Midwife Sued

Midwife in the Clouds discusses being sued here and here - for allegedly misrepresenting the fact that she was an "in-network" provider:

Obstetrics in America is filled with stories of birth workers who can no longer have loving relationships with their patients because they are scared to death of lawsuits. The only people who suffer from these lawsuits are the mothers and babies because it becomes harder and harder to get the care you want when your caregiver is scared or limited by malpractice insurance.

Thankfully, this case was not about my ability as a midwife or my care of the mother and baby but a question of contracts, insurance, and money. I am so grateful to have learned what I did without anyone being seriously hurt - my heart goes out to midwives who are charged with an unwarrented medical lawsuit.

ABA Journal Blawg 100

The American Bar Association Journal has published a list of this year's 100 best legal blogs. I didn't make the list. Neither did Blawg Review, though, so I'm in good company.

NaBloPoMo

Poland debates paying for childbirth pain meds

From Anna Wilkowska-Landowska ("Poland Says No to Pain-Free Childbirth"), the Polish health system no longer plans to pay for childbirth drugs. The Ministry of Health Director suggested (in an article in a Polish newspaper) that not only can the state budget not afford to ensure free anesthetization during childbirth to all Polish women, but that there are not enough anesthesiologists in Poland. Says Wilkowska-Landowska:

In Western European countries, as well as in Poland's neighboring countries, childbirth anesthetization is considered a standard service provided to women. The question becomes, then, why do Polish women have to pay for it? This situation divides the Polish women into two groups: those who can afford to pay for anesthetization and those who cannot afford to pay for something to which they are entitled.

The article also mentions that since the Polish government is encouraging families to have more children, the Minister's statements only make the decision to have a baby more difficult for women.

Well, I guess it's another strike against socialized medicine.

NaBloPoMo - almost there!

Well, twenty-nine straight days of blogging, and I've run out of steam. Tomorrow we'll celebrate (it's also my birthday), but for now I'm going to get some sleep.

Thanksgiving

Happy Thanksgiving, everyone! I'm thankful for the fact that it's NaBloPoMo and I'm still technically in the game.

From Thanksgivings past, I bring you What To Do With Leftover Turkey and Leftovers (or, a Tale of two grandmas). Don't forget to watch the Thanksgiving Day Parade!

Birth Center Grand Opening - Cleburne, Texas

If you live near the Dallas/Ft. Worth metroplex - particularly the southwesternmost portion - you might want to check out the newest birth center:

We are thrilled to announce the Grand Opening Celebration of Edenway's Cleburne Birthing Center on Saturday, December 6, 2008 from 11am to 4 pm at 805 N Main, Cleburne, Texas 76033. Come see how we can help you achieve the birth you desire. Meet our staff! Tour our facility! Bring the whole family for FREE refreshments! FREE pregnancy testing! FREE chair massages! Door prizes! Kids' jump house! Free info about natural childbirth, waterbirth, fertility health, baby slings, massage, herbs, birth photography, and chiropractic care in pregnancy… This will be a fun event for the entire family! Visit us at www.cleburnebirthingcenter.com or call 817-558-BABY for more information.

New ABA Poll on the job market and the economy

The ABA Journal is surveying lawyers about the job market and the current state of the economy. Results will be published in the January edition of the Journal.

Links for Midwives and others

Thanks to Citizens for Midwifery for posting a link to USPharmD.com's list of 100+ Essential Online Resources for Midwives.

Homeschooling and Vaccinations under the Obama administration

I guess this is the sort of question that everyone is asking these days. Yesterday I received a flyer in the mail advertising a seminar for estate planning professionals on how to advise their clients in light of the incoming administration. Of particular interest to my readers is how the Obama presidency will impact home schoolers and "mandatory" immunization programs. (If you have any input or links regarding midwifery, homebirth, or breastfeeding, please feel free to post in the comments; however, they tend to be state issues and I haven't heard any buzz about these topics).

Homeschooling - The Home School Legal Defense Association (HSLDA) recently sent out an e-lert on the subject of what to expect under an Obama administration. It states, "Despite HSLDA's efforts prior to the election to get an official statement from the Obama campaign regarding their position on homeschooling, we received no response." It goes on to mention the Democratic Party's support of the National Education Association (NEA) and public education in general, but asserts that the Federal government has no constitutional authority over home education. Of greater concern, perhaps, is the possibility that the United States under Obama will ratify the United Nations Convention on the Rights of the Child, a move which HSLDA opposes.

The blogger at Obama States of America has done quite a bit of research. Rational Jenn critiques the HSLDA position. And then there are Homeschoolers for Obama ("because there is no such thing as 'the homeschool vote'").

Vaccinations - Before the election, Autism activist Becky Estepp contacted the Obama and McCain campaigns regarding the candidates' positions on the issue of vaccine safety. The McCain campaign responded with a statement that "John McCain believes in the right for individuals and in the case of children, parents, to make informed health care decisions, and does not support pre-empting these prerogatives." Obama, however, responded only with a general letter about autism which did not address the issue of vaccine safety or parental choice. However, according to New Jersey mom Claudine Liss who asked Obama point-blank about his stance, Obama replied, "I am not for selective vaccination. I believe it will bring back deadly diseases, like polio." More details are available from Age of Autism (McCain Addresses Vaccine Safety, Obama Silent, McCain Senior Policy Advisor Responds To Autism Questionnaire, and McCain or Obama: Who Will Reform Vaccine Safety?); Inside Autism (The autism election and McCain supports vaccine choice) and the Oct. 23, 2008 press release.

