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.

California Raw Milk Regulations

A new law regulating the amount of coliform bacteria allowed to be present in raw milk is angering some California consumers.

Huntington Beach Bans Nudity

Aren't there state regulations on this?

The [Huntington Beach] City Council unanimously voted to ban public nudity during its Monday meeting after a brief debate that resulted in striking portions of the proposed ordinance.

The council decided to limit the law to being nude where it is visible from a public area. They deleted regulations on a women breastfeeding an infant older than age 2, and restrictions on wearing a costume or device that simulated nudity.

The article goes on to say:

This type of ordinance is not new to cities in Orange County. More than half of the cities in the county have approved similar bans on public nudity, said [Police Chief Kenneth] Small.

Wonder what those ordinances say about breastfeeding?

Placentas, Protests, and Property Rights

Before Anne Swanson gave birth at Sunrise Hospital in Las Vegas, she requested that her placenta be saved so that she could take it home. At the time of discharge, however, the hospital refused to release the placenta to her. According to placenta activist Jodi Selander, "There are no laws in NV that state a hospital can not release a placenta, yet the hospital refused because it 'was not comfortable' doing so." (link)

Swanson is now waging a legal battle against Sunrise for possession of the placenta. The hospital normally keeps placentas in cold storage for three days, then disposes of them. According to Swanson, the hospital has informed her that it will not release the placenta without a court order, and will destroy it on May 15th. A pro-placenta rally was held on Monday, May 7, and supporters are planning a push for legislation, similar to that passed by Hawaii last year, which would require hospitals to release non-infectious placentas to patients on request. The Hawaiian statute states:

§321-30 Human placenta. Upon negative findings of infection or hazard after appropriate testing of the mother, the human placenta may be released by the hospital to the woman from whom it originated or to the woman's designee. The department shall establish a release form which shall stipulate appropriate measures for the safe release of human placenta.

That seems pretty simple and covers all the bases, doesn't it?

I know that stopping the spread of infectious disease is serious business, and proper disposal of hospital waste is an important part of that. We don't want needles and body parts thrown in dumpsters, where they might be discovered by dogs, rats, and homeless people. But look at it this way: Baby comes out of mommy's uterus - baby gets taken home. Placenta comes out of mommy's uterus - placenta gets thrown away. Placenta is infectious waste. Baby isn't. Huh? Yes, I know that the baby is a living, breathing human, and the placenta is an organ. But for some people, placental burial is an important religious or cultural ritual, and for others, it is about having control over one's body and retaining ownership of its products.

Now, to turn to the broader legal question: does a person have a property interest in his or her own cells, organs, or body parts? I'm not going to give this question the full treatment, but the leading case on this issue seems to be Moore v. Regents of University of California, 793 P.2d 479, 51 Cal.3d 120 (1990). In this case, university researchers used tissue taken from Moore's diseased spleen to create a cell line which they later patented. The Supreme Court of California held that Moore did not have property rights to or a financial interest in his cells (Wikipedia). Part of the Court's reasoning was that California statutory law restricts a patient's control over his or her medical waste, citing California Health and Safety Code section 7054.4:

[n]otwithstanding any other provision of law, recognizable anatomical parts, human tissues, anatomical human remains, or infectious waste following conclusion of scientific use shall be disposed of by interment, incineration, or any other method determined by the state department [of health services] to protect the public health and safety."

Of course, each state may come out a little differently on this issue (California Supreme Court decisions not being binding on the rest of us). And even if a person does have an ownership right to their body parts doesn't mean they necessarily have a possessory right to them. As we learn on the first day of property class in law school, property rights are like a bundle of sticks.

If you are finding this fascinating, you may want to read Ownership of Human Tissue: A Proposal for Federal Recognition of Human Research Participants' Property Rights in Their Biological Material, Wash. & Lee L. Rev. (Winter 2004). I didn't - it was too long and I dont' have the time. But I did get out my bluebook for that cite, which I'm hoping makes up for the fact that a cited to a Wiki a couple paragraphs ago.

Anyhow, hope that give you something to - er - chew on.

