Calls for Support of Birth-Related Legislation at State and Federal Levels

By Rachel Walden — February 26, 2010

A bill has passed in the Mississippi House that could effectively make  midwives who are not also trained as nurses illegal in the state. The bill states that “the practice of midwifery shall only be conducted by Certified Nurse Midwives; to provide that any person who is not a Certified Nurse Midwife who engages in the practice of midwifery shall be subject to criminal penalties and injunctive relief.”

The bill would make it illegal for Certified Professional Midwives — midwives who who are specially trained to deliver babies in out-of-hospital settings– to practice.

Right now, the Midwives Alliance of North America (MANA) categorizes the current situation in Mississippi for non-nurse midwives as “Legal by Judicial Interpretation or Statutory Inference” – in other words, interpreted to be legal but not explicitly provided for in the current law.

The organization provides some documentation from the previous MS Attorney General who concluded in 1991 that, “By its express terms, the practice of medicine as defined in Miss. Code Ann. Section 73-25-33 specifically excludes the practice of midwifery. Thus, it is the opinion of this office that those persons otherwise not licensed as nurses may engage in the practice of midwifery without licensure as a physician and for compensation.”

The current bill, which would add language to explicitly make non-CNM midwives illegal, passed the state House on February 9th and has been referred to Public Health and Welfare committee in the state Senate, whose members bill opponents are contacting. That committee consists of: Hob Bryan, Chairman; Alan Nunnelee, Vice-Chairman; Terry C. Burton; Eugene S. Clarke;Bob M. Dearing; Joey Fillingane; Hillman Terome Frazier; Billy Hewes; W. Briggs Hopson III; John Horhn; Cindy Hyde-Smith; Gary Jackson; Kenneth Wayne Jones; Tom King; Chris McDaniel; Nolan Mettetal; Willie Simmons; Bennie L. Turner; Lee Yancey. Contact information for each Senator is linked from this Senate roster.

MANA is encouraging supporters of Certified Professional Midwives who live in Mississippi to contact their state Senators. Tell them that you do NOT support making Certified Professional Midwives illegal, and ask them to vote NO on HB 695.

In other birth-related legislative news, the American Association of Birth Centers is asking supporters to contact their Senators and Representatives to support the Medicaid Birth Center Reimbursement Act (H.R. 2358 / S. 1423). For further information, see our previous post.

12 responses to “Calls for Support of Birth-Related Legislation at State and Federal Levels”

  1. “Certified Professional Midwives — midwives who who are specially trained to deliver babies in out-of-hospital settings”

    CPMs are not specially trained to deliver babies in out of hospital settings. They are grossly undereducated and undertrained and therefore are not allowed in hospitals: their only choice is to “practice” at home.

    CPMs are a second inferior class of midwife. They have less education and training than ANY midwives in the industrialized world. They lack the education and training to qualify for licensure in ANY first world country, even those like the Netherlands where homebirths are far more common.

    All the existing scientific evidence shows that homebirth with an American CPM nearly TRIPLES the rate of neonatal death. Mississippi should keep the experience of Colorado in mind. LICENSED homebirth midwives in Colorado have an appallingly high rate of perinatal death. Even though they care for only low risk patients, their perinatal death rate exceeds the death rate for all patients, a group including high risk patients and premature babies!

    The trade organization for homebirth midwives, MANA, has been collecting safety statistics since 2001. They have publicly announced the availability of these statistics but only to people who can prove in advance that they will use them for the benefit of midwifery (not patients). It doesn’t take a rocket scientist to suspect that MANA’s own data shows that homebirth with a CPM increases the risk of neonatal death, and that they are trying to hide this information from American women.

    Rachel, why don’t you contact MANA and ask them for their neonatal death statistics? Maybe you can get them and share them with American women who deserve to know the truth.

  2. Amy, perhaps more to the point is that CPMs have experience in attending home births (whether or not you consider their training to do so “specially trained”), and are generally the only provider-of-any-sort option for women who choose to give birth at home. I’m aware that midwifery training and standards vary – I’d be interested in what you would propose as educational standards for home birth providers, given that home birth itself will continue to happen and not be made illegal, and assuming that CNMs/MDs aren’t going to be offering in-home support to women who make that choice. I’m under the impression that you don’t think home birth should happen at all with any type of provider with any level of clinical and practical education, but perhaps that is a mistaken assessment.

  3. I think we could both agree that safety statistics are crucial for making an informed decision. So how can any woman make an informed decision if MANA refuses to let the public see their safety statistics? These statistics exist and it would be a tremendous public service if you could obtain them and share them with women.