While the issue of mandatory immunizations and exemptions are currently a matter of state law, the federal government does have a role to play in funding vaccine safety research, enacting legislation exempting vaccine manufacturers from tort liability, the availability of military exemptions, and so forth. In addition, there are Constitutional issues involved in religious exemptions (the Equal Protection clause) and the reach of state vaccination requirements, for example to private schools which do not receive government funding, which could be decided by presidentially-appointed federal judges.

For my part, just because we have elected a president who does not appear to share my views on issues that I am passionate about (namely, the right of citizens to make healthcare and educational decisions on behalf of themselves and their children without government interference) does not mean that The End is upon us. Of course, we must be eternaly vigilant in guarding our precious rights and liberties. Fortunately - in this case at least - government is a slow-moving beast, and I have come to the conclusion that one man cannot screw things up so bad that we cannot get it fixed four or even two years from now.

Baby, You're Home

The New York Times published a piece on homebirth this week ("Baby, You're Home") which is getting good reviews in my normal-birth circles, though it was inexplicably placed in the "Home & Garden" section of the paper. It seems that while homebirths are up all over the country, the biggest surge seems to be in New York, according to local midwives and sellers of birth tubs. according to the article, this may be due, in part, to the impact of last year's documentary The Business of Being Born, which was filmed in New York City. Actual statistics on this won't be available for several more years, though.

Doctors 'in denial' about safe home births

Australian doctors are "in denial"about safe home births, according to an article in the Australia and New Zealand Journal of Obstetrics and Gynaecology:

And in the absence of publicly funded homebirthing programs, women who cannot afford private midwives are increasingly opting for unassisted homebirths, says Lareen Newman, a researcher in the department of public health at Flinders in Adelaide... When obstetricians point out the real risks of this trend, women may believe they are ‘crying wolf’ because of their unfounded opposition to safe homebirths, she writes.

She calls on RANZCOG [the Royal Australian and New Zealand College of Obstetrics and Gynaecology] to acknowledge the evidence for homebirths and support public homebirth programs in its revised statement expected next month.

Good luck with that.

Midwives who Blog

Infomidwife discusses legal considerations for Australian midwife-bloggers in Cyber Talk and Midwives.

Farm-to-Consumer Legal Defense Fund

If you are interested in topics such as consumers' access to raw milk and other farm-fresh products, and the regulation of small farms in general, check out the Farm-to-Consumer Legal Defense Fund and related organizations, the Farm-to-Consumer Foundation and the Farm and Ranch Freedom Alliance.

Minimum Length of Hospital Stays

The Raising Women's Voices blog notes that new federal regulations take effect January 1, 2009 for group health plans and health issuers concerning minimum length of hospital stays for mothers and newborns following childbirth. The regulations can be found here: 73 FR 62410 (.pdf).

NaBloPoMo

I am, once again, making an attempt at National Blog Posting Month. As before, since I have three blogs, I intend to post to only one of the three every day:

The Mommy Blawg
The Baby Blawg
The Book Blawg

I may or may not mirror posts on the NaBloPoMo website; I have in the past but it is a bit time-consuming.

Happy Reformation Day

My husband found the Reformation Day Symposium, sort of a blog carnival of reformation day posts.

Midwifery and the Law

This week's Midwifery Today E-news is on the topic of Midwifery and the Law.

Guess what! I have an email address!

If you will kindly turn your attention to the right-hand sidebar, you will see the word "Email". Directly under that word is something that looks like this: mommyblawger AT gmail DOT com. It is, in fact, my email address. It is in a format which obscures it from the view of evil email address-gathering spambots. If you simply replace the word "AT" with the "@" sign and the word "DOT" with a period, and close up the empty spaces, you will have my email address. You can send me an email and I will get it. I might even write you back - eventually.

International "Talk Like a Pirate" Day

September 19th is International Talk Like a Pirate Day. Be sure to visit the official website.

And for my lawyer friends, check out the Pirate-themed Blawg Blarrgh Review #153 at Declarations and Exclusions.

Some news, and a break

Hello, faithful readers.

I'm going to be taking an extended blogging break - probably 4-6 weeks - and then I will be back with an announcement and a renewed commitment to my blogs. Until then, here are a couple headlines that have popped up recently:

An Arkansas court of appeals says that shackling prisoners during labor is not unconstitutional.

After a six-year absence, nurse-midwives are returning to Austin hospitals.

Midwife-signed birth certificates along the Texas-Mexico border questioned.

If you haven't heard, the AMA has joined ACOG in opposing homebirths. For more on this flap, check out these responses from ICAN, MANA (pdf), Citizens for Midwifery, and Ricki Lake, Jennifer Block & Abby Epstein on the HuffintonPost. Feel free to leave a link to your favorite blog post in the comments.

When Faith and Health Care Clash

When faith and health care clash for French Muslims:

The law in French state hospitals is clear. Women can request women doctors and probably get them most of the time. But if the attending doctor that night is a man, as happened in this case, the woman — and in this case, her husband — have to accept that. When this woman went into labour in November 1998, the couple rushed to a hospital in Bourg-en-Bresse and a midwife examined her. She recognised a complication and called the doctor, but the husband physically blocked him for half an hour because he did not want a strange man touching his wife. By the time he gave in, it was too late for a caeserian and the baby had to be delivered by foreceps. Little Mohammed is now 100% handicapped.

