RN assist at homebirths?

Nurses General Nursing

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Hi. I'm just wondering if anyone knows if there would be legal problems with this.

I would love to be a birth assistant or apprentice/student midwife. We have no CNMs around here doing homebirths so it would be with a direct entry midwife. She's done many births and I am confident in her skills.

Non nurse midwives are considered alegal in my state...they're not illegal but they're also not regulated by the state. There is no licensure available for them (although they may choose to become a certified professional midwife)

My concern is my RN license. Since I technically would be the only licensed person at the birth would she be considered to be working under my license? Would I be held accountable for anything she does? And could I be accused of practicing medicine without a license as a assistant or student? What constitutes that anyway? If Im just providing labor support and FHTs I could not be accused of practicing medicine without a license, right? How about catching babies?

Thanks for any help!

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Best place to check would be with your BON, but don't be surprised if they tell you not to do it. Once you identify yourself as a nurse, you are held accountable to whatever a prudent nurse would do in a situation. That means if something goes wrong and you step in as a nurse, your license could be liable.

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could you train as a Doula so as to be supportive without having to be medical? Don't suppose that would help w/ the license problem, though.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

be realllly careful here.

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Thanks for the responses! I'll check with the BON.

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could you train as a Doula so as to be supportive without having to be medical? Don't suppose that would help w/ the license problem, though.

Even if Im functioning in the role of a doula though, Im wondering if my RN license will hold me reliable since I'd be working with a unlicensed midwife, kwim? If homebirth mw were licensed in my state, it'd probably be different Im guessing.

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Even if Im functioning in the role of a doula though, Im wondering if my RN license will hold me reliable since I'd be working with a unlicensed midwife, kwim? If homebirth mw were licensed in my state, it'd probably be different Im guessing.

Even if you're "functioning" as a doula, if you are licensed as an RN, you are held accountable for the accepted standards of Registered Nurse practice in your state. If you have accepted a responsibility to (the pregnant woman) by coming to her home to assist with her birth, then, legally, you are obligated to do everything a careful, prudent, competent RN would do for her. You don't get to say, well, I'm not "functioning" as an RN in this situation.

Also, entirely apart from the legal issues, if there were (heaven forbid!) a bad outcome with the birth, you would be a sitting duck for a civil suit. Regardless of whether or not you actually broke the law or violated your state's Nurse Practice Act (or did anything objectively "wrong"), I can't imagine that it would be v. difficult for any halfway competent attorney to convince a jury that this young woman/family had suffered a terrible loss, and you and the midwife were responsible ...

I've been an RN for a v. long time, and I wouldn't touch a situation like this with a ten foot pole. I can't even count how many ways you're asking for trouble ...

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I hope you're not from Illinois... they're really strict about such things. One RN, for instance, who also practiced as a direct-entry midwife, lost her RN license and was charged with practicing medicine and as a CNM without a license.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

If you are an RN, you are held to that standard in many states. Make sure you are very clear on your BON rules and again, proceed with extreme caution. As an OB nurse, I would not do this myself, as appealing as it may be at the outset.

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You don't get to say, well, I'm not "functioning" as an RN in this situation.

I agree with folks about not doing this...unless you are 100% sure the BON has a written policy about this and/or an experienced attorney has some input.

However, I do know things can vary state by state. I am in acupuncture school (in a state where acupuncurists are licensed) and asked my BON if I needed to be held to the standards of my license when seeing patients with purely oriental medicine (OM) needs. They (BON) said if I follow only OM guidelines and advertise and sign as only an LAc and not as a Nurse Practitioner, then that would be OK. However, if I do anything western medicine, I need to operate under both licenses and the LAc would be seen as an adjunct to my NP license. This seemed confusing to me and I wasn't sure if there was anything solid that would back me up in court so I decided to assume I could be held liable for not functioning as an NP in a LAc/OM situation.

This situation might be different than yours since both examples involve licensed professionals (NP and LAc)--in yours there is no license for the assist. Still, it seems very confusing. I decided not to even observe/"third assist" at a CNMs homebirths since she did not have and I was also worried that if anything happened, I would be considered involved since I had a license. If, for example, I saw something going wrong and just "observed," I might be held liable; or if I did something and there was still a bad outcome, I might be held liable, all under my RN license. So, I don't know. But be careful, if you're really worried about assets and legality etc.

Good luck! You should volunteer at Holy Family Birth Center something. You can get some experience, and you'd be working as an RN at least in an out of hospital setting.

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I forgot to add that I know some RNs who have given up their licenses so as not to have to be held to it in all their other situations such as in being an acupuncturist. It made their lives easier and their guidelines more clear.

So it can be really confusing!

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I hope you're not from Illinois... they're really strict about such things. One RN, for instance, who also practiced as a direct-entry midwife, lost her RN license and was charged with practicing medicine and as a CNM without a license.

No, I'm not from Illinois, but non nurse midwifery is illegal there so that would make sense.

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