Historically, midwives played an important role in pregnancy, including assisting in the birthing process. In the late 19th century, however, medical practice became more standardized and physicians, specifically obstetricians, lobbied for more restrictive licensing laws because midwives were direct competitors. Until 1910, approximately 50 percent of Kansas births were assisted by midwives although they were not viewed as engaging in the practice of obstetrics. By 1986, only 12 states, including Kansas, had no legislation directly or indirectly allowing or prohibiting lay midwifery. In 1993, the State Board of Healing Arts (SBHA) (plaintiff) published a policy stating the lay midwifery was the practice of medicine and surgery and that practicing midwifery without approval by the State Board of Nursing (Nursing Board) (plaintiff) would be classified as unlicensed practice of medicine and surgery. E. Michelle Ruebke (defendant) was a lay midwife who assisted with prenatal care, delivery, and post-partum care. She was the president of the Kansas Midwives Association and followed the association’s standards. Ruebke worked with supervising physicians who offered consultation and assistance whenever needed. Ruebke did not hold herself out as anything other than a lay midwife. The SBHA and the Nursing Board brought an action against Ruebke for practicing medicine and nursing without a license and requested injunctive relief to stop Ruebke from performing lay midwife duties. The trial court denied the injunction, holding that the provisions of both the Healing Arts law and Nursing law were unconstitutionally vague. The SBHA and the Nursing Board appealed.