The father sued the hospital for €100,000 in damages and €10,000 in personal compensation. The court rejected this and blamed the father, saying: “The child’s state is totally attributable to the attitude of Mr. Radouane Ijjou.”

The court additionally fined the father for court costs.

Podcast: Jake Marcus on nursing in public and the law

The Motherwear Breastfeeding Blog has posted a podcast interview with attorney Jake Marcus on the subject of nursing in public and the law:

Jake discusses the different types of breastfeeding laws, what to do if you're harassed for nursing in public, and where to get information on the law in your state.

Also, don't miss her article on Lactation and the Law at Mothering.com.

Midwifery Legal News - Pennsylvania

The big news this week is that a Pennsylvania appeals court has overturned the State Board of Medicine's decision against Diane Goslin, who was charged with practicing medicine without a license and practicing midwifery without a license. In the decision, the Commonwealth Court of Pennsylvania made the crucial distinction between Midwifery and Nurse-midwifery:

Thus, section 1 of the 1929 Law regulates, by the issuance of certificates, persons who are not registered nurses with nurse-midwife licenses, but who make a practice of attending women in childbirth gratuitously or for hire.11

Given the different purposes of the two statutes, we conclude that the nurse-midwife charges against Goslin under the 1985 Act did not give Goslin adequate notice to defend against the midwife offenses described in the 1929 Law.12

11 We recognize that statutes in pari materia shall be construed together, if possible, as one statute. Section 1932(b) of the Statutory Construction Act of 1972, 1 Pa. C.S. §1932(b). However, the 1985 Act and the 1929 Law do not relate to the same class of persons. Although both relate to midwifery, the 1985 Act relates to the licensing of registered nurses as nurse-midwives and the 1929 Law relates to the granting of certificates to other persons who attend women in childbirth.

12 Moreover, we note that, although the Board concluded that Goslin violated section 1 of the 1929 Law by holding herself out to the public as a midwife, section 1 does not make such conduct unlawful. It is section 5 of the 1929 Law that prohibits a person from “advertising herself as a midwife” without a certificate or a license. 63 P.S. §175.

The ruling apparently means that Ms. Goslin will be able to resume attending births.

Links:
Text of the decision (pdf)
Story from the Philadelphia Inquirer
SaveHomebirth.com
Midwives Alliance of Pennsylvania
PA Pundits has commentary here and here.
Commentary and video from Independent Childbirth.

US Air Force Pays Record Settlement for Injured Baby

U.S. Air Force Pays Record Amount for Baby Injured in Government Hospital

What is the take-away here? That VBACs are dangerous? That VBACs shouldn't be augmented with Pitocin? Or something else?

Placenta Victory

Sunrise Hospital, threatened with a second lawsuit, reversed their policy to allow the release of healthy placentas to women upon request, reports The Placenta Blog.

Blawg Review #158

Welcome to Blawg Review #158! Today is International Midwives' Day (sometimes called "International Day of the Midwife"), when traditionally I remind my readers to call, write, or email their midwives and thank them. Accordingly, the theme of today's Blawg Review is "Midwives and the Law":

But the midwives feared God, and did not do as the king of Egypt commanded them, but saved the male children alive... Therefore God dealt well with the midwives, and the people multiplied and grew very mighty. And so it was, because the midwives feared God, that He provided households for them.
-Exodus 1: 17, 21 (NKJV)

For those of you who are wondering, "What's a Midwife? Are they still around?", I would invite you to visit the Wikipedia on the subject before reading any further. Also, for a look at modern, urban midwifery, rent or buy Ricki Lake's (yes, that Ricki Lake's) movie The Business of Being Born. By the way, Ms. Lake is scheduled to discuss her movie today on The View.

Why Does the World Need Midwives?, you may well ask. In most industrialized countries in the world, midwives attend 70% to 80% of all births and are the primary providers of maternity care. The U.S., where hospital- and home-based midwives attend less than 8% of all births (and despite spending the most per-capita on health care), ranks near the bottom of developed countries in terms of infant and maternal mortality rates.

A few quick definitions. There exists in the U.S. a class of midwives which is unique to this country, the Certified Nurse-Midwife (CNM). In every state, CNMs are licensed to practice with varying degrees of autonomy. CNMs have their own legal issues; however, they are not usually subject to being arrested, sued, or otherwise prosecuted merely for practicing midwifery, and I will not deal with those issues today.

Rather, when I use the term "midwife", I am referring to direct-entry midwives (DEMs); those who have completed a course of study and an apprenticeship in midwifery, but who are not also nurses; and who are licensed by the North American Registry of Midwives as Certified Professional Midwives (CPMs), and/or licensed under a particular state's regulatory requirements for direct-entry midwives (variously termed "Licensed Midwife", "Certified Midwife", and so forth). They are almost never hospital-based.

The term "lay midwife" is, increasingly, only used for uncertified or unlicensed midwives who are educated through informal routes. They may also be called "traditional birth attendants", "community midwives", "traditional midwives", etc.

