Missouri midwives speak out against pending state regulations

Wednesday, February 16, 2011 | 9:36 p.m. CST; updated 10:04 p.m. CST, Wednesday, February 16, 2011

COLUMBIA — Midwifery by anyone other than a licensed nurse was decriminalized in Missouri four years ago. Now, many Missouri midwives fear that if a bill currently in the state House becomes law, they could be "regulated into oblivion."

"Some of the things in that proposed bill are so restrictive and tighten things so much that it would make it impossible for us to even practice," said Ivy White, a Columbia-based midwife who, along with her two partners, has delivered approximately 30 mid-Missouri babies in their mothers' homes over the past year.

There are two types of midwives currently operating in Missouri: Certified Nurse Midwives, nurses with additional training in midwifery who work in tandem with practicing physicians, and Certified Professional Midwives, or so-called "lay" midwives, who attend midwifery schools and are certified and regulated by one of two nationally-recognized organizations.

The most popular of the organizations among Missouri midwives, the North American Registry of Midwives, requires that before certification they assist in at least 20 births, do a minimum of 75 prenatal exams and take an eight-hour written exam, among other requirements. The process can take as little as three and as many as seven years to complete.

However, Rep. Mike Talboy, D-Jackson County, said the state ought to have its own system for tracking and regulating the practice. His proposal, House Bill 301, would create a committee for that purpose. It would also require that all practicing midwives carry malpractice insurance and enter into "collaborative agreements" with licensed physicians at nearby hospitals. The agreements would include emergency transportation plans and establish a relationship between a doctor, a midwife and a soon-to-be mother before her first contraction.

A Wednesday hearing on the proposed legislation drew a standing room only crowd, filled with medical professionals, midwives, lobbyists and mothers, many of whom agreed that a state licensing mechanism would be a good thing for Missouri mothers and their babies. The rest of the restrictions, however, drew mixed reviews.

Several midwives in attendance argued against the financial burdens the proposed law would place on them. Malpractice insurance can run about $10,000 a year and the proposed state licenses would be another $1,000, making compliance a costly endeavor. Most midwives charge somewhere between $1,000 and $5,000 per birth, including prenatal and postpartum counseling and exams.

In comparison, paying out-of-pocket for hospital births typically runs upward of $8,000.

Rep. Mike McGhee, R-Lafayette County, testified against the bill on Wednesday. McGhee has many Mennonite and Amish communities in his district, he said, and charged that the bill, as proposed, would make many of them into criminals. "Don't they live in America, too?" he asked the committee. "If they want to give birth at home, don't they have the right to do that?"

Some legislators proposed inserting a religious exemption into the bill, but supporters of the midwives, including Judy Pierce of Patton, said women of all religious beliefs deserve to have access to their services.

Jeff Howell, a lobbyist with the Missouri State Medical Association who helped write the bill, likened the current system to "invit(ing) your neighbor over to help you deliver your baby." The medical association was party to a lawsuit aimed at preventing the legalization of midwifery shortly after the passage of the 2007 law.

Poppy Daniels, a doctor who testified in opposition to the bill, said the lawsuit was just one manifestation of an ongoing antagonistic attitude that characterizes many physicians' attitudes toward midwives. That attitude, she said, already makes it very difficult for midwives to gain the support of practicing doctors and would make the provision requiring a collaborative agreement nearly impossible to comply with.

"If we worked together, it would benefit the state and it would benefit women," Daniels said.

The Professional Registration and Licensing Committee could vote to move the bill to the House floor as soon as next week.

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Brandon Stuerke February 16, 2011 | 10:50 p.m.

My wife and I had our first daughter this past August, delivered in our home by the midwives at New Village Midwives. As a husband and now father I have to say I couldn't have asked for a better experience. My wife and I wouldn't trade our home birth experience as a family for anything and for those who would say that it may put mother or child at risk, don't you think a woman that is willing to go thru a home birth is the kind that probably does more homework on what's best for her and her child's health than most. I believe this would just be more government interference which I think most of us agree we DONT need. Besides has anyone proposing this bill ever interviewed those who have been thru a home birth or even know at all what takes place? To assume a traditional M.D. is the best option is to made a decision based on cultural bias without any real knowledge on the subject. I was also surprised that at times we were told by the midwives that if we were at any point deemed to be a "high risk" pregnancy they would refer us to a doctor and would not allow us to have a home birth. Anyway, from personal experience leave the midwives alone. Leave it to the people to make the choice, don't over regulate to the point that you cause upper middle class families like ours that are plenty educated on our choices for healthcare, to not have the choice.