  4. I also would love to see a comparison of educational requirements of CPMs and other homebirth midwives worldwide. I chose not to have a homebirth because I considered the local direct entry midwives to be insufficiently trained and educated to handle emergencies. There will likely always be women who wish to have a homebirth ( including the large Amish communities here in Ohio), and they deserve to have attendants who are educated and equipped for the best possible outcome within the limits of that setting.

  5. My reading of the scientific literature supports home birth attended by Certified Professional midwives for healthy women expecting healthy babies. A recent study in Canada (where Certified Professional Midwives attend births at home and in hospitals) indicates that women and babies actually do BETTER at home than in the hospital. The World Health Organization, and the American Public Health Association agree. I am a family physician in private practice who has had the honor of working with Certified Nurse Midwives and Certified Professional Midwives in birth centers and at home. Midwives are well-trained, capable, and professional. I wish more of my physician colleagues would stop the silly turf battles and be willing to work with a learn from midwives as physicians do in Canada and Great Britain. I have learned so much from my work with midwives. Women in the United States deserve only the best. We need physicians and midwives who are willing and able to work together and learn from each other.

    In my state of Missouri, we have recently allowed the legal practice of Certified Professional Midwives. I can tell you that a system where CPM’s are legal is much better for women and babies than a situation where CPM’s are considered to be breaking the law.

  6. A better solution for most states is to make legal that CNM attend home births.

    In New York the CNM attends home births, and they have backup physicians in hospitals if needed and the the ability to create hospital privileges for emergencies. As well the CNM is well trained clinically to attend low risk births, and carries oxygen and medication to stop hemorrhages.

    From responses I’ve read by Amy elsewhere, she trolls the web looking to comment aganist homebirth, she is clearly aganist any birth that is not directed by a MD in a hospital.

  7. Some quick fact checking is in order here:

    In NY there is legislation being considered (I use that term loosely) that would stop physician agreements with CNMs. I hope it does not go through. When I looked on behalf of a friend for an HB midwife in Manhattan- I found the physician’s agreement is mostly “wallpaper” so- I hope that legislation never passes. The bottom line- consumers would be unprotected.

    Anyone, and I do mean anyone, can join MANA- so although one may not share the data at least one can have access to it. Most professional trade organizations represent the interest of their members. One cannot join ACOG unless licensed and their more salacious pages under professional iability are impossible for the lay person to access so it goes both ways. BTW if it did not put $$ in MANA’s pocket- I would join under the names of women from the local graveyard just to prove a point. Not everyone should be allowed to call themselves a midwife.

    IMO, consistent legislation coupled with rigorous educational standards, a bachelor’s in midwifery, plus what equals a master’s degree in training for “low risk” birth attendance, plus a lengthy internship based on hours and years not number of births and all midwives required to carry malpractice insurance is the only way to go. Without it consumers again- are on the chopping block. I know it sounds like heresy- to some but this is akin to the Canadian model- so if we are going to try to point at their success then we need to follow their model.

    Lastly, I see the criticism of HB data all the time but I honestly feel like we have forgotten the obvious- in states where home birth midwifery remains- illegal – or “underground”- there is aboslutely no way to track and keep real stats. I feel like we cannot say that home birth in undoubetly safe- or unsafe- because there are no real accurate, current and relevant stats. in all the states. By the time we can get access to data it is almost past its shelf life. If we really want to find out about outcomes we would insist that a system be in place to collect this data.

    I think we need to put the focus on the safety of women who are childbearing- providing transparency in the field of home birth is the way. I can’t see any other way but all midwives delivering babies at home (CPMs, or CNMs in some states) being regulated and required to step up professionally.

    The MS bill will hopefully die on the vine. It is imperative that all midwives attending births be regulated. I don’t see how else we can be assured that the right people are calling themselves midwives. This will just create a more underground and dangerous home birth culture for MS women because it opens the door for egregious practice in the care of women. Families will still choose home birth and will be subject to little more than an interview, and due diligence in order to glean what credentials their practitioner has. (not okay.)

  8. I’m not sure what part of “specialist” Dr. Tuteur has an issue with, but the fact is that certified pprofessional midwives are the only maternity care providers in the United States who are required to receive clinical training in out-of-hospital settings.

    Anyone with any experience in delivering babies knows there’s a world of difference in the skills required to manage a birth that takes place outside of the hospital vs. a hospital birth.

    Nurse-midwives, family practice physicians and obstetricians do not have the required training to anticipate and manage potential emergencies that can develop in home and birth center births and to know when to refer when necessary.

    Given these facts, it makes no sense whatsoever for states to outlaw certified professional midwives. I smell a turf battle.

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