Although planned homebirths with CPMs have been shown to be just as safe (with fewer complications) as hospital births, only 22 states specifically authorize the practice of direct-entry midwifery. Ten states prohibit the practice of midwifery outright (in Missouri it is a felony), while in the remaining states the status is a little less clear:

[M]any midwives have long operated under the assumption that states without a [Direct Entry Midwifery] statute are "alegal," a word that doesn't officially exist but has been understood to mean neither authorized nor forbidden by law, or "unregulated." But the problem with this concept, as more midwives are beginning to realize, is that the practice of midwifery - that is, the act of attending women in childbirth - is defined and regulated in all fifty states, through the medical and/or nursing practice acts, all of which contain broadly worded language that defines various acts associated with the practice of midwifery as either medicine or nursing.

-Katherine Prown, Ph.D., "Understanding the Legal Status of Direct-Entry Midwives: an Introduction" , From Calling to Courtroom

Currently, a midwife can be licensed & regulated in one state, but in a neighboring state with the exact same credentials she is subject to charges ranging from practicing medicine, nursing, or nurse-midwifery without a license, to manslaughter, child endangerment, and possession or use of controlled substances. Moreover, it is not always clear what the legal status of midwifery in a state is; some states, such as Pennsylvania, in which the practice of midwifery was long considered "legal", have suddenly begun to prosecute midwives. Many direct-entry midwives are under the mistaken impression that they are practicing legally, when they are in fact at risk.

And you thought that multijurisdictional practice of law issues were complicated.

I was going to include a list of midwifery-related legal resources, but it was getting a bit long, so I've published it as a separate post.

One more quote and then on to "This Week in the Blawgosphere":

We who live in the United States are fully aware how different our country is from most others when it comes to midwifery and the way the state looks at childbirth. If we try to list every variety of midwife that has come into existence during the last half-century, we have to write a very long sentence with lots of adjectives and commas. We lead the world in the number of criminal trials for the practice of midwifery or the practice of medicine, or even manslaughter or second-degree murder charges brought against unlicensed midwives. In this dubious sweepstakes, we have the company of our neighbor to the north, Canada, which got itself into a similar societal mess a century ago by neglecting to create a way for midwives to continue to exist by following the example of the rest of the industrialized world.

— Ina May Gaskin, "Unity: An Elusive but Necessary Goal for US Midwives and Their Advocates," Midwifery Today Issue 64.

Blogging and Blawging

Midwives tend to be a little (ok, a lot) less tech-savvy than, say, lawyers; although I've noticed the younger generation is changing that somewhat. On the sidebar of The Baby Blawg, you will find a list of "birth biz blogs", many of them written by midwives. There's some great stuff there. Besides me, the only blogs I can think of right now that write specifically about midwifery legal issues are Midwifery World, Jennifer Block (Pushed Birth), and possibly the Citizens for Midwifery blog.

Real Lawyers Have Blogs, but does your employer have a Law firm blog policy?

Bag and Baggage's Denise M. Howell discusses Blawgs In (Magazine) Space.

Nick Holmes of Binary Law explains what makes a good blawg; Anne Reed of Deliberations suggests that Alltop offers a great way to find them (Finding Good Blogs), and Scott Greenfield concurs, but thinks that

It also is going to give an odd impression to the person who doesn't know much about the blawgosphere, since there doesn't seem to be any particular rhyme or reason to why blawgs are listed in any particular order . . . . This page makes no distinction for the looker who doesn't know what he's looking at.

There seemed to be a great deal of discussion regarding the creation of law.alltop.com ("Blawgs Get Kawasakied"), including at Jim Calloway's Law Practice Tips Blog, Brett Trout's BlawgIT, and Sheryl Sisk Schelin's The Inspired Solo; but NY Personal Injury Lawyer Eric Turkewitz feels Personal Injury blogs were Dissed Again.


Coming and Going

Check out this new blog, The Legal Antiquarian. And say goodbye to Decision of the Day's Robert Loblaw who is calling it quits and hanging up his keyboard.


Social Media

John Phillips presents Young Teachers Gone Wild posted at The Word On Employment Law. And learn about Social Media's Impact on Health Care at Bob Coffield's Health Care Law Blog.

Would you turn down a job offer from a firm that did not allow you to access social networking sites such as Facebook or MySpace? No Facebook? No thanks!


Searches and Seizures

In another turn, [Midwife Marcia Kay McCulley] was arrested in March at her birthing center in front of two couples and their babies. A witness said about a half-dozen Medical Board officers came to the center, and one of them had his gun drawn.

"It seemed like the kind of conduct you would use on a drug house or on a dangerous criminal," said Jett Whitworth, who was in the waiting room with his wife and their 6-day-old girl.

- "Midwife disputes health allegations", Ventura County Star, May 12, 2007

From The Faculty Lounge, Dan Filler informs us Canada Supreme Court Nixes Suspicionless Dog Sniffs. And EFF's Jennifer Granick helps out with Protecting Yourself From Suspicionless Searches While Traveling.


Hiring a Lawyer

From Calling to Courtroom: A Survival Guide For Midwives has a wonderful chapter entitled Looking For a Lawyer (And Why You Should Do it Sooner, Not Later).

Austin Criminal Defense Lawyer Jamie Spencer presents Hiring a Jerk to be Your Lawyer. And watch out - Eliot Spitzer Enters Private Practice.

After my first son was born, and until about six months after my second was born, I practiced law from home, as did my husband for a time. Do you care if your lawyer has an office? Susan Cartier Liebel of Build a Solo Practice, LLC, writes When Going Home To Go To Work Benefits The Client.


