Natural by default. Medical by exception.
The law should not treat every birth as medical, because most births, like most breaths, are not.
This distinction is the whole question now in front of Pennsylvania. If every birth is defined as medical, then anyone who attends a birth is practicing medicine, and every traditional midwife is unlicensed by definition.
If birth is natural by default and medical by exception, then Pennsylvania can protect both: skilled medical care when it is needed, and the freedom of families to welcome a baby at home with an experienced midwife when it is not.
What changed in 2026
Language in the 2026–27 state budget law repealed Pennsylvania's 1929 midwifery statute and replaced it with new provisions. Traditional midwives who serve Amish and other plain communities have gone to court, concerned that the new language could be read to prohibit midwives who are not nurses and not certified, which describes nearly every midwife these communities rely on.
The Commonwealth has told the court the law does not ban traditional midwives. The midwives are asking the court to make sure of it before enforcement begins.
What is at stake
- Under the new law, a traditional midwife could be arrested for doing what she has done safely for decades. Pennsylvania's plain communities have trusted these midwives for centuries.
- Plain-community families will still birth at home whatever the law says. The law would only remove the most experienced woman from the room, and mothers would carry the risk.
- Rural Pennsylvania is already losing maternity care. When hospital maternity units close and drive times grow, traditional midwives are part of how families keep access to safe, attended birth close to home.
- This reaches far beyond the plain communities. Across Pennsylvania, families of every background choose traditional midwifery, and the new words reach every one of them.
Where we stand
Families deserve both: excellent medical care when a birth needs it, and the freedom to birth at home with an experienced midwife when it does not.
The Keystone Birth Collaborative supports preserving lawful access to traditional midwifery in Pennsylvania, alongside strong, respectful transfer relationships with medical care for the births that need them. Regulation should start from what birth is: natural by default, medical by exception.
Contact
A resource for your office
The Keystone Birth Collaborative is a Pennsylvania nonprofit working to improve access to maternal and newborn care for families in rural Pennsylvania. We are glad to be a resource to your office on birth and women's health: plain-language briefings, connections with the families and midwives this issue touches, and data on rural maternity access.
Reach the Collaborative