FORT WAYNE, Indiana – A growing number of Hoosier families are choosing home births, but the state’s recent disciplinary action against an unlicensed birth attendant has sparked renewed debate over safety, emergency care and oversight.
Certified midwives vs. unlicensed practitioners
The Indiana Capital Chronicle’s investigation highlights the clear divide between certified direct‑entry midwives, who must meet state‑mandated training and safety standards, and unlicensed attendants who operate outside that system. Certified midwives are required to hold at least an associate degree in nursing or an accredited midwifery program, complete an apprenticeship of 80 births, maintain CPR and newborn‑resuscitation certifications, carry liability insurance and work under a supervising physician.
Since Indiana issued its first direct‑entry midwife certificate in 2017, certified midwives have attended or assisted with more than 3,200 live births. State reports recorded seven stillbirths and no maternal deaths during that period, underscoring a strong safety record for regulated providers.
Unlicensed practitioner under scrutiny
The state’s oversight system is now focused on Becky Cantieri of Mishawaka, who has conducted home births for decades without certification. Cantieri, who describes her work as a Christian ministry, estimates she has attended about 3,000 births. During a recent cease‑and‑desist hearing, the Indiana Attorney General’s Office questioned her about six stillbirths and one maternal death linked to her cases. In the 2007 Goshen incident, Cantieri admitted she did not call 911 or monitor fetal heart tones when the mother experienced 14 seizures during a three‑day home birth. The mother had refused hospital care after being told she had high blood pressure, a warning sign of preeclampsia.
Police were not notified for four days after the 2003 Columbia City mother‑and‑baby deaths, and Cantieri said the delay was due to remaining at the home to pray. Her attorney, Tom Dixon, argues that her unpaid religious ministry is constitutionally protected and claims investigators cleared her. Nonetheless, the state’s midwifery committee issued a cease‑and‑desist order, and Dixon is considering an appeal.
Medical experts stress emergency preparedness
Maternal‑fetal medicine specialist Dr. Erin Cleary of Riley Children’s Hospital warns that even low‑risk pregnancies can develop life‑threatening complications such as uterine rupture, postpartum hemorrhage, fetal distress or preeclampsia. Rapid access to an operating room can be lifesaving, especially for patients with multiple prior cesarean sections.
Certified midwives must refer high‑risk patients to obstetricians and arrange hospital transfers when complications exceed their scope. State data show 32 emergency transports by certified midwives in 2025, including eight newborns with respiratory distress or slow heart rates.
Access gaps and the role of trained midwives
The March of Dimes classifies one in four Indiana counties as maternity‑care deserts, leaving many women traveling an average of 14 minutes—and up to twice that distance in desert counties—to reach the nearest labor and delivery hospital. Approximately 71,000 Indiana women live more than 30 minutes from such a facility.
Dr. Nathan M. Riley, a Louisville obstetrician who supervises nine certified midwives in Indiana, says many families seek home birth for greater autonomy. He notes that a formal physician‑supervisory relationship helps midwives provide accurate information while staying connected to medical standards. In March, Indiana’s medical board granted Riley a waiver to supervise more than four midwives simultaneously.
Balancing choice and safety
The debate centers on respecting patient choice and addressing maternity‑care shortages while ensuring safeguards for mothers and newborns. Supporters of certified midwifery argue that rigorous training, physician consultation and emergency‑transfer plans make home birth a viable option for carefully selected low‑risk pregnancies. Medical experts caution that sudden complications demand rapid hospital access, reinforcing the importance of state oversight.
As Indiana continues to confront provider shortages, the distinction between regulated midwives and unlicensed birth attendants remains critical to protecting women who choose to deliver at home.
Original reporting: WOWO News/Talk (Fort Wayne) — read the source article.