Legal Drafting

Mark Liberman of Language Log parses Closer, my ex, of you; Ken Adams discusses "Survival" Provisions; and Conglomerate's Christine Hurt asks Who Wants in on the Nineteenth Edition of the Bluebook?


Trial Preparation

Tom O'Connor of Law Technology News claims Bates Stamps' Days May Be Numbered. Lean and Mean blogger Stewart Weltman makes easy work of taking expert depositions. South Carolina Trial Law Blog's guest blogger Brian Ford gives advice on Using Multi-Media at Trial.


Trials and Class Actions

Occasionally I will hear rumors of an effort by midwives and midwifery consumers to bring a class action suit against insurance companies for denying coverage of their services; or aginst someone (obstetricians?) for restraint of trade. The Class Action Blawg provides a most helpful Partial Glossary of Representative Actions and Terms.

Drug and Device Law has a long but worth-it post ("New Decisions Raise Old Issues") that refers to Bendectin which, as a three-time HG sufferer, I sure wish was still available.


Judges & Juries

Picking a Jury? Anne Reed writes "Your Honor, I Move To Strike Your Mother For Cause".

JD Hull opposes the elected judiciary at What About Paris? (a/k/a "What About Clients?")

Law Ingenue loved her Civil Procedure professor (Law Ingenue: Civil Procedure... Or Is It?) and so did I. In fact, Prof. Mayo not only blogs on health law, but writes poetry columns.

Speaking of poetry, and because no Blawg Review is complete without either Limerick or Haiku, recovering lawyer Madeleine Begun Kane (Mad Kane's Humor Blog) presents Ode To A Grudge-Holding Judge:

There once was a federal judge
Who was famous for holding a grudge.
But his clerk found a way
To get him to say,
“I forgive you.”
She bribed him with fudge.

Perhaps this Oklahoma judge needed some fudge as well - Publish or Perish: Lawyer Sanctioned With Order to Write Bar Journal Article by Alan Childressat at Legal Profession Blog:

She ordered the offending attorney "to submit to the Oklahoma Bar Journal for publication an article pertaining to civility and professionalism as they relate to adversary proceedings." He has six months to write it.

Consider yourself warned.


Family Law

Midwives' conferences often contain one session on family law basics. Usually these are conducted by other midwives; but sounds like a good marketing opportunity to me.

There was lots of blogging this week on the raid on the Texas FLDS compound. My major interest in the case was the allegation that nursing babies were being separated from their mothers.

Austin blogger Scott Henson (Grits for Breakfast) says More law blawggers need to weigh in on West Texas polygamy case. Robert J. Ambrogi talks about An Army of Lawyers in West Texas. Eugene Volokh had several posts concerning facets of the case arising from the raid on the FLDS' Texas compound. Audree Heath at World on the Web addresses Polygamy and religious rights. And J. Craig Williams (May It Please the Court) pens Who's On First? The Polygamous Mess In A Texas Courtroom.

Speaking of J. Craig Williams, my blogging about Placentophagy does not hold a candle to his Blood Sausage post.


Birth Certificates, Social Security, and Taxes. Oh My.

One issue that parents living in, and midwives practicing in, "illegal" states face is, how to file for a birth certificate. Should a midwife sign the birth certificate, or will this bring her to the attention of local authorities? And if she doesn't, what additional documentation must the parents provide in order to register the birth?

Without a birth certificate, you cannot get a social security card, a driver's license, or pretty much any job for which you are not paid in cash. Although I have known parents who delayed obtaining social security numbers for their children, without one you cannot claim them as dependents on your tax return (unless you are Amish, by the way. Hint, hint.). I recently filed an amended tax return because I neglected to include my most recent tax deduction child one year, and discovered that, while my children may be priceless to me, to the IRS they are worth $1000 per year. Each.

Why is My Rebate So Small? Tax Girl's got the lowdown on The Incredible Shrinking Tax Rebate. Nick Cowen asks Should Inheritance Tax Be Defended? (Civitas Blog), and Pundit Mom wants to see your I.D.


Women's Bodies, Women's Wisdom?

Having given birth to three babies, I sometimes think about having "a little work done". But then I realize that I am a mother, and my body looks like the body of a mother, and to try to look as if I have not had three babies would be an insult to mothers everywhere. Besides, how would I explain the surgery to my children without Encouraging Vanity and Misogyny? (Frank Pasquale of Concurring Opinions). And though I cringe to mention it, my body is not Just like open-source software! (Ann Bartow, Feminist Law Professors).

On that topic, among birth-related (non-legal) blogs, Birth Rape (see also More Than a Traumatic Birth) is being widely discussed. The legal implications are obvious - I have heard stories of women, even in my own community, who have been given unwanted (and unconsented-to) episiotomies, even while kicking and screaming "No!". Unfortunately, attorneys (prosecutors or plaintiff's) seem reluctant to pursue litigation. But I wish more lawyers would join this conversation. The situation is so bad that those in the birth biz are discussing, writing about, and conferencing on post-traumatic stress disorder. No wonder women are rejecting hospitals and doctors and birthing at home with midwives.


Green Things

This week I ran across Bamboo Diapers. I'm skeptical. David Yaussy at WV Environmental Law discusses Bamboo as Environmentally Sustainable Crop. And AgLawyer Susan Schneider reflects on Recent Perspectives on Meat Production.


Well, that's a wrap for Blawg Review #158! Thank you, everyone, for you submissions. A special award goes to Anne Reed of Deliberations as the "Most Suggested" blawger.

