By Kaitlyn Kelly
Flatwater Free Press
Kirsten Johnson was sitting at home on Christmas Eve when a sharp wave of pain stole her next breath. More than a week past her due date, the first-time mother immediately recognized the first sign of labor.
Johnson and her husband left their rural home near Dunning and sped off on the two-hour trek to the hospital in Kearney, a trip Johnson had reluctantly made for dozens of appointments.
Battling heavy fog and icy roads, the couple arrived around 1 a.m. The contractions intensified just before dawn.
A few hours later, Johnson held her wailing baby boy after delivering him in a natural water birth on Christmas Day 2024. While successful, it also solidified Johnson’s desire for a different avenue for birth: midwifery.
“Being a first-time mom, you don’t know what to expect,” Johnson said. “So, just hearing that X, Y, Z can go wrong and people are going to pressure you into things, it’s a lot all at once. I think, had I have had a midwife with him, I would have felt a lot more empowered.”
Mothers like Johnson interested in alternative forms of birth run headlong into existing Nebraska law.
State law prohibits nurse midwives, the most qualified group of midwives, from assisting in home births even as mothers continue to seek such care from less-educated midwives and doulas.
Nebraska is the only state in the nation where certified nurse midwives — registered nurses with advanced training — can’t assist with home births. Nebraska is also one of only two states that requires physician supervision of nurse midwives.
A 1984 state law licensed and regulated nurse midwives, but a last-minute addition requested by the Nebraska Medical Association prohibited them from assisting in home births.
The measure also failed to address forms of unlicensed midwifery in the state. This allowed less-educated midwives to assist in home births until two years ago, when the Nebraska Supreme Court ruled that all midwives must hold a license to practice.
In 2024, about five planned home births occurred in Nebraska per 1,000 live births, according to the Nebraska Department of Health and Human Services. That number had slowly increased over the previous decade.
[graphic showing rise in home births]
Nurse midwives have been practicing in Nebraska hospitals, birth centers and clinics for more than 40 years — under the supervision of a physician.
Beyond their specialization in primary, sexual and reproductive care, nurse midwives can conduct exams, order tests, prescribe medications, do procedures such as pap smears and address gynecological concerns.
Ann Seacrest, who moved to Nebraska in 1981 while pregnant, led the movement to license nurse midwives after realizing there was no systematic way to receive midwifery care in the state. She began working on what became the 1984 law soon after delivering her baby.
While physician supervision agreements were standard at the time, Seacrest said the midwife legislation didn’t originally include the home birth restriction until the Nebraska Medical Association requested that such a provision be added. Wanting the measure to pass, Seacrest and other supporters agreed to the addition.
“I have huge remorse every time I get asked about home birth,” Seacrest said of the wording that prohibits nurse midwives from assisting in home births. “… I would do anything I could to undo it, because it shouldn’t be there. Particularly now, it shouldn’t be there.”
Although some efforts have been made over the years to reverse the restrictions, the Nebraska Medical Association and the Nebraska Hospital Association have begun to talk with the state’s nurse midwife group and expressed openness to supporting and advancing the profession with certain guardrails.
“(Nebraska) families have strong feelings about home birth,” said Robert Wergin, president of the medical association. “… If they should occur, it should be with a highly trained person in a low-risk identified patient with collaborative arrangements made.”
A 2024 analysis from the Journal of Clinical Medicine found that midwife care often reduces medical interventions during childbirth with favorable maternal and neonatal outcomes in most cases. Additionally, a researcher at the Boston University School of Public Health found that states with larger proportions of their births attended by midwives tend to have lower infant and pregnancy-related mortality rates.
Elizabeth Mollard, president of the Nebraska affiliate of the American College of Nurse Midwives, said the state’s regulations have made it difficult for nurse midwives to function “from the get-go.”
Under the 1984 law, nurse midwives must practice under a licensed physician who is readily available for consultation.
Mollard said many midwives have struggled to find physicians willing to sign a supervisory agreement because of possible liability risks. This has caused some nurse midwives to switch to non-birth-related roles or to leave the state altogether.
As of June, 113 people had active nurse midwife licenses in Nebraska. Approximately 87 were practicing in some capacity, while only 44 were providing birth services.
The supervision requirement has also been the “primary barrier” to opening and sustaining freestanding birth centers in Nebraska, Mollard said. Such centers in other states are run by midwives, exist separately from hospitals and handle low-risk pregnancies.
Nebraska has seen three separate freestanding birth centers fail over the years, with the latest closing in Lincoln in 2024. Although multiple factors led to their demise, Mollard said the underlying issue was unreliable physician collaborations.
Nurse midwives are a “highly trained workforce” that could help fill the gap in the state’s maternity care shortage, she said.
“It’s just silly when we see these statistics about maternal care deserts and that there’s no obstetric care provider in that community, and it’s like, ‘Oh, wait, actually there is,’” Mollard said, referring to nurse midwives. “It’s just our laws don’t allow them to actually care for patients.”
