Tuesday, December 19, 2006

Midwifery Legal Update - Wisconsin

Midwife Helen Dentice of Milwaukee was sentenced this week to six months of jail time and three years' probation on charges of practicing medicine without a license and delivering a controlled substance (link).

Although one could argue (I am not making a case either way, as I was not there and do not know what happened) that Ms. Dentice was somehow culpable in the death of this baby - and certainly she did not meet the requirements for certification of midwives now in place in Wisconsin - the Mommy Blawger would like to point out that the acts for which she was convicted are perfectly legal and/or regulated in most of the 41 states which authorize direct-entry midwifery, including my home state of Texas.


Elizabeth Giromini said...

Technically, there is not enough information in the news article to know if what she did would be illegal or legal in Texas. It says she was delivering a prescription drug. In Texas a midwife, (CNM, CPM or LM) may only do that with standing order from a physician. So at least delivering a prescription drug without a license or standing orders would be illegal in Texas.

It also does not say what drug she administered. Was it antibiotics as the mother was GBS+, did she have an epi pen in case the mother was allergic to penicillin? Was it pitocin, which should never be given outside the hospital before delivery of the placenta?

I trained as a midwife and just 8 weeks ago had a midwife assisted homebirth here in Texas, so I am very pro-midwife. However, we do need to make sure we get enough facts before judge or support something. Otherwise we could wind up promoting a foolish action and hurting the cause instead of helping it.

The Mommy Blawger said...

I agree with you about getting all the facts; I did not support what I wrote as I should have. Earlier news articles reported:

"During a difficult home birth of a town of Vernon couple's baby on Nov. 28, 2005, Dentice, a midwife for more than 20 years, injected a drug used to prevent hemorrhaging into the mother's thigh and performed a surgical procedure on her to aid delivery. The baby was stillborn."


I am interpreting that to mean pitocin and an episiotomy.

While technically in Texas a standing order for pit would be necessary, I was under the impression that it was not difficult to obtain; practially automatic for LMs. Do you know differently?

Elizabeth Giromini said...

Honestly, it mainly depends on the area and the political climate. I was fortunate to have worked with midwives who had a very long term relationship with a friendly doc. I know several midwifes in Texas who are without standing orders, some do without pitocin, some obtain it by "other means" And I also know of some midwives who choose not to seek standing orders as they do not feel adequetly trained to use medications.

It's a sad state that politics keeps women from receiving the best possible care from the provider of their choice, but this is America after all.

Anonymous said...

Just a quick update on Wisconsin's new law, which takes effect in May 2007. It will require licensed midwives who provide OOH services to be credentialed by NARM (as CPMs) or by the AMCB (as CNMs or CMs).

The new regulations that were recently promulgated by the Department of Regulation and Licensing will allow LMs to obtain and administer medications via the standing orders of a licensed prescriber. Fortunately we have a lot of supportive physicians in the state who've been working with midwives for many years, and they were very helpful in writing regulations that all of the "stakeholders" felt were both reasonable and safe.

Also, the midwives here have been very vigilant about maintaining their medication skills and training via regular MEAC-approved CEU workshops, which has allowed them to document additional training beyond the NARM requirements.

Thank you for keeping readers updated on all of the legal developments for midwifery here in Wisconsin!

Katie Prown
Legislative Chair
Wisconsin Guild of Midwives