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.

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".

I'm so behind, I'll never catch up

Here are a couple things on the radar today:

The Australian parliament is debating whether breastfeeding legislators should be given a proxy vote - that is, to have their vote recorded while they are out of the chamber:

The issue of breastfeeding in Parliament made headlines in 2003 when Victorian Labor MP Kirstie Marshall was thrown out of State Parliament for breastfeeding.

Committee members said the debate had resurfaced in light of an increasing number of new mums in the House of Representatives in the past decade.

The committee found only 10 female MPs had given birth while in office - out of a total of about 130 female MPs.

"Women have faced the difficult choice between prioritising their duties as a member with those of being a mother," members said.

Pennsylvania's governor signed that state's breastfeeding legislation. Although breastfeeding advocates would have preferred a stronger bill, it's better than nothing.

A Missouri judge has issued a temporary restraining order blocking implementation of HB 818 which decriminalizes direct-entry midwifery. This bill has caused a lot of controversy. Apparently, it's a circus over there in the Missouri legislature:

A senator secretly attached the provision to a bill intended to make health insurance more accessible to some Missourians. Gov. Matt Blunt signed the bill into law.

Several physician groups sued last Thursday, claiming the midwife language violates the Missouri Constitution by going beyond the bill’s health insurance title and by changing the bill’s original purpose.

The recently passed legislation says that regardless of the current felony statute, anyone with a “tocological certification” — meaning in obstetrics — from a privately accredited group can provide services related to pregnancy.

The title of the bill that passed described it as “relating to health insurance.”

(link)

Alabama has voted down its midwifery bill. Try again next year?

Nancy Ver Steegh of The Family Law Prof Blog reports Problems at Center Where Mothers Serve Prison Terms With Young Children:

"The authorities in California are investigating accusations that poor health care at a center where mothers serve prison terms with their young children led to the stillbirth of a 7-month-old fetus and endangered the lives of several children.

Staff logs, statements by prisoners and interviews with investigators, staff members and prisoners’ families depict a facility where inmates and their children were denied hospital visits and medications, and where no one kept adequate records of accidents involving injuries that included a skull fracture and a broken collarbone."

Giving Birth With Confidence links childbirth issues to a recently-released government list of hospitals where heart patients are most likely to die in Out of the Dark: Transparency and Birth:

Transparency is suddenly a big deal. This government report follows on the heels of efforts in New York City, and communities across the country, to improve the level of transparency related to childbirth. Giving birth in the dark is an apt metaphor for the current state that women find themselves in when attempting to access information about maternity care. The recent NYC public advocates’ report identified that city hospitals although legally mandated to do so, are still failing to provide maternity information. Public Advocate Betsy Gotbaum is working tirelessly to insure that hospitals do what they are legally mandated to do…including reporting induction and cesarean rates.

Better get this posted before I get distracted by something else...

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 Miscellaneous

Former Vermont midwife Roberta Devers-Scott has a new attorney for her state Supreme Court appeal - civil rights lawyer Michael Sussman. (link)

The Guardian (which "Covers Prince Edward Island Like the Dew") reports on an effort to regulate midwivery in that part of Canada (link). Some choice quotes:

The Birth Options Research Network (BORN) was established in 2003 by a handful of women to explore birthing options for women in Prince Edward Island.
...
Kerstin Martin, president of the Canadian Association of Midwives, is helping to draft midwifery legislation for Nova Scotia. Currently, the Yukon and all Atlantic provinces are the only jurisdictions in Canada that don’t have regulated midwifery.
...
BORN is also keen to meet with policy makers, politicians and hospital administration to continue to express the concerns of birthing women in P.E.I.

Martin, who has tended to more than 1,000 births, said there needs to be a perception of a need for midwifery to gain support in the province.

“This group BORN is certainly going to do everything it can with that,’’ she said.

“I think they need to really listen to the women of this Island and the communities. What are the women’s experiences of maternity care as it is delivered right now and look at whether women themselves want something different.

“And, of course, women can’t ask for things that they don’t know about.’’

And sorry I haven't done a complete legislative roundup, but Missouri's bill to authorize/legislate direct-entry midwifery,HB 974, did not pass. (link).