. The bill enables the state of Illinois to establish the Illinois Midwifery Board that will develop and set the rules and standards for Illinois CPM licensure along with the Illinois Department of Financial and Professional Regulation. Sheets thinks that process will take about three years.
According to the North American Registry of Midwives (NARM), which administers the CPM credential, there are currently 36 CPMs in Illinois. Wisconsin has 101 CPMs and about one-half the population of Illinois. Additionally, the Midwives Practice Act does not allow licensed Illinois midwives to be covered by Medicaid, whereas Wisconsin midwives are covered. Even when the CPM license is fully recognized in Illinois, Sheets acknowledged, it will take some time for the number of midwives in the state to catch up with the demand.
Emma McAleavy is a freelance writer living in Madison, Wisconsin. Her work has previously appeared in The New York Times, The Boston Globe, and Outside Magazine.