Women’s birth freedom shouldn’t require a judge’s order

After a court granted a temporary restraining order in a lawsuit brought by Pacific Legal Foundation, Nebraska mother Hope Lindstrom was able to give birth at home with the assistance of a certified nurse-midwife on April 26 — the first CNM-assisted home birth in Nebraska history.That moment should not have required emergency litigation. Nebraska law prohibits CNMs from attending home births, even though these highly trained professionals are licensed to provide maternity care in hospitals and other clinical settings. Lindstrom’s case exposes a glaring contradiction in state law: Nebraska trusts CNMs to care for women during pregnancy and childbirth, but not if the woman chooses to give birth in her own home. Lay midwives, with no formal medical credentials, may legally attend a home birth in Nebraska. But a highly trained CNM? That’s against the law.CNMs are the gold standard of midwifery practice in the United States. Credentialed by the American Midwifery Certification Board and represented nationally by the American College of Nurse-Midwives, CNMs hold graduate degrees in nursing and midwifery, complete rigorous clinical training, and are licensed as advanced practice registered nurses in every state, qualified to provide the full spectrum of women’s healthcare in hospitals, birth centers, and homes alike.Their scope of practice is grounded in evidence. Research consistently demonstrates that CNM-led care improves outcomes, reduces unnecessary interventions, and increases patient satisfaction, particularly for low-risk pregnancies. ACNM’s own clinical practice guidelines and position statements support the safety and appropriateness of planned home birth for carefully screened low-risk individuals attended by qualified providers with clear transfer protocols.Nebraska’s position is difficult to justify given the growing national conversation around maternal health, patient autonomy, and access to care. America spends more on maternity care than any other nation in the world, yet maternal outcomes remain some of the poorest, especially in underserved and rural communities. Many women are increasingly seeking alternatives to the conventional hospital model, and states that authorize CNMs to practice independently across a range of settings consistently show better access to care. Nebraska’s law forecloses this potential not just for families who choose home birth but also for every woman whose access to skilled midwifery care depends on a provider’s ability to practice where patients live.Many states continue to shackle CNMs with burdensome restrictions that limit patient choice and access to care. A Pacific Legal Foundation research brief details how physician supervision requirements, often in the form of collaborative practice agreements, reduce access to maternity care, especially in rural and underserved communities, effectively requiring CNMs to pay physicians for permission to practice. While 35 states now allow CNMs to practice independently or to transition toward it over time, 16 states, including Nebraska, still require a full collaborative practice agreement. Nebraska is one of just two states with the most restrictive requirements for CNM practice in the country, and it also restricts the settings in which CNMs may provide care.These restrictive laws often have less to do with patient safety than with preserving outdated regulatory structures that prioritize institutional control over individualized care. Hospitals remain the safest setting for high-risk births, but women with low-risk pregnancies should not be denied alternatives simply because state regulations refuse to recognize qualified providers. Women in states where CNMs can practice independently are more likely to access midwifery, home birth, and birth center options without negative effects on outcomes.Laws that categorically ban CNMs from home birth settings, while permitting less-credentialed attendants, are not supported by the clinical or epidemiological evidence; they reflect regulatory history, not patient safety science. CNMs practicing in home settings maintain the same clinical standards and professional accountability as those in hospitals or birth centers. They are trained in emergency management, neonatal resuscitation, and transfer coordination. The notion that a CNM’s presence at a home birth is inherently unsafe defies the evidence and the professional record.KANSAS CITY KNEW ITS DEI PROGRAM WAS INDEFENSIBLE. IT RAN IT ANYWAYLindstrom’s successful home birth marks an important milestone for Nebraska families, but one legal victory is not enough. Other mothers in Nebraska deserve the same options without needing to file a lawsuit first. Women across the country deserve maternity care systems that respect informed consent, skilled providers, and patient choice.Birth freedom is not about mandating one model of care over another. Hope Lindstrom’s story is a reminder that mothers can weigh risks, consult medical professionals, and choose the care that is right for them.Caitlin Styrsky is a strategic research manager at Pacific Legal Foundation, specializing in equality and opportunity. Michelle Munroe is the CEO of the American College of Nurse-Midwives.