Understanding Birth Laws in Pennsylvania: The Truth About Direct Entry Midwives

If you’re exploring home birth or out-of-hospital maternity support in Pennsylvania, it’s critical to understand what the law actually says—and what it doesn’t.

Direct entry midwives—those who enter the work through apprenticeship, certification, or calling rather than nursing school—have served Pennsylvania families for generations. Yet under current law, they are not licensed, not recognized, and not protected. This puts both families and midwives in a legally vulnerable position, even when the care is excellent and fully consensual.

What Is a Direct Entry Midwife?

Direct entry midwives do not become nurses first. They often train through community-based pathways or national certification bodies, or through faith-based mentorship. Examples include:

  • Certified Professional Midwives (CPMs) – credentialed by the North American Registry of Midwives (NARM)

  • Traditional or “granny” midwives – trained by elders, usually through apprenticeship

  • Religious or faith-based birth keepers – who serve based on spiritual calling, not medical training

  • Holistic birth workers – sometimes combining herbalism, bodywork, or ancestral knowledge

  • Student/apprentice midwives – who are learning in the field, not in a nursing program

These midwives may be highly trained, deeply experienced, and spiritually called—but under Pennsylvania law, none of them are legally recognized.

The Legal Reality in Pennsylvania

  • The only midwives licensed in Pennsylvania are Certified Nurse Midwives (CNMs), who operate under the nursing and medical boards.

  • All other midwives—regardless of training—are considered unlicensed.

  • There is no formal law explicitly banning direct entry midwifery, but the state defines any clinical support provided without a license as “practicing medicine or nursing without a license.”

  • This means simply attending a birth, monitoring vitals, or supporting labor may be considered a criminal offense.

Pennsylvania is often described as a “grey area state,” but the truth is harsher: direct entry midwifery may already be illegal by omission. The lack of licensure isn’t neutrality—it’s a trap door.

What SB507 Would Change

Senate Bill 507 is currently under consideration in Pennsylvania. If passed, it would:

  • Define “midwifery” as a licensed medical profession

  • Criminalize the practice of midwifery by anyone not licensed through the state

  • Create clearer grounds for prosecuting direct entry midwives, even if they’re certified elsewhere or have community support

  • Potentially block families from accessing any out-of-hospital support unless it meets institutional standards

This bill does not simply ignore traditional midwives—it positions them as criminals.

What Direct Entry Midwives Can Safely Offer (and What They Risk)

Because there is no licensure pathway, direct entry midwives currently serve without protection, and often at great legal risk. Things that may be considered evidence of “practicing medicine” include:

  • Monitoring fetal heart tones

  • Assessing blood pressure or fundal height

  • Supporting a birth in progress

  • Responding to bleeding or newborn distress

  • Ordering or interpreting lab work or ultrasounds

  • Keeping medical-style charts or records

Even when families give full, informed consent—these acts can still result in criminal charges or civil lawsuits.

So What Can Be Done?

While the legal system does not support direct entry midwives, families still have the right to:

  • Choose their own support system

  • Learn from traditional birth knowledge

  • Invite trusted individuals into their birth space

  • Practice their faith and traditions in pregnancy and birth

  • Take full responsibility for their decisions outside the system

Some birth workers now serve only in non-clinical, spiritual, or educational capacities—offering:

  • Prenatal education, coaching, and emotional support

  • Labor companionship and non-directive presence

  • Faith-based prayer, preparation, and traditional postpartum care

  • Advocacy and empowerment without medical responsibility

At Cardinal Birth

We do not practice licensed medicine or nursing. We are not CNMs and are not licensed in the state of Pennsylvania.

We serve in a traditional and faith-based capacity only—walking beside families who are informed, prayerful, and fully aware of the risks involved in choosing this path. Our support is relational, spiritual, and rooted in values—not protocols.

We are watching SB507 closely. We are consulting with legal advisors. We will always tell the truth about what we can and cannot offer under the law.

This is not about defiance—it’s about obedience to God, fidelity to tradition, and protection of informed choice.

For Families Considering Traditional Support

You have the right to birth on your terms—but you must know what that truly means.

  • You are choosing autonomy, not state protection

  • You are choosing relationship, not insurance

  • You are choosing risk, but also freedom

If you still feel called to walk that path—we are here. Not as providers, but as witnesses, encouragers, and sisters in faith.