Currently in South Dakota homebirth is a difficult choice. While the state has acknowledged a woman may choose to give birth at home, and even provided specific protection for family members present at the birth, it is impossible for her to hire a qualified birth attendant.
Physicians typically have no training or experience in out-of-hospital birth, and malpractice insurance excludes physicians who provide homebirth services. Certified nurse-midwives are not required to have training or experience in out-of-hospital births, though currently several in South Dakota do have out-of-hospital experience or are seeking out-of-hospital training and experience and are willing to provide homebirth care within the guidelines established by the American College of Nurse Midwives (ACNM) the certifying body for Certified Nurse Midwives. However, the licensing of CNM practice in South Dakota is contingent on a signed collaborative agreement with a physician that is submitted to and approved by the Boards of Nursing and Medicine. Physicians entering into these types of agreements are often construed as having vicarious liability for the practice of the nurse-midwife. Given the lack of training and experience of physicians in regard to homebirth and the exclusion of homebirth from medical malpractice insurance coverage, it is impossible for a physician to enter into a signed collaborative agreement with a CNM planning to include homebirth in her practice. No CNMs whose practice includes homebirth are approved by the Boards of Nursing and Medicine in South Dakota.
The practice of midwifery by non-CNM midwives has never been made illegal in South Dakota, nor has midwifery practice by other midwives gone into complete extinction. In recent years, however, other midwives have been tried and convicted of the charge of practicing nurse-midwifery without a license, leaving these other midwives unregulated yet vulnerable to legal action. Midwives willing to assist with out-of-hospital births are currently arranging to meet with South Dakota families in neighboring states. Prenatal visits take place across state lines, and births take place in hotel rooms, state park cabins, or a network of “birth and breakfast” homes just over the South Dakota border. In many parts of the state it is not practical to try to cross the border to give birth. Instead, families are increasingly choosing to study books and videos, talk to others with experience, and give birth at home unassisted.
With no regulated midwives available to provide homebirth services, families are seeking birth attendants by word of mouth. Families have no way to verify the credentials, qualifications, or practice record of the birth attendants they may hear about. Families are vulnerable to misunderstanding the skills and experience level of a birth attendant. With no other resources for locating midwives or verifying credentials, they have limited options for a more secure and informed decision.