Midwives Face Felony Charges For Assisting With Home Births as States Grapple With ‘Maternity Care Deserts’

A South Dakota midwife who says God called her to attend home births is facing the prospect of prison time in Nebraska for a practice as old as civilization itself. Seventy-seven-year-old Judy Jones stands charged with multiple felony counts for helping deliver babies outside hospital walls, a violation of Nebraska’s law prohibiting mothers from receiving assistance from midwives for at-home births. Ms. Jones has aided in more than 1,200 home births over a quarter-century; however, she is not certified to perform midwife services in either South Dakota or Nebraska. The state’s attorney general argues that her ongoing failure to follow credentialing standards puts mothers and babies at risk. Indeed, one of the charges stems from the death of a newborn in 2022 whom Ms. Jones could not free in time from the umbilical cord wrapped around her neck. But the criminal complaints against Ms. Jones have raised questions about the broader legal assault on midwifery across multiple states, where legislators and prosecutors are wielding criminal penalties to eliminate centuries-old birthing practices in the name of medical safety. “Laws that prevent qualified midwives from providing care do not eliminate demand for out-of-hospital birth,” a senior attorney at the Pacific Legal Foundation, Joshua Polk, told The New York Sun. “Rather, they simply reduce the availability of experienced providers who can make those births safer.”Limits to Aiding a Mother in LaborWhile home birth is legal in all 50 states, Alabama, Illinois, Iowa, Kentucky, North Carolina, and South Dakota, among others, maintain frameworks that effectively criminalize professional birthing assistance at home, often forcing families to choose between hospital delivery, hiring underground practitioners, or giving birth entirely alone.The restrictions are even more concerning given the vast number of “maternity care deserts” across the nation. March of Dimes data show that as of 2022, 38 percent of Alabama’s 67 counties had no hospital or birth center offering maternity care — a figure that has worsened considerably over the past decade — while 55 of Nebraska’s 93 counties lack a hospital with birthing services. Overall, 35 percent of the nation’s 3,142 counties do not have a single obstetric clinician or birthing facility.Despite the dearth of services, in Alabama, the Court of Civil Appeals ruled in January 2026 that freestanding birth centers must be licensed and regulated as hospitals, a standard that would effectively make it impossible for them to provide midwifery care. The ruling reversed a May 2025 trial court decision that allowed birth centers to operate. The prohibition has not yet taken effect, however, allowing the centers to provide care as plaintiffs seek further review.Nebraska’s PaternalismNebraska holds the distinction of being the only state that explicitly bans certified nurse midwives from attending planned home births. The state’s 1984 Certified Nurse Midwifery Practice Act requires midwives to practice under physician supervision and limits births to hospitals or health care facilities, with felony penalties for violations.The regulations on certified nurse midwives are different from similarly trained advanced practice clinicians in the state, including certified registered nurse anesthetists, who carry full practice authority without physician oversight. The rules are also far more restrictive than the national norm — a disparity that advocates say most residents are unaware of or wrongly assume reflects standard practice when it does not.Nebraska’s statutes have raised pointed questions about whether the restrictions solely reflect concerns about patient safety. Nebraska’s certified nurse midwife workforce is entirely female, a notable distinction from a historically male-dominated specialty.One certified nurse-midwife with doctoral training and the Nebraska affiliate president of the American College of Nurse-Midwives, Heather Swanson, filed a federal lawsuit in April 2024 challenging the ban. At oral arguments before the Eighth Circuit in May 2025, Judge Lavenski Smith questioned the state’s rationale for allowing women to give birth at home without any medical assistance but prohibiting trained midwives from assisting at home. The position seemed “not entirely rational,” according to Judge Smith, but the Eighth Circuit ruled against Ms. Swanson anyway, saying that Nebraska’s decision to regulate medical care is grounded in safety concerns. The court also found that she lacked standing to assert the rights of her prospective patients. Pacific Legal Foundation has petitioned the U.S. Supreme Court to take up the case.Policy’s Profit Motive The question of financial motive sits just beneath the surface of the policy debate. Members