Links:
Diva/Mamma (the go-to blog for this case)
Placenta Benefits
Placenta befouled, mom told (Las Vegas Review-Journal)
Making pills from placentas (Las Vegas Review-Journal)
Action News 13 Las Vegas (video)

Midwifery Legal Update - Iowa, California

Certified Professional Midwife Melanie Moore of Iowa has been charged with violating Iowa Code Section 147.2, practicing medicine without a license, a class D felony. She has not been arrested, but a court appearance is scheduled for later this month.

Licensed Midwife and Nurse Practitioner Marcia McCulley of Simi Valley, California was arrested on March 14th at her office for practicing medicine without a license. According to eyewitness accounts, agents from the LA County Sheriff's office entered the premesis, where clients with babies were present, with guns drawn. Pursuant to a search warrant, patient charts were seized (anyone know the HIPPA ramifications?). Ms. McCulley seems to be in trouble with both the California state Nursing and Medical boards. You can read about it on the birth center's website.

Attorney-Client Sexual Relations

**Update 10/03/2006 - I have changed the title of this post, since upon further reflection I felt it could be misleading. **

It has been reported (actually, he announced it on Larry King Live) that the father of Anna Nicole Smith's baby is none other than her lawyer, Howard K. Stern. Which, if nothing else, explains why he was spending the night in the Nassau hospital room with Smith and was there when her son passed away. I mean, I spend lots of postpartum time with my lawyer, but I happen to be married to him. Otherwise, that's a little freaky, don't you think?

I know that the first thought all you lawyers had was "Sex with a client? What jurisdiction is he licensed in?". Yah, admit it, you're a law geek too. Stern is licensed in California, which frowns upon attorney-client relationships but does not prohibit them.

And (because it's hard for me to blog about anything that can't be related to childbirth, breastfeeding, or midwifery) I will point out that Dr. Cyril Wecht, the infamous coroner who performed a second, private autopsy on Daniel Smith, was also in charge of the investigation into the childbirth death of Issac Daley and subsequent prosecution of Judy Wilson. Small world, I know. In that case, Dr. Wecht has opined (outside his area of expertise, something he seems to do often) that "laboring women are unable to think rationally and thereby make decisions about their own care."

Placentas in the News (or: Everything You Ever Wanted To Know About Placentas But Were Afraid to Ask)

Item One: The Hawaii legislature has passed a measure allowing parents to take home their baby's placenta, a practice currently prohibited by state health rules. ("Hawaiian parents seek right for birth ritual")

Here's a question - what experience have any of you had requesting or receiving your placenta after a hospital birth? Please leave me a comment. I would also be interested to know what country, state, or metro area you live in. And what reason was given if the placenta was not released to you.

In California, you must have a license to transport medical waste, which makes things a little tricky for homebirth midwives (Placenta Disposal).

With my first birth, I merely requested in my birth plan to be shown the placenta, something which did not happen. (The Doctor or Midwife has to look it over anyway, they might as well do it in front of you.) With my second, a homebirth, I got to examine it but I did not choose to keep it, something I now regret. I think it got thrown out with the trash. Our third son's placenta is happily sitting in our freezer next to the ground beef and frozen chicken breasts. Some day we will plant something nice over it, like a tree or a rosemary bush. Then we will never be able to sell that house. Just kidding.

Once I blogged about a thief who stole food from a freezer - including a placenta.

The placenta was, after all, a baby's companion since, well not quite since conception, but close. It was the source of the baby's nutrition, oxygen, and so forth, and it deserves some respect. I'm not really a fan of lotus birth, but I can definitely see the attraction.

Item Two: Okay, this happened in February, but I had a one month old baby and didn't get around to blogging it:

From 1996 to 2003, hospitals throughout Oregon, Washington and California quietly collected the placentas of as many as 700 women who suffered difficult births. They sent the placental tissue to a Portland institute underwritten by the insurance industry. The institute, called Cascadia Placenta Registry, was separate from the hospital's own pathology labs; it existed in large part to help doctors sued for malpractice.

This marshaling of evidence often happened without patients' knowledge or direct consent. One of the patients, Angela Desbiens, didn't know her placenta had been squirreled away as evidence until after she sued Providence St. Vincent Medical Center for failing to prevent fetal distress.

In the process, Desbiens learned that Cascadia had sliced her placenta into chunks, making it harder for other pathologists to analyze. She also discovered that Cascadia used incorrect information about the birth, as well as genetic data from some other patient, to draw its unsurprising conclusion that the hospital wasn't to blame for her child's brain damage.