In late April, a nurse midwife legally assisted with a home birth in Hastings after a pregnant mother named Hope Lindstrom sued the state. The state settled and allowed the birth to proceed in the home. Lindstrom had argued that the home birth ban on nurse midwives violated her 14th Amendment rights and religious freedom.
Heather Swanson, a nurse midwife in the state since 2002, attended Lindstrom’s birth along with two registered nurses. Before the birth, Swanson said she conducted a risk assessment to ensure Lindstrom was fit for out-of-hospital care. She also met with the city’s emergency medical services team to discuss a transfer in case of complications.
Lindstrom’s home birth gave Swanson and nurse midwives across the state hope for change.
“I feel like there’s enough evidence to say planned home birth attended by a licensed provider is where we see the safest outcomes, if risks are appropriately assessed and attended to,” Swanson said.
On the other hand, Mollard said the current system of home birth in the state “is the most dangerous system of home birth.”
Mollard said home births have been handled “underground” by individuals with varying levels of experience. If something were to go wrong, there is little to no communication with healthcare authorities upon transfer to a hospital.
“Right now, we have a really ugly system where you have a choice of a hospital or giving birth alone or giving birth with somebody who is practicing illegally,” Mollard said. “If, for whatever reason, a hospital is not acceptable to you, then your two options that are left are not great options.”
Because of the 1984 nurse midwifery law, nurse midwives are the only type of midwife recognized under Nebraska statute. That lone recognition created an avenue for the less-educated midwives in the state, including certified professional midwives and traditional midwives, to practice unregulated.
[sidebar explaining differences between midwives]
The loophole was addressed by the Nebraska Supreme Court in 2024 after it ruled that the state’s Uniform Credentialing Act restricts unlicensed persons from presenting themselves to the public as individuals qualified to treat any physical condition.
The cases that triggered the Supreme Court decision involve a now 78-year-old professional midwife named Judy Jones. She had attended home births in 2021 and 2022 in Madison and Douglas counties. In the Douglas County case, the baby died because the umbilical cord wrapped around her neck.
Judy Jones is charged with unlawfully practicing as a nurse midwife after receiving a cease-and-desist order, a felony punishable by up to four years in prison.
The cases are moving through the courts in both counties. Trial dates have been set for this summer.
The regulations on midwives and home birth have left mothers in search of alternative birth services with one remaining option — unassisted birth.
Madison Jones, a mother of four who lives in Hay Springs, is an advocate for midwifery care, but after moving to rural Nebraska in 2022, she found she had no midwife option. When it came time to deliver her fourth child last year, she decided to do it unassisted.
Madison Jones has worked as a labor and delivery nurse in Chadron and Alliance and as a certified doula. Her experience in maternity care made her feel more prepared to handle her own unassisted birth. She also lives within 25 miles of a hospital and said she could have gotten there quickly if complications had arisen.
Both nurse midwives and professional midwives are now engaged in separate legislative efforts trying to remove barriers to their work.
Nurse midwives want to receive full practice authority and be authorized to assist with home births. Professional midwives want to gain licensure from the state to legally do the same.
Two midwifery bills — one addressing nurse midwives and the other addressing professional midwives — were introduced in the 2025 legislative session by State Sen. Ben Hansen of Blair but failed to advance.
Both midwife groups plan to continue their efforts in the 2027 legislative session.
Mollard emphasized that the primary goal of the nurse midwife legislation is not to move births out of hospitals. Instead, she said, it’s to make use of a workforce ready to provide women’s healthcare in “the communities that need it most.”
“We have licensed nurse midwives living in Nebraska who would like to be caring for women and families,” Mollard said.
Abigail Cada, a representative for the Nebraska Certified Professional Midwives Alliance, said acquiring state licensure would allow professional midwives to serve clients at home without legal uncertainty.
Wergin, president of the Nebraska Medical Association, said nurse midwives could be important collaborators in both urban and rural communities. But the medical association, he said, does not believe professional midwives are equipped to “ensure patient safety” during home births.
“They don’t really have the formal medical training that a certified nurse midwife has, and their standards fall far short of what we felt was a safe maternity situation, especially in obstetrical emergencies,” Wergin said.
Margaret Woeppel, the chief nursing and informatics officer with the Nebraska Hospital Association, said the association is open to nurse midwives practicing to the full extent of their training with proper safeguards and coordination of care.
The medical and hospital associations produced a set of guidelines for home birth care that they say are needed to gain their approval in future legislation. The guidelines include the early recognition of high-risk pregnancies that shouldn’t be handled outside of a hospital and a written plan for transfer if a birth becomes complicated.
Mollard said nurse midwives are accepting of the guidelines to allow them to practice without physician supervision and assist in home births. She’s hopeful that, by this time next year, Nebraska will join the majority of states providing access to alternate forms of birth care.
“I think a lot of people misunderstand moms and babies who are pushing for midwifery care, thinking that the safety of our babies and ourselves aren’t our No. 1 priority,” Madison Jones said. “Women are still having unattended home births, and the bad outcomes that come from those things could be prevented by better midwifery care access.”
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