Blawg Review has information about next week's host, and instructions on how to get your blawg posts reviewed in upcoming issues.

Midwifery-related Legal Resources

This is something of a work-in-progress, so if you know of others, please email me or leave a comment.

From Calling To Courtroom: A Survival Guide for Midwives, an online book. Although some of the state-by-state resources are out of date, it remains the only legal guide of its kind.

Midwives Alliance of North America's list of state laws and chart.
Citizens for Midwifery's State by State Guide to Midwifery in the United States.

Articles:
CfM's Midwifery and the Constitution
What to Do When Your Midwife Has Been Charged by Katherine Prown, Ph.D.
Suzanne Hope Suarez, Midwifery is Not the Practice of Medicine, 5 Yale JL & Feminism 315 (Spring 1993).
Eric Jansson, In childbirth, the new makes way for the old.

For cases where the courts ruled that midwifery does not constitute the practice of medicine or nursing for purposes of statutes regulating the practice of medicine, see the NARM Position Paper on the Practice of Midwifery.

Websites:
Legal Aspects of Midwifery from Ronnie Falcao's Gentle Birth Archives.
Midwifery Related Law from Motherstuff.com
The Big Push for Midwives

Books:
Jennifer Block, Pushed: The Painful Truth About Childbirth and Modern Maternity Care (Chapters 6 & 7).
Raymond DeVries, Making Midwives Legal: Childbirth, Medicine, and the Law.

Blawg Reviews & Other Bloggy Goodness

Hello Faithful Readers!

Next week's Blawg Review will be hosted right here, by Yours Truly. Not coincidentally, May 5th is also International Midwives' Day, so of course the theme of Number 158 will be "Midwifery and the Law". But posts on a wide variety of legal topics will be included as well. If you would like to submit a post for consideration, instructions are available at Blawg Review.

This week's Blawg Review has been posted at Thoughts From a Management Lawyer, a Canadian labor & employment law blog. Also of note: Carnival of Moms in The Law is a monthly law-moms roundup hosted by Power of Attorney. Moms In Lawschool is a weekly carnival which rotates between PT-LawMom and A Little Fish in Law School. And the law-student author of the intriguing The Art of Manliness is starting The Manival, a blog carnival "for posts dedicated to man stuff."

Enjoy, and please come visit next Monday for Blawg Review!

Breastfeeding in Moscow

Muscovites, amid a baby boom and changing attitudes towards children, wrestle with public breastfeeding:

Sheer lack of an alternative may ultimately have an effect on general attitudes and official handling of the issue of breast-feeding in public.

Britain, for example, introduced anti-discrimination legislation mandating that mothers be allowed to breast-feed babies wherever they like. Under the law, restaurants, stores and other public establishments preventing women from breast-feeding would face fines of up to ?2,500, or $5,000.

An incident last year in London, in which an exhibit attendant at the National Gallery told a woman to either stop feeding her 11-month-old daughter or to take her to the museum's mother-and-baby room, focused attention on the issue in Britain.

Similar incidents in the United States at shopping malls, restaurants and other public places over the last two decades have prompted many states to prohibit bans on public breast-feeding.

There are also countries, including Italy, Israel and many in Africa where legislation has never become an issue because there is no cultural bias against the practice.

It would appear to be an issue in Moscow.

A highly random and even more unscientific survey of employee attitudes at Independent Media, which publishes The Moscow Times, provided insight into how Muscovites feel about the issue. Of the respondents, who were divided almost evenly between men and women, about 80 percent said they did not think that breast-feeding should be done in public unless in an emergency, and then only discreetly.

This is the same traditional Russian approach that led to the creation of special "mother and child" rooms in Soviet times that are still found in airports, railway stations and some metro stations.

Outside of the transport milieu, however, things are tougher.

Finding herself in the city center with a screaming baby and no plans to travel by plane or train, Charlotte Baring said she had no other option than to feed her infant son on the nearest park bench.

"I was terrified I would get shouted at by a babushka for subjecting my baby to the germs of a public place," said Baring, an interior designer from Britain. "Nobody actually said anything to me, but I definitely got a few stares and funny looks."

Having been on the receiving end of a scolding by a babushka once or twice in my life, I should say that "terrified" is an apt word to describe the feeling.

Midwifery in the News

In the news this week...

California - Midwife surrenders licenses to regulatory boards.

Florida - Linda McGlade and her daughter-in-law, Tanya McGlade, will get a new trial after being convicted in 2006 of practicing midwifery without a license, a third-degree felony:

Under the law, there are three components to midwifery: supervising labor and childbirth; advising as to the progress of the childbirth; and rendering prenatal and postpartal care. Also, there is no standard instruction for the crime of midwifery, according to the 4-page ruling written by Chief Judge Stevan Northcutt.

Judge Nicholas may have misled jurors to believe they could use only one of the three elements of the charge to determine if the McGlades were guilty, according to the higher court's ruling.

"In the absence of a standard jury instruction, the trial court clearly attempted to craft a proper instruction by employing the statutory language," Northcutt wrote in his opinion. "A defendant is entitled to have the jury correctly and intelligently instructed on the essential and material elements of the crime with which she is charged."

(Link)

The court "rejected the McGlades’ claim that they were entitled to a jury instruction on the defense they were engaged in the free exercise of religion" (Link). The full court opinion is available here (pdf).