Hat tip to the American Journal of Bioethics Blog.

Item Three: Tom Cruise and the very, very pregnant Katie Holmes have been the subject of much birth gossip lately, but Tom doesn't do much to squelch those rumors, does he? He is reported to have told GQ Magazine he would eat the placenta ("Is it safe to eat a placenta?"), but later made it clear to Diane Sawyer that he wouldn't ("Cruise Downplays Placenta Plan").

Ok, let's answer that question. Placentas have a great deal of prostiglandins and oxytocin, and they can be used in an emergency to slow postpartum hemorrhage when eaten or placed in a woman's mouth between her cheek and gum. Personally, I think it would be much saner just to let midwives administer pitocin. Ya think?

Placentas also have, apparently, a large amount of iron and other nutrients, so if they are consumed, after either being cooked or freeze dried and placed into capsules, they supposedly help the woman gain back her strength after the birth (see Medicinal Uses of the Placenta). Ok, I am going to draw a line here. If you want to eat your own placenta, fine. Personally, I would have to be bleeding to death before I would do so, but that's just me. But please, don't eat anyone else's. That's just gross. And probably not safe, either.

Must we go here? Apparently we must:
Placentophagy from Wackipedia
Wikibooks Cookbook

Bill aims to limit inmate shackling

If I try to comment on this news item, I'll get really angry. So I'll just quote a little:

In California and across the country, female prisoners are routinely shackled for most of labor and immediately after childbirth -- a longstanding practice opposed by a growing number of legislators and even a spokesman for the conservative guards union. A bill introduced by Assemblywoman Sally Lieber that would ban the practice has moved from the Assembly into the Senate.
...
The practice of shackling laboring inmates is defended by the state Department of Corrections and Rehabilitation, although there is no known record of an escape or assault by a prisoner giving birth. All inmates, male and female, who leave state institutions for community hospitals are shackled and guarded by at least one armed correctional officer. That includes the 185 female prisoners on average who give birth each year in California.
...
In general, the women ride to and from the hospital in handcuffs. Inside, they can be shackled to a bed during early labor, a critical period when walking and changing positions assists the progress and comfort of delivery. Per department policy, after giving birth, they have one leg shackled to the bed for the duration of their stay.

Callahan, a first-time offender from Merced, said the shackles were more than emotionally traumatic -- they made her physical recovery more difficult. "You have to be stuck to a bed even though the doctors say you need to get up and walk because your stomach was cut open," she said. "They uncuffed me because a doctor and a nurse had given direct orders for me to walk around."

Between 1998 and 2004, California prisoners gave birth to 1,300 babies, the majority conceived before their mothers' sentencing. Most of those babies went home with relatives or into foster care.

Pregnant inmates get extra milk with meals and the services of a "doula" -- a trained labor coach who runs weekly childbirth preparation classes and provides bedside support during delivery.

According to prison officials, hospital doctors decide when a patient is in "active labor," and that is when restraints are removed. But that stage is ill-defined.

"Active labor means contractions that are regular, forceful and coordinated, and that can go on for 36 hours," said Corey Weinstein, a correctional medical consultant who serves on the board of the San Francisco-based California Prison Focus. Women interviewed by advocacy groups report being restrained until the pushing stage, the last part of active labor, a practice Weinstein described as "barbaric."

You've got to be kidding

Reuters is reporting that a California teacher was directed by his principal not to give students documents from American history which refer to God -- including the Declaration of Independence.

California Yankee lists the blogosphere's reaction to this event (and the enevibable ensuing litigation), and includes a link to the Alliance Defense Fund's pleadings (PDF file).

As has been pointed out many times before, the phrase "separation of church and state" is not found in the Constitution. And anyway, it's the separation of church and state, not the separation of God and state. I don't belive that a mere belief in "God" is the same as adhering to a particular organized religion. Nevermind that the founders were trying to protect the church from the state, not the other way around.

News Link: Declaration of Independence Banned at Calif School

BIRTH CONTROL

The California Supreme Court has ruled that a Catholic charity must provide insurance coverage for prescription contraceptives for its employees. The court noted that the charity, while affiliated with the Catholic Church, was a separate entity and therefore was not a "religious employer", which would have exempted it from state legislation mandating such coverage. Read the full article from Yahoo!/Reuters.