Still, several reproductive endocrinologists and other medical traditionalists I spoke with were surprised, even alarmed, to learn that midwives had branched out from pregnancy, labor, and delivery into intrauterine inseminations.
“I certainly understand the desire to have as pleasant an environment as possible in order to conceive, but I think most doctors try to provide that in their clinics,” said Dr. Eric Surrey, a board-certified reproductive endocrinologist and medical director with the Colorado Center for Reproductive Medicine. “Insemination is a medical procedure, and like anything else in medicine, it requires training. It’s not totally straightforward.”
While it’s true that the procedure has some potential risks—minor ones, such as cramping, and potentially life-threatening ones, such as infection or uterine puncture—those complications are extremely rare, both in home and clinical settings, and they are risks that an informed patient can choose to take. So the problem isn’t that some midwives offer home insemination options. Lesbian couples, transgender women, and single mothers deserve and are entitled to start their families on their own terms, in whatever environment is most comfortable for them, and midwives who offer home insemination services make that possible. The problem is that state governments should not and cannot legislate every variation of the safe ways women choose to conceive, carry, and deliver their children—but they’re trying to anyway. This unclear and inconsistent government interference in midwifery and alternative insemination has created a climate where even trained, professional, and law-abiding midwives often aren’t entirely sure what is or isn’t explicitly legal.
“I’ll teach someone how to inseminate her partner, but I won’t do it myself,” one midwife, who asked not to be named, told me. “I can’t jeopardize my home-birth practice over this.”
If the legality of providing inseminations is a gray area, the legality of receiving them is even murkier. In many states, only women or couples who receive inseminations under the care of a licensed physician, using a frozen sample from a sperm bank, are protected. Earlier this year, for example, a Kansas man who donated sperm to a lesbian couple was ordered to pay child support, largely because a physician did not perform the insemination. Laws vary state by state and in some cases are very problematic. In Minnesota, for example, Statute 257.56 says: “The donor of semen provided to a licensed physician for use in artificial insemination of a married woman other than the donor's wife is treated in law as if he were not the biological father of a child thereby conceived." The wording of "licensed physician" and "married woman," therefore, doesn't protect sperm donors who want to help unmarried women or those who inseminate under a midwife’s care.
“The legality of home insemination isn’t the only issue,” said Steven H. Snyder, an attorney who specializes in assisted reproductive technology law. “Statutes governing artificial insemination vary state by state, and if the state requires a doctor to inseminate, but instead a midwife inseminates, there could potentially be a lawsuit about the parentage of the resulting child.”
So what needs to happen? Home intrauterine insemination should be formally and officially included in the training courses for certified professional midwives, certified nurse midwives, and other licensed midwives so that providers of that valuable service are explicitly protected. On top of that, state laws need to be reformed to protect both the women who choose to inseminate at home and the known sperm donors who choose to help them. California took a step forward last year when Gov. Jerry Brown signed AB 2356, which ensures that women in same-sex relationships can access fertility services on the same terms as women in opposite-sex relationships. Now other states need to examine their own laws surrounding the fertility and insemination process to ensure that all women can start their families in whatever environment and with whatever licensed provider they choose.
“Yesterday I showed up a little bit early to an insemination, so first we sat out on her balcony, drinking tea and eating banana bread,” said Catherine Boshe, a certified nurse midwife who was first trained in home intrauterine inseminations by Eichenbaum-Pikser. “There’s just a connection that develops. It’s an amazing honor to be involved in such an intimate and important part of these women’s lives. Then, when they finally get a positive pregnancy test result, it feels like we’re celebrating for a good friend or a sister.”