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.

Indiana Mom Still in Pain

An Indiana teen who was given an incorrect dose of painkiller in her epidural is still in pain three months later:

During childbirth on Oct. 8, Methodist officials said, Baise received the wrong dose of an epidural painkiller. In one hour, she got a dose that was supposed to be given over 10 to 12 hours. Initially, it left her unable to walk and with severely limited leg movement.

Lawsuit? You bettcha:

Attorney Nathaniel Lee, who represents the family, is seeking damages. He submitted a complaint on Oct. 20 to the Indiana Department of Insurance against the anesthesiologist, Dr. Gloria Lee, and Clarian Health Partners. The doctor did not return calls, and her attorney, Daniel Fagan, declined to comment.

In Indiana, patients must first go through a complaint process and wait for a ruling from a physicians panel before filing a malpractice lawsuit.

Bill Stephan, senior vice president for corporate communications at Clarian, said in October, "We believe human error entered into the equation."

No kidding.

Midwifery Legal Update - Indiana

Indiana resident Doris White was permanently enjoined this week from practicing midwifery. White was indicted in November 2005 by a grand jury on a felony charge of practicing midwifery without a license.

Links:
Judge tells midwife to stop practice (Reporter-Times)
Midwife ordered to stop delivering babies (Indy Star)

Midwifery Legal Update - Florida & Indiana

In Florida this week, Linda McGlade and her daughter-in-law Tanya McGlade were sentenced to 2 1/2 years in prison after being found guilty of practicing midwifery without a license. The charges stem from the 2004 childbirth death of another daughter-in-law, Mara McGlade. The Florida case is a bit bizarre, because Florida licenses direct-entry midwives:

The defendants said they never claimed to be midwives, a profession regulated by the state. They said they merely attended an unassisted home birth, which is legal.

But Circuit Judge Edward Nicholas noted that they checked the heart rate of the fetus, delivered oxygen to the mother and examined the placenta.

(link:"Women sentenced for unlicensed midwifery")

In Indiana, Jennifer Williams, CPM, pled guilty on Wednesday to a charge of practicing midwifery without a license ("Ind. midwife pleads guilty in infant death"). As part of the plea deal, the charges of practicing medicine without a license were dropped. No charges were brought in connection with the death of the baby. Ms. Williams' case gained national notoriety after she was featured in a New York Times article ("Prosecution of Midwife Casts Light on Home Births"). In May, she brought suit against the Attorney General of Indiana, requesting that the state clarify the definition of midwifery. Indiana regulates nurse-midwifery, but has no statute regarding the practice of direct-entry midwifery.

From Ms. Williams' press release:

I am a Certified Professional Midwife which means that I am a fully trained and fully educated midwife and credentialed through the North American Registry of Midwives. There are two types of certified midwives in Indiana, and elsewhere in the United States - Certified Nurse Midwives and Certified Professional Midwives. In many other states across the country Certified Professional Midwives practice legally, with the sanction of the state. CPMs in these states are able to accept insurance and Medicaid reimbursement and interact fully with the medical establishment. Indiana chooses to prosecute these same CPMs with felony charges, instead of utilizing CPMs in the maternal child- health care system, which desperately needs support and re-enforcement.

Prosecuting CPMs is a short-sighted waste of money, time and effort. CPMs are not criminals or felons. They are well-trained professionals who practice with the highest of standards, who pass academic and clinical skills board exams, and undergo peer review and continuing education, just as any other health care professional does. Indiana should be incorporating these midwives into the health care system, rather than prosecuting them.

Midwifery supporters in Indiana have been trying for years to pass legislation legalizing and regulating direct-entry midwifery, but have been blocked by Sen. Patricia Miller, a nurse and the chair of the Senate Public Health Committee ("Desperate midwives: Sen. Miller continues to block legislation").

News links:
State questions legality of midwifery
Trying to boost at-home births
Midwives fight to practice in Indiana

Blogs:
Kemplog - Midwives vs. State and Midwife Takes Plea
**Updated 6/17/06 to add: Legal Status of Unlicensed Midwives in Indiana
Belly Tales - Homebirth Prosecution
Chai There - Calling my elected official
5 Dollars - Midwife charged in Edinburgh case