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Columbia Missourian

UPDATE: Mo. Supreme Court upholds midwifery law

June 24, 2008 | 1:49 p.m. CDT

COLUMBIA — There was celebration Tuesday afternoon at a Columbia birth center after the Missouri Supreme Court upheld a 2007 state law that legalizes midwifery without fear of potential criminal charges.

"We're all still kind of like goofy around here," Ivy White, a certified midwife and executive director of the Columbia Birth Center, said in a mid-afternoon phone interview to a chorus of cheers and claps in the background. "Everybody's jumping up and down, screaming, and high-fiving."

A look at Missouri’s 2007 midwifery law

The Missouri Supreme Court reinstated a law Tuesday that allows certain trained midwives to work in the state. The law was passed in 2007 after Sen. John Loudon, R-Chesterfield, inserted some obscure wording into a bill. Here’s what the law says and what it appears to mean. THE LANGUAGE “Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 f-6(b) (4) (E) (ii) (I).” THE MEANING • “Notwithstanding any law to the contrary” is a routine way of saying this new provision supersedes existing laws on the topic. • “Tocology” is a synonym for obstetrics, coming from the Greek root word of childbirth. • NOCA is an organization that provides guidance to other organizations that provide professional certifications. • The lengthy U.S. government citation refers to “services related to pregnancy (including prenatal, delivery, and post partum services).” So the sentence could essentially say: Despite an existing law against midwifery, anyone who is certified in obstetrics can deliver babies.

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The cause for her jubilation was a 5-2 state Supreme Court decision earlier Tuesday to reinstate a 2007 law making certified midwifery legal without the presence of a physician. The issue has undergone more than 25 years of debate and met with opposition from groups such as the Missouri State Medical Association. A Cole County Circuit Court had ruled against the law, saying its passage in an unrelated health insurance bill was unconstitutional.

"We've had setback after setback, and it's finally nice to have something go in our favor," said Dr. Elizabeth Allemann, medical director of the Columbia Community Birth Center. Allemann has been involved with the midwifery issue since 1990 and was a defendant in the suit ruled on Tuesday by the Supreme Court.

White said the Columbia birthing center is home to two of the 10 certified professional midwives in Missouri and hopes to be able to provide more options for mothers-to-be should the decision withstand a 10-day period before becoming law.

"It's going to change many options for women in Central Missouri and throughout the state," Allemann said.

The restrictions on midwifery in Missouri limited the opportunities for women who wanted to give birth at home, Allemann said. Now, she said, the birth center will be able to provide more accessible prenatal care and expand the number and location of women it serves.

Plaintiffs in the suit are now considering their options, which include an opportunity for a re-hearing on the case.

"Well, we're obviously disappointed," said Tom Holloway, director of government relations at the Missouri State Medical Association.

In its decision, the court's majority said the Missouri State Medical Association and three other medical groups had no legal standing to sue in the first place.

The doctors groups claimed that allowing unlicensed midwives to practice medicine could put physicians who cooperate with them at risk of professional discipline. They cited existing state laws allowing the Board of Registration for the Healing Arts to discipline doctors who aid others in the unlicensed practice of medicine.

But the Supreme Court said that argument overlooks the fact that the 2007 law exempted certain privately certified midwives from the prohibition on practicing medicine, and thus freed physicians from potential discipline for aiding or encouraging them.

"This court holds, therefore, that plaintiffs cannot predicate standing (to sue) on the perceived risk that their physician members will be subject to discipline," Judge Stephen Limbaugh Jr. wrote for the majority.

In dissent, Judge William Ray Price Jr. said the physicians groups did have the legal standing to sue. He based that on their claim that the use of midwives would result in an increased need for emergency health care and thus affect both the physicians' medical practice and the health of their patients.

Price said he would have upheld the lower court ruling striking down the law.

The Associated Press contributed to this report.