DULUTH, Minn. — Some midwives are warning that Minnesota's unregulated midwifery practices pose a danger to mothers and babies as home births rise.

More mothers are choosing home births over hospital deliveries in recent years. Minnesota's heath department recorded 721 home births last year, compared to just two in 2000.

As that demand shifts, so are midwives' concerns over why the state lets midwives practice unregulated.

"Without licensure, anyone can hang a shingle and say they are midwife," Tavniah Betts, a licensed midwife in Duluth who studied licensure across the country as she pursued a master's degree in public health. "To have no definition of what that means can be very confusing."

To be licensed, home birth midwives must earn their Certified Professional Midwife credential. The Minnesota Board of Medical Practice has licensed 44 midwives, but there's no official count of midwives who practice without a license.

Minnesota and Utah are the only states in the nation where such licensing is optional, and Duluth-based midwife Margo Nelson supports that policy.

"By not being licensed, I can really truly serve the families that I work with as opposed to serving a third party, and in the case of licensing that's the state," Nelson told Minnesota Public Radio News.

Nelson noted that she has extensive training through apprenticeships and coursework and that her decision not to secure licensure comes down to a fundamental belief that her relationship with her clients doesn't require state oversight.

Nelson's experience impressed Paris Alvar of Duluth when she was interviewing midwives to help with her in-home birth of her one-year old daughter Rosie.

"She's very, 'I want to do what's comfortable with my client' kind of thing," Alvar said of Nelson. "For us, it was her experience that mattered, more than any tests that she took."

Meanwhile, Leah Fitzgerald, a medical malpractice attorney, said the lack of state oversight on midwifery practices leaves no standards for midwifes to follow.

"If it's voluntary, we take away all of the oversight that's created by licensure statutes. If you don't have oversight, it's kind of the Wild, Wild West," Fitzgerald said. "They can be providing care to a higher standard. They may not be."

Fitzgerald said while most babies are born healthy, a small percentage are not and need immediate medical help. She said unlicensed midwives may lack adequate training that would lead to missed complications.

State Sen. Jim Abeler said he's surprised by the number of midwives operating without a license and that he plans to reconsider the model he helped write two decades ago that doesn't require midwifery licenses.

"We expected that the midwives would choose the option of being credentialed," Abeler said.