HATTIESBURG — For Cassidy Sager, the birth of her child wasn’t just a life-changing moment — it was a calling.

After experiencing a home birth with Hattiesburg Midwifery, she knew she wanted to be part of the birthing community. But as she works toward her doula certification, she’s reminded that midwifery in Mississippi still lacks the legal recognition and regulation that other states provide.

“I just knew that the Lord was calling me to birth work,” Sager said. “I knew that I was interested in midwifery, but I was also interested in becoming a doula. So, I knew the first step towards this journey of birth work was to become a certified doula, just to kind of get my foot in the door.” 

Sager is among a growing number of mothers and birth professionals advocating for midwifery licensure in Mississippi. Yet for the third year in a row, House Bill 927, which sought to regulate and license midwives, has failed to pass in the state Senate. The failure leaves expectant mothers with limited options and no formal oversight for those calling themselves midwives.

The legislative fight for licensure 

The Association of Mississippi Midwives, a nonprofit organization advocating for midwifery, has pushed for licensure to establish standards for education, training and credentials. Amanda Smith, owner of Hattiesburg Midwifery, has been at the forefront of this fight.

“So, currently in Mississippi, certified nurse midwives are licensed through the Board of Nursing, but there’s no license for community midwives, which means anyone who wants to call themselves a midwife in Mississippi currently can — without anyone checking their credentials or their training or their background — anything like that,” Smith explained. “And it’s totally up to the consumers to check that.” 

Smith, who has been working alongside Better Birth Mississippi to push for the bill’s passage, said that regulation is not about restricting midwifery — it’s about ensuring that both mothers and midwives have legal protections.

“I mean, we are the third-lowest state,” Sager added. “Only 2% of births in Mississippi are attended by midwives — that’s extremely low — and it’s sad to me because I think there are a lot of mamas who would like to have a birth experience that’s more holistic, more natural minded, but the options are just not there.” 

HB 927 passed the House of Representatives 88-23; however, after being referred to the Senate Public Health and Welfare Committee on Feb. 18, the bill died in committee on March 4.

Committee Chair Hob Bryan (D-Amory) did not bring the bill up before the deadline, effectively stopping its progress. Bryan told RHCJC News partner Mississippi Today “he’s not in favor of encouraging midwives to handle births independently of OB-GYNs — even though they already do, and keeping them unlicensed makes it easier for untrained midwives to practice.”

Bryan acknowledged to Mississippi Today that the bill would have created stricter standards around who could call themselves a midwife, but ultimately, he does not “want to pass legislation recognizing the group at all.”

What HB 927 proposed

 The bill aimed to:

— Create a Mississippi State Board of Licensed Midwifery to oversee licensure and enforce regulations.
— Define the scope of practice for midwives, ensuring clear professional responsibilities.
— Require health coverage plans that offer maternity benefits to include midwifery care.
— Establish a perinatal transfer certification to ensure safe transfers between facilities.
— Clarify that midwifery is not the same as practicing medicine under state law.

A key provision would have allowed licensed midwives to administer essential medications, including Vitamin K for newborns, antihemorrhagic drugs to prevent postpartum bleeding, local anesthetics for perineal repair and oxygen for emergencies.

Emily Thompson, owner of The Little Nest Birth Services in Hattiesburg and a mother who had a home birth, emphasized how these changes could improve care in Mississippi.

“There’s a certain amount of accountability that comes with licensure that we just don’t have right now in our state,” Thompson said. “Through licensing midwives, we’re giving families options, and it’s good for families to have safe options.” 

The risk of an unregulated system

Although midwifery has been a part of Mississippi’s maternal landscape since the early 20th century, the state is one of few without regulations for professional midwifery. Advocates argue the lack of licensing and oversight limits access to midwifery care, especially for low-income women, and has driven some trained midwives out of the state, according to the Center for Mississippi Health Policy.

Mississippi’s shortage of OB-GYNs has also left many women with few options for maternity care. Forty-six counties, including Greene, Perry and Stone, lack an OB-GYN.

“Over 50% of our state are maternity care deserts. So that means there’s no access to prenatal care, obstetrics at a hospital … people who live in these counties that are deserts have to drive outside of their county to receive care,” Smith said. “We believe that licensing midwives and implementing midwives into the health care systems could, for sure, improve outcomes in these more rural locations.”   

Smith pointed to decades of data to highlight the need for regulation, noting that Mississippi’s infant mortality rate remains among the highest in the country.

In 2022, the state recorded 319 infant deaths, with a rate of 9.2 deaths per 1,000 live births, according to the Mississippi State Department of Health.

“Mississippi is truly facing a maternal and infant health crisis where more moms and babies die in Mississippi than in any other state in our country,” Smith said. “Midwifery care could be part of the solution for that.” 

Research indicates that midwife-led care is associated with fewer medical interventions, lower cesarean section rates and improved breastfeeding outcomes, according to the Center for Mississippi Health Policy.

Looking ahead: The push for change continues 

Despite the bill’s failure, Smith and other advocates remain committed to pushing for licensure in future legislative sessions. The Association of Mississippi Midwives is already preparing for next year’s effort.

“It’s only a matter of time before licensure happens,” Smith said. “And what we want is for midwives to be involved with creating the board and creating the standards for midwifery care.”

For Sager and Thompson, the fight is personal. Their experiences with home birth have fueled their passion for supporting other mothers in finding safe, informed birthing options.

“Midwives are not just these ladies who decide one day that they want to become a midwife,” Sager said. “They go to school for five to seven years, and they get certified, and they take exams, and they are trained in the emergencies.” 

“Ensuring that our midwives are not just Sally Joe off the street who are coming in and claiming to be a midwife,” she continued. “We need licensure to make sure that midwives are taking the correct route to get certified so that moms and babies and midwives are all protected.”