Here in western South Dakota, we have an independent streak that often manifests itself in a do-it-yourself attitude.

That's true for pregnant women, too. A small, but increasingly vocal, minority of area women are choosing a home birth over delivering their babies in a hospital.

Nationwide, midwife-attended home births are growing across all socio-economic groups as more women and their families question the unwanted medicalization of the birth process.

South Dakota women are questioning this state's policies toward the practice of midwifery and home birth, too.

Current state law does not make home birth illegal, but it does make it all but impossible for a midwife to be present during one. South Dakota restricts certified nurse midwives (CNM), who are registered nurses with advanced obstetrics training, to practicing their profession under a collaborative agreement with a physician. Those physician agreements are hard to come by for any midwife who is not employed by a physicians' practice. They are non-existent for any midwife who wants to do home births.

The state also refuses to regulate or license non-nurse midwives, called certified professional midwives (CPM), who train through apprenticeship and may have years of experience delivering babies, but not necessarily any formal medical training.

By refusing to establish minimum licensing requirements for CPMs, and by requiring certified nurse midwives to practice under a collaborative physician agreement, South Dakota makes it impossible for pregnant women to be attended by midwives during home births. As a result, it inadvertently encourages the kind of dangerous, unattended home births it says it wants to prevent.

People choose home births for a variety of reasons. Agree or disagree with those reasons if you wish, but government will never stop families from making that choice. It should, instead, adopt policies that make that choice as medically safe as it can be.

South Dakota should develop licensing and regulations for CPMs recommended by the North American Registry of Midwives and it should eliminate the collaborative physician agreements for CNMs that keep them from attending home births.

We urge the state to help decrease, not increase, the medical risks of delivering a baby at home.