of the Nebraska Hospital Association and Nebraska Medical Association have testified against midwifery reform bills in the state legislature, and the Nebraska Medical Association filed an amicus brief with the state Supreme Court siding with the attorney general in Ms. Jones’s prosecution. Birth centers and home births represent a direct revenue loss for hospitals: the median in-network cost of a hospital vaginal birth exceeds $15,000, according to FAIR Health’s 2024 data, revenue that evaporates when a family chooses to deliver at home or in a birth center. Mr. Polk said if the state is truly concerned about the health of the mother and baby and not financial self-interest, it could do more to sever the financial incentive for the opposition. “To the extent that states regulate this choice, they should focus on establishing training standards and that sort of thing,” he said. “That approach focuses on the factors that actually matter for safety rather than protect the profits of local hospitals who might object to losing patients to trained midwives.”The Safety ParadoxResearch published by the Cochrane Library concludes that planned hospital birth is not demonstrably safer than planned home birth assisted by an experienced midwife, provided mechanisms exist for seamless transfer to a hospital if complications arise. Restrictive state laws prevent those mechanisms from being built.The American College of Obstetricians and Gynecologists acknowledges the complexity, noting in data provided to the Sun that while planned home births are associated with fewer maternal interventions than planned births in hospitals, data show higher rates of perinatal mortality when trained midwives are not present at home. A separate study found that the more integrated midwives are into health care systems, the better a state’s birth outcomes tend to be, meaning states that criminalize rather than regulate midwifery create the opposite of their stated safety goal.“Safety and access are not competing goals,” Mr. Polk said. “When qualified midwives are allowed to practice, families gain access to trained professionals rather than being pushed toward unassisted births or other less safe alternatives.”Prosecutions and PenaltiesMs. Jones’s case carries particular weight because it involves not only regulatory violations but potential religious freedom defenses. Ms. Jones has invoked Nebraska’s First Freedom Act, passed in 2024, claiming the law protects her belief that God called her to assist home births. As of mid 2025, motions to dismiss the charges on religious liberty grounds were pending before district court judges in Douglas and Madison Counties, with the question widely expected to reach the Nebraska Supreme Court. The charges against Ms. Jones stem from two 2022 cases — the case in Douglas County involving the baby with the umbilical cord wrapped around her neck, and the case in Madison County of providing prenatal care and attending a home birth without supervision. Ms. Jones was previously ordered to cease practicing in South Dakota in 1993 and in Nebraska in 1999 and served 30 days in jail in Sioux Falls in 2003, according to the Lincoln Journal Star, which has been covering her case. She also avoided a 2015 manslaughter charge in Nebraska over the death of a newborn when the case was dropped before it went to trial. In late 2024, the Nebraska Supreme Court reversed rulings that had dismissed the 2022 charges, finding that the Uniform Credentialing Act requires Ms. Jones to have a Nebraska certification before she can even practice under supervision. That sent the case back to the lower courts for further proceedings.A parallel case, Lindstrom v. Hilgers, brought on behalf of a mother, Hope Lindstrom, who moved to Nebraska from Oregon only to discover that her care option was prohibited, is also working its way through the courts. The conflict between state restrictions and family autonomy intensifies against a backdrop of accelerating rural hospital closures atop the maternity care deserts. To address the shortage, a bill by state Senator Ben Hansen would allow certified professional midwives to assist with home births. The bill advanced out of committee in 2025 yet failed to reach a final vote before the Legislature adjourned in May. Carrying over into the current session, it is currently held up in the Health and Human Services Committee. Mr. Polk argues the stakes could not be higher for underserved communities. “Laws that block midwives from practicing or opening birth centers often end up reducing access to care when many communities are losing hospital maternity services,” he told the Sun. “That leaves people with less access to quality care.”

Midwives Face Felony Charges For Assisting With Home Births as States Grapple With ‘Maternity Care Deserts’

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