Missouri - Midwife legislation still stalled in Senate; Fierce Debate Over Midwifery Licensure; Midwifery bill runs into issues in Senate.

Pennsylvania - Diane Goslin's case in the news. Midwives Alliance of Pennsylvania has more information.

Also check out Midwifery World's Legal Cases in the News.

Breastfeeding and FLDS Mothers

I'm taking a bit of a blogging break this week while we have houseguests, but I wanted to pop in and mention this new blog, FLDS Babies Have Right To Breastmilk:

I am saddened to say that many Texan breastfeeding mothers may be separated from their nursing infants immediately, if not already... While we may not agree or understand the circumstances, I think we need to fight for the right of the children to have the best care and nutrition, which includes breastmilk.

The blog also contains information on breastfeeding and family law/custody issues.

NaBloPoMo - March

Well, March is over, and with it the little experiment that was List Month. I did better this time - a total of 17 posts over 3 blogs.

See you next November, NaBloPoMo!

NY Hospital Bans Vaginal Births

Women's Health News reports today's alarming announcement:
Nation’s Largest Hospital to Ban Vaginal Birth, NY State Likely to Follow

Breastmilk as a Human Right

It's always interesting to read news articles from other countries. The perspective is just... different. Take this one from India, for example:

Can fashionable young women who do not breast feed be pulled up for violation of human rights of the child? Alleging that many young women influenced by television ads on bras are not breastfeeding to maintain their breasts, CPI(M) member in Lok Sabha Varkala Radhakrishnan on Wednesday said: "It (denial of breast milk) is human rights violation."

Maintaining that "breast milk is not just the only wholesome food, but also the child's right", Radhakrishnan said that "breastfeeding must be strictly enforced".

Link: Breast milk denial is human rights violation.

Childbirth Classes as a Tax-Deductible Expense

ABC News reports a list of Tax Deductions You Should Know About, including the fact that:

You can deduct a number of medical expenses as they pertain to the expansion, or even delay, of your family. Deductions include fees paid for childbirth preparation classes, certain fertility enhancement procedures, birth control pills and/or legal operations to prevent having children.

Wonder if Doula services would be permitted, too.

NaBloPoMo - Redux

You might recall that back in November, I signed on to National Blog Posting Month (NaBloPoMo). The idea is, you write at least one blog post each day for the entire month. In one sense, NaBloPoMo was a failure for me - I posted a total of 15 times on my 3 blogs before running out of steam. In another sense, however, I was very successful in getting out of my blogging slump and just getting stuff out there.

So, I was really interested to hear that NaBloPoMo is going monthly ("This is not the same as Blog365. Those [crazy -ed.] folks are blogging every day FOR A YEAR."). Each month they will have a theme, and this month's theme is: Lists. Now, anyone who knows me knows that I am a list-kind-of gal. I am totally about lists. I can do this. So to kick off the month, here's an easy one: Movies I Want to See.

• All the President's Men
• American Dreamz
• Analyze This/That
• Anchorman
• Anger Management
• Around the World in 80 Days (Disney 2004)
• Batman Begins
• Bourne Supremacy/Identity/Ultimatum
• Catch Me if You Can
• Cheaper by the Dozen (modern)
• Cinderella Man
• Devil Wears Prada
• Dodgeball
• Facing the Giants
• Groundhog Day: The Weight of Time
• Hamlet (Brannaugh)
• Hamlet (Gibson)
• Jurassic Park 2
• Legally Blond
• Legend of Zorro
• Little Miss Sunshine
• LOTR: Return of the King
• Love Actually
• Man of the Year
• Manchurian Candidate
• Master and Commander
• Matrix 1, 2, & 3
• Music & Lyrics
• National Treasure I & II
• Ocean's 12/13
• Office Space
• Pee Wee Herman's Big Adventure
• Pride & Prejudice (Kiera Knightly)
• Prince of Egypt
• The Prize Winner of Defiance, Ohio
• Rocky
• RV
• Serenity
• The Seige
• Surf's Up
  
• Three Musketeers (Mickey Mouse)
• Topsy-Turvy (1999)
  
• Two Weeks' Notice
• War of the Worlds (Cruise)
• What a Girl Wants
• Yentl

There ya' go. As a mom of 3, I don't see many current movies, and some of these I've seen and just want to see again.

Midwifery Legislative Updates

The Big Push For Midwives, launched on January 24, is a coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states and the District of Columbia. The website includes a page with links to news articles related to midwifery-related legislative efforts, and a map of states where licensure is available or where legislation is pending. Licensure is currently available to CPMs in 22 states.

Here's what's going on - at least, what's been in the news lately. Not a comprehensive list, but hopefully I'll get these updates out more often.

Alabama - SB240 and HB 314 establish a State Board of Midwifery. Link: Bill would allow home childbirth, a healthy option.

Idaho - HB 488 would provide for voluntary licensure for CPMs. Link: Idaho midwives want licensing option, ability to offer meds.

Maryland - HB 1407 would end the requirement that nurse-midwives practicing in Maryland have a written agreement with a doctor. Get the info from VBACFacts.com.

Missouri - Home birth supporters return with new midwifery measure:

Last year, lawmakers unwittingly approved a lay midwifery law after [Senator John] Loudon inserted an obscure medical term into a broader health insurance bill during the legislative session's frantic final days. The measure was signed by Gov. Matt Blunt but has since been overturned by a Cole County judge. An appeal to the state Supreme Court is pending.

