Midwifery Legislative Update

A lot going on. Let's get right to it.

Federal (US) - The Midwifery Care Access and Reimbursement Equity Act of 2007 (HR 864/S.507) would "amend title XVIII of the Social Security Act to provide for reimbursement of certified midwife services and to provide for more equitable reimbursement rates for certified nurse-midwife services."

Illinois - SB 385 would provide for the licensure of direct-entry midwives. I'm not hearing a lot of buzz about this one.

Indiana - A Midwifery Licensure Bill, HB 1238, is scheduled to be heard by the Committee on Public Health on Monday morning. Quick! Contact your legislator!

Missouri - SB 303 and HB 503 provide for the licensure of direct-entry midwifery. The bill defines "direct-entry midwife" as one licensed as a Certified Professional Midwife by NARM. Currently, the unlicensed practice of midwifery in Missouri is a felony.

North Dakota - SB 2377 was originally a bill making it a Class B Misdemeanor for a person to provide obstetrical services without a license; however it now appears to be a bill providing for a legislative council study "of the provision of obstetrical services by laypeople."

South Dakota - HB 1207, the bill to regulate direct-entry midwifery seems to be dead. HB 1267 would remove the requirement that Certified Nurse-Midwives have a written collaborative arrangement with a physician, which would in effect allow CNMs to attend homebirths.

Utah - SB 243 would amend Utah's Direct-Entry Midwife Act by defining what constitutes a “normal” pregnancy, labor and delivery; and clarify when consultation or transfer is required. Opponents of the bill say that the language is too restrictive, and would effectively end homebirth in the state for all but a handful of women. The Mommy Blawger thinks that legislators, the vast majority of whom have neither given birth nor delivered a baby, are not qualified to define "normal" birth by any stretch of the imagination.

Know of any legislation that I've missed? Shoot me a comment or an email.

Midwifery Legislative Update

Birth and Breastfeeding News reports that efforts are underway in Alabama, North Carolina, Idaho, South Dakota, Illinois, Kentucky, Georgia, Missouri, and Indiana to legalize/regulate the practice of direct-entry midwifery:

Legalization and licensure of CPM practices in all these states would represent a massive legislative victory for advocates of traditional home birth.

It would also be a startling rebuke to the many physicians who have long maintained that such practices are unsafe, despite growing statistical evidence that suggests CPM-supervised home births are as safe – sometimes safer – than hospital births.

Well-organized opposition within medical lobbying groups makes such a one-sided result unlikely within the next two years, Ms. [Ida] Darragh says. But, when asked if the flurry of activity in the nation’s statehouses is indicative of a national trend in support traditional childbirth methods, she adds: "We certainly hope so."

As with many health issues, the debate about CPMs may seem arcane to non-experts. The debate is a minefield of acronyms, and home births account for just 1 to 3 percent of all births in an average year, with similar percentages in each state.

Yet the debate casts in sharp relief a philosophical tug-of-war over the nature of childbirth that powerfully affects how expectant mothers approach the ordeal of birth.

ACOG, a "well-funded proponent of childbirth in the hospital setting, opposed the Wisconsin reform, publishing a position paper stating that CPM-supervised home birth 'cannot be considered safe'", despite numerous studies to the contrary. However,

Asked to provide any statistical evidence contradicting such studies, for the sake of this story, ACOG sent none but e-mailed two policy statements further explaining the organization's position on the certification of midwives.

Miscellaneous Items

The Chicago Tribune reports that Illinois has passed a law automatically exempting breastfeeding moms from jury duty. In most states, persons who are the primary caregivers for young children are exempt from jury duty anyway, but this law comes into play in the situation, for example, where a mom works full-time and pumps.
8/5/05 ETA: Don't miss the discussion over on PrawfsBlawg

Speaking of which, this is World Breastfeeding Week. Information on WBW from La Leche League, ProMom, and World Alliance for Breastfeeding Action.

Tom Mayo of the HealthLawProfs blog has some interesting comments on the Susan Torres case.