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.