Midwives law barred: violates Missouri Constitution, physician groups say

Tuesday, July 3, 2007 | 1:49 p.m. CDT; updated 6:11 p.m. CDT, Monday, July 21, 2008

JEFFERSON CITY — A judge temporarily barred a new law Tuesday that would let some lay midwives deliver babies in Missouri without the threat of criminal charges and prison sentences.

Cole County Circuit Judge Patricia Joyce issued a temporary restraining order against the midwives law, scheduled to take effect Aug. 28, and set a hearing to consider a preliminary injunction on Aug. 2.

Sen. John Loudon secretly attached the midwives provision to a bill intended to make health insurance more affordable and accessible to some Missourians. Gov. Matt Blunt signed the bill into law.

Several physician groups sued 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.

In court Tuesday, an attorney for the doctors’ groups argued that women and infants could be placed at risk by allowing the practice of midwifery by people who aren’t licensed by the state and may have no collegiate education in medical care. Attorney Harvey Tettlebaum also argued that doctors who cooperate with lay midwives could risk professional discipline by their state oversight board.

Midwives typically provide prenatal care and help deliver babies in mothers’ homes. Under existing Missouri law, midwifery is illegal unless done by physicians or certain specially trained nurses working under a physician’s supervision. A violation is punishable by up to seven years in prison.

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 lawsuit cites two constitutional provisions: one barring a bill from being amended to change its original purpose; the other barring a bill from containing more than one subject, which must be clearly expressed in its title.

The bill’s original title, when introduced in the House, described it as relating “to portability and accessibility of health insurance.” The title of the bill that passed described it as “relating to health insurance.”

The physicians’ lawsuit contends midwifery isn’t covered by either of those titles and wasn’t part of the bill’s original purpose.

But a state attorney defending the law said there was a legitimate connection between midwifery and health insurance.

“It’s reasonable for the legislature to conclude midwives will hold down medical costs, and thus increase the availability of health insurance,” Assistant Attorney General John McManus said.

Missouri is one of 10 states and the District of Columbia that prohibit “direct-entry midwives,” who enter the profession without medical or nursing degrees, according to Midwives Alliance of North America.

McManus cited that fact in arguing that the new Missouri law allowing lay midwives would pose no harm, especially not the immediate and irreparable harm he said was needed to justify a temporary restraining order.

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Ann Sterling July 3, 2007 | 10:22 p.m.

Midwives who hold CPM recognition are certified by an accredited body, and it is wrong to refer to them as 'lay' practitioners. They are trained and have earned that certification, and indeed do hold a national tocological certification.

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