Thank you for reviewing the licensing and regulation of certified professional midwives! I have given birth at home twice myself, and am also a doula who has attended births at home, in birth centers, and in twenty different hospitals across the country. With this broad experience I can attest that home birth with CPMs is a safe option, validated by many studies and reviews to-date. 

I've worked in Virginia for seven years, but previously worked in California and Utah where CPM midwives can carry and administer standard medications such as anti-hemorrhagic drugs, IV saline, and oxygen. Birth emergencies are extremely rare for women who are healthy when they go into labor, but when an emergency such as hemorrhage occurs, there are mere minutes to treat it for optimal outcomes. CPMs have many non-pharmaceutical tools to prevent and manage hemorrhage, and some studies have shown hemorrhage rates to be lower at home than in hospital due to the lower rates of interventions such as epidural anesthesia and induction/augmentation with Pitocin. But when serious hemorrhage occurs, the Virginia laws currently in the books could cost a woman her life -- when a CPM could have saved it with the right tools (that she is already trained to administer).

Aside from emergencies, it should not be necessary for a woman to transfer mid-birth for dehydration (which IV fluids could easily solve at home) or for antibiotics should she wish to receive them for Group B Strep infection. Similarly, if she wishes to accept Vitamin K or erythromycin ointment for her baby, she should be able to receive them shortly after birth within the standard timeframe, and without having to leave her home. ANY disruption during the first few hours/days after birth can impact breastfeeding, bonding, infant health, and maternal mental health longterm --- hospital transfer is not only disruptive but potentially traumatic. Having these medications available to her chosen home care provider allows the mother-baby dyad to be as undisturbed during birth and postpartum as possible. 

There is nothing to lose in expanding the legal scope of Virginia midwifes to match their professional scope and training.