House hearing on HB 520 probes midwife licensure, safety, and access; Department of Public Health urges guardrails

Representative Maziak presented House Bill 520 as a hearing-only bill to create a licensure framework for direct-entry/community midwives and an advisory board to regulate midwifery practice outside hospitals.

The author opened by describing concerns about "bad actors" practicing without standardized oversight and noted historical changes in Georgia regulation: non‑nurse midwife certification previously existed in Title 31 but ended when certified nurse‑midwife programs expanded. The bill would repeal the old chapter and move licensure under Title 43 (professions and licensing), establish an advisory board, set licensure pathways and renewal requirements, and create penalties and informed‑consent requirements for persons who call themselves "midwives" without the required training or license.

Witnesses supporting licensure described clinical training and outcomes for licensed and credentialed midwives. Sakissa Berry and Missy Burgess (certified professional midwife) explained differences between doulas, nurse‑midwives (CNMs), and direct‑entry midwives (CPMs and traditional midwives), noting direct‑entry pathways typically require 3–7 years of training and continuity-of-care practices including in‑home postpartum visits. Missy Burgess summarized the bill's four licensure pathways: (1) current national credential holders, (2) non‑credentialed midwives who document three years of apprenticeship and pass a competency exam, (3) a grandfathering pathway for direct‑entry midwives with 25 or more years' practice, and (4) midwives licensed in other jurisdictions with substantially similar requirements. She also referenced required CPR/newborn‑resuscitation certification and a pharmacology course for licensees.

Several mothers and clinicians testified in favor, citing continuity of care, improved postpartum outcomes and access for people choosing home birth. A labor-and-delivery nurse who is a CNM student described observed differences in intervention cascades in hospital care versus home birth, and multiple midwives described clinical training and emergency skills practice.

Opposition and concerns were raised. Megan Andrews, assistant commissioner for policy at the Georgia Department of Public Health, told the committee DPH has concerns about the bill as drafted: no requirement for physician supervision (in contrast to nursing protocols), no minimum proximity to a hospital or backup facility (rural hospital closures have increased travel distances), and lack of explicit treatment of multiple high‑risk conditions that would make home birth inappropriate (e.g., prior cesarean, preeclampsia, post‑dates or preterm labor, substance use). Andrews said DPH is not categorically opposed to licensure but recommended carefully drafted statutory guardrails.

Other witnesses urged broader or different approaches: some recommended the Department of Public Health retain certification authority rather than creating a new licensing board, and others recommended amendments to ensure grandmothering provisions and other pathways do not unintentionally exclude experienced community midwives. Representative Park Cannon offered that licensure may set too high a bar and proposed a substitute she said would preserve access while addressing safety; she circulated a proposed sub and urged additional review.

Committee members asked about data and scale. Testimony included a CDC-WONDER figure cited in the hearing that 5,861 intended home births occurred in Georgia between 2016 and 2023; one witness cited Georgia Department of Public Health rankings for prematurity, infant mortality and maternal mortality in 2022 (as presented in the packet). Witnesses also described that community midwives have filed birth certificates through the state's GABRIS system since 2013 and have performed newborn hearing screening with portable equipment purchased by midwives (machines costing roughly $5,000–$10,000).

The committee did not take a vote; the chair closed the hearing and said the bill will be continued for future consideration. Testimony revealed a substantive divide about supervision, data collection, grandfathering, and whether oversight should remain with the Department of Public Health or be assigned to a new licensing board.