(Report Comment)
Tracy Greever-Rice February 16, 2011 | 10:57 p.m.

Jeff Howell, a lobbyist with the Missouri State Medical Association, is both wholly inaccurate and wholly hateful.

His statement "invit(ing) your neighbor over to help you deliver your baby." in describing home births is quite telling of the attitude his organization holds of women. What thinking healthy woman carrying a healthy baby would choose to enrich doctors that believe them to be idiots?

Shame on the Missouri State Medical Association for its greed and condescension in second guessing the decision-making capacity of Missouri's mothers.

(Report Comment)
Ida Fogle February 17, 2011 | 7:34 a.m.

I'd like to add that not only midwives, but also a couple of physicians testified against the bill and in favor of midwifery care. Also, I believe Certified Professional Midwives - who have years of training, and have passed rigorous exams and other requirements to become certified - do not refer to themselves as lay midwives. This term is thrown about quite a lot by lobbyists in an effort to make the midwives seem unprofessional.

I had both of my children at home with a midwife several years ago. I was able to eat as I needed to keep my strength up, move about as I needed to minimize discomfort and keep labor moving, was monitored but in an unobtrusive way. And I did not risk being in a car wreck on the way to giving birth nor having unnecessary interventions which so often lead to complications.

Look at the on-line Yellow Pages for Portland, Oregon. Scads of ads for midwives, and it's been that way for years. Don't Missouri mothers deserve as much as Oregon mothers?

(Report Comment)
Derrick Fogle February 17, 2011 | 9:02 a.m.

Midwifery was finally "legalized" in Missouri 4 years ago now. Since then, we've heard of, what? One sensational case?

Don't we hold up Texas as a "darling" of low taxes and minimal regulation? They have some of the least restrictive midwifery laws in the nation. And, I might add, they have pretty darned good birth outcomes too. If Midwifery were anything less than as safe as hospital birth, you'd see statistically worse outcomes in states like Texas and Oregon. Fact is, states that allow midwifery have as good, or better birth outcomes, as states like Missouri that are burdened by control freak legislators and excessive government regulations.

Midwifery is a very safe, and very cost effective, way to deliver health services to pregnant women and birthing mothers. It's an incredibly wonderful experience, too. I've been there and done that. I know.

I might agree that there could be a little more regulation of Midwifery, but... not much more. I'd much rather see the laws stay the way they are, than see Missouri go back to overly restrictive midwifery laws.

This "collaboration" requirement is exactly why Midwifery practice used to totally suck in Missouri. It's exactly the same principle as having to "collaborate" with McDonalds, Burger King, and Wendy's before you can open up your own burger stand. Furthermore, the medical community tends to be a hateful and vindictive bunch that will ostracize the doctors that are willing to collaborate, and hospitals will revoke those doctor's privileges. Thus, it's almost impossible to set up a practice within such overly restrictive regulations.

Requiring certification or licensing for midwives is one thing, and I think that's OK. But that's as far as it needs to go. Allowing the medical-industrial complex, which has a vested business (but not moral or safety) interest against the practice of midwifery, to have so much control over the practice, is another thing. It's just plain wrong.

(Report Comment)
Paul Churnock February 17, 2011 | 3:25 p.m.

Is there something derogatory in a process that "can take as little as three and as many as seven years to complete." Engineers and Architects take the same amount of time to 'complete their process'. Yet we instill trust in their abilities every day to construct buildings and ensure the safety and well being of their occupants. Should they as well be regulated by doctors to ensure they are competent in their abilities, and suited to perform those abilities as well?

