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.