Senate President Pro Tem Michael Gibbons responded to Loudon's tactics by removing him as chairman of the Small Business, Insurance and Industrial Relations Committee. He earned the job back by promising to push a bill repealing the law allowing those with private "tocological certification" to offer pregnancy-related care.

Tocology is a synonym for obstetrics, coming from the Greek root word of childbirth.

On Wednesday, the Senate Pension, Veterans' Affairs and General Laws Committee considered two Loudon bills - one to repeal the midwifery law, and the other to create a state licensing board to monitor midwives - but took no action.

The Missouri bills are HB 1600, SB 1021 and SB 870.

New Hampshire - The NH legislature has passed a bill, SB131, which requires insurance companies to cover midwife-attended home births in that state:

The bill builds on New Hampshire's long history of supporting alternatives to hospital birth. For more than 20 years, the state has permitted "lay midwives" who do not have medical or nursing degrees to practice in the state once they obtain proper training. Two years ago, it approved a measure that required health insurers to pay for deliveries in birthing centers run by midwives.

The newest bill does not change much other than the range of places where a woman can deliver her baby, but that choice is critical, many of the bill's advocates said.

"This gives women a real choice," said Rep. Jim Martin of Sanbornville, a Republican who was one of the bill's sponsors.

link: Backing at-home births.

North Carolina - Midwives seek state sanction:

Rep. Charles Thomas, R-Buncombe, submitted language to legislative bill drafters last year but never turned it into a bill. He said the supporters didn’t meet with doctors and trial lawyers seeking common ground, as he had encouraged.

So Rep. Ty Harrell, D-Wake, won legislative leaders’ agreement to form a commission to study the issue. The panel includes medical professionals as well as Thomas, Harrell and other lawmakers, and is co-chaired by Rep. Bobby England, a doctor and Democrat from Rutherford County.

After the panel’s first meeting, Thomas was skeptical of the proposal he called “an end run around medical school” but said a compromise might be reached if concerns about safety and liability are met.

Ohio - Legalizing Birth: Ohio criminalizes midwives wanting to help women deliver at home:

Ohio law only recognizes nurse midwives, who are registered nurses with a master's degree in midwifery, according to Stephanie Beck Borden, chair of Ohio Families for Safe Birth.

"In Ohio, nurse midwives are not independent practitioners" but rather have a "written collaborative agreement with an obstetrician to practice," she says.

But CPMs or direct-entry midwives like Helwig, who care for women giving birth in their homes, lack official approval.

"Direct-entry midwives are at risk of legal prosecution for practicing medicine," Beck Borden says. "In Ohio there is no protection, no regulatory body for direct-entry midwives. (They can be) prosecuted for practicing advanced-practice nursing without a license or practicing medicine without a license, which is a felony."

South Dakota - Senate Bill 34, which allows Certified Nurse-midwives to attend home births, passed both the House and the Senate by wide margins. House Bill 1155 which would license and regulate Certified Professional Midwives, is struggling. See also Home Birth Midwifery "Smoke Out".

Babies at Work

Time Magazine had a piece in January, Bringing Babies to Work. It reminded me of a website I stumbled across a while back, Babies in the Workplace (www.babiesatwork.org), which details the why-tos and how-tos of developing a truly family-friendly workplace.

The Latest from ACOG

The American College of Obstetricians and Gynecologists "reiterates its long-standing opposition to home births":

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby.

Anyone besides me think that this statement is a response to The Business of Being Born?

Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death.

Oh, that's nice. More and more doctors and hospitals won't "do" VBACs, but they're telling you not to do them at home either. I think most HBAC-ing women would rather have been in the hospital, if they thought they would actually have been successful there.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan.

Really??? Then don't ignore our birth plans when we make them. And put pressure on the hospital staff to respect them, as well. How come the L&D nurses think that birth plan = cesarean section? What's up with that?

The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.

But the two aren't mutually exclusive, the "process" and the "goal"! Don't you get it? A healthy process creates a healthy mom and a healthy baby. Disturbing the process adversely affects the outcome.

And I'm sorry, women who are so traumatized by their birth "experiences" that they will not set foot in a hospital again unless they are dying, are not "healthy". Women whose bodies are cut and then stitched back together are not "healthy". Babies who leave the hospital formula-fed when their mother had planned to breastfeed them are not "healthy". Healthy is not the absence of disease or medical condition. Healthy is body, mind, and spirit.

So ACOG, if you don't like out-of-hospital birth, start practicing evidenced-based medicine. Start trusting women's bodies to birth. Stop pretending that you know everything (anything?) about natural (normal, physiological) childbirth. Stop lying to women. Try listening to them instead.

Midwives & Malpractice Insurance

The Citizens for Midwifery blog discusses malpractice insurance for midwives:

When looking through this lens, it becomes clear that lawyers and insurance companies have more to gain from legislation mandating insurance policies for midwives than do birthing women and their families.

The impetus for CfM's post was an article by Judy Slome Cohain in the Winter 2007 issue of Midwifery Today entitled, "Mandatory Malpractice Insurance—Increases CS Rate & Profitability of Litigation, Decreases Planned Homebirths". I don't subscribe to MT, and the article isn't online yet, but the description in the table of contents is intriguing:

This frequent contributor argues convincingly that making malpractice insurance mandatory for midwives will lead to more profitable lawsuits and decrease the number of homebirth midwives to deliver babies, rather than improving birth outcomes or public health.