The issue at hand is not the need for regulation, board review, and state licensing, but rather the appropriateness of the legislation providing that oversight. If Mr. Howell and the Missouri State Medical Association want to ensure that oversight by doctors, are they willing to also allow that same oversight of themselves include midwives? Should they then not also provide that oversight on the State Nursing Board to ensure their abilities?

What Ms. Pupovac also leaves out is the requirement that a CPM has served as a primary under the supervision of a licensed midwife for a number of births before they can obtain their certification. As Ms. Fogle notes, referring to these individuals as 'lay midwives' is inappropriate and actually misleading. In the same breath then, Mr. Howell's organization should be the State Lay-Medical Association, and Sen. Talboy should be a lay-Senator.

Don't tarnish the reputation of those that are seeking to provide safe alternatives for parents and soon-to-be parents through your hasty research and ill-fed information, there are plenty already trying to do that, and they were in full effect yesterday in the Capitol.

(Report Comment)
Michael Williams February 17, 2011 | 3:35 p.m.

ok, derrick and ida.

You both posted under pseudonyms on the Trib forum.

Inquiring minds wanna know if you ever had a newspaper food fight under pseudonyms.


(The visual image is funny. h4 posts on a topic and wifey doesn't agree so they change seats in front of the same computer and she posts and makes him mad so she gets up and he posts which makes her mad so he gets up and eventually they play musical chairs and the one left standing is outa luck, and h4 goes without dinner and sleeps on tha couch, and so on. h4...I'm trying to remember who you had the most arguments with, lol.)

(Report Comment)
Derrick Fogle February 17, 2011 | 4:00 p.m.

LOL, it didn't happen *quite* like that, but I'll leave the true details to the imagination, since you seem to be having so much fun with that ;-)

(Report Comment)
Michael Williams February 17, 2011 | 4:14 p.m.

Derrick says, " didn't happen *quite* like that..."

which is, of course, not a "denial".

We haven't heard from Mrs h4 yet. She may have a different and more accurate perspective...which is the side of things we males rightfully, and usually, end up on.

Yeah, I did have fun with the visual.

(She prolly hid yer hackysack if there's any justice in the world.)

(Report Comment)
Derrick Fogle February 17, 2011 | 4:20 p.m.

She's definitely not hiding my hacky sack today:

'Nuff Said.

(Report Comment)
Paul Allaire February 18, 2011 | 12:58 p.m.

I'm glad the legislature is working on this large severe problem. We will celebrate the creation of COUNTLESS jobs once their process is complete.

(Report Comment)
David Redfern February 22, 2011 | 5:40 p.m.

Ironic in that 4 short years ago the midwives were pushing a regulation bill authored by then Rep. Davis.

Do the Amish need CPMs to do what they have been doing for years? I don't buy that argument.

The CPMs don't have the uniformity of education that should be required. There is no way, without a formal structured program (like a MEAC accredited midwifery school) that apprentice CPMs can get a unified education. The CPM sponsors acknowledge that.

Don't babies harmed by midwives deserve the same legal options that babies harmed by doctors get (malpractice insurance)? Especially when the planned homebirth neonatal death rate is 2-3 times that of planned hospital births?

How would putting a hospital and physician on notice that they might be needed in an emergency harmful to patients seeing CPMs?

(Report Comment)
Amy White February 24, 2011 | 2:17 p.m.

My husband & I delivered our first baby (she is our only baby) at home. I went into labor on Thursday around noon I had my first contraction, and she was delivered Saturday at about 8 a.m. She was delivered in the water, and was perfectly healthy at birth. She is now 9 months old and still perfectly healthy.
The experience alone was only one of the upsides to having a midwife. I also used an OB (who was not happy about my delivering at home, but agreed that my pregnancy was fine and healthy) and the care was completely different. I was one day short of being two weeks "over-due" with my daughter, and instead of being induced and taking the chance of putting her in danger, she was born in her own timing. She was 8lbs 11ounces, and I did not have an episiotomy or tear at all. The cost is immensely cheaper as well. In my opinion, this should not even be an issue at all & the state should stay out of it because it is women's/parent's choice, not the state's.

(Report Comment)

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