(Jefferson City, MO) – The Missouri Supreme Court will hear arguments to reconsider the permanent injunction on the state’s new midwifery law at 9:30 a.m. on Wednesday, March 5 at the Cole County Courthouse, 301 E High Street. A coalition of state and national midwife supporters, midwives and home birth families, led by Friends of Missouri Midwives (FOMM) and mobilized for the appeals process, has learned that the Court has granted their motion to file an amicus curiae (friend of the court) brief, submitted by:

• Citizens for Midwifery (CfM)
• Midwives Alliance of North America (MANA)
• National Association of Certified Professional Midwives (NACPM)
• Our Bodies Ourselves
• The National Birth Policy Coalition (NBPC)

The amicus brief submitted by the coalition (click here for PDF) supports the lifting of the midwives law injunction and makes the case that increasing access to trained and qualified Certified Professional Midwives (CPMs) and out-of-hospital birth is beneficial to Missouri citizens. In seeking to provide such access, Missouri is following the wisdom of a growing number of states recognizing the benefit of authorizing CPMs, who provide safe and high quality care, to practice.

“If the Supreme Court lifts the injunction, this law will permit CPMs to provide high quality, cost-effective care that will benefit Missouri’s citizens and fill some significant gaps in the state health care system,” said Susan Jenkins, legal counsel to the midwives coalition and steering committee member of National Birth Policy Coalition. “Home birth among low-risk women attended by CPMs does not jeopardize the health of mothers or infants, is authorized in 22 states, and is supported by many highly regarded international and professional organizations.”

Mary Ueland, Grassroots Coordinator for Friends of Missouri Midwives, says she hopes the Court will rule to decriminalize Certified Professional Midwives and remove the threat of prosecution to professional midwives who assist families who choose out-of-hospital birth. “Missouri shouldn’t drag its feet when it comes to allowing mothers to have safer and healthier birth options.”

The new Missouri Midwifery law was supposed to take effect Aug. 28, 2007, but the Missouri State Medical Association (MSMA) organized a well-financed challenge to the new law and was granted a temporary restraining order on July 3. Then on Aug. 8, Circuit Court Judge Patricia Joyce, who serves on the Board of Directors for St. Mary’s Health Center in Jefferson City, disallowed the Certified Professional Midwives provision contained within HB818 regarding portability and accessibility of health insurance.

Judge Joyce ruled the provision was unconstitutional and unrelated to health insurance, despite hearing from Assistant Attorney General John K. McManus and Midwifery Coalition attorney Jim Deutsch that decriminalizing midwifery does indeed relate to health insurance as they recalled that the Missouri Supreme Court has already ruled health insurance is interdependent on health services, and the two subjects are related.

During the Circuit Court appeal to Judge Joyce on Aug. 2, Deutsch cited nine other states where Medicaid covers home births attended by Certified Professional Midwives and many others where CPMs receive private insurance reimbursement. Both McManus and Deutsch argued that families obviously cannot get health insurance reimbursement for their midwives if their providers are considered felons by the state. They agreed that legalizing Certified Professional Midwives is a first step to home birth families being able to have their maternity care providers covered by insurance. They also cited the lower cost of midwifery care, which in turn could encourage insurance companies to lower their rates for healthy women.

“We’re seeing a strong shift in support of professional midwives as families become more aware of the benefits of CPMs, as well as more alert to skyrocketing c-section rates,” Laurel Smith, President of Friends of Missouri Midwives, said. “Beyond the additional risks for mothers and babies that c-sections create, what effect does a c-section rate of more than 30percent have on our insurance premiums, and how reliant are doctors and hospitals on these increasing revenues?”

Missouri is part of The Big Push for Midwives Campaign, a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.The case defendants and midwifery supporters who are listed on the appeal to the Missouri Supreme Court include:

• Friends of Missouri Midwives (FoMM). A nonprofit organization representing the interests of Missouri families who choose to have safe, alternative, out-of-hospital childbirth options. FoMM was created to support, promote and protect the rights of Missouri families to make choices about how, where, and with whom their babies will be born and to promote access to the midwifery model of care. Contact: Laurel Smith 636-209-1033.
• Kelly Dallion Rehm, and Eric & Jessica Kerr. Two families that were expecting babies to be born after Aug. 28, 2007, the day the new law was to take effect. They were planning home births with legal, well-trained CPMs. When the new law was struck down, they had to choose between breaking the law, birthing at home without a trained attendant or the expense and interventions of a hospital birth. Contact: Kelly & Dallion Rehm 417-777-8005, Eric & Jessica Kerr 314-962-1143 or 314-248-0952
• Columbia Community Birth Center, Kim James, CPM; Ivy White, CPM; and Dr. Elizabeth Allemann, MD. Columbia Community Birth Center is the only licensed birth center in the state of Missouri. The Center is a place where families give birth in a comfortable home-like setting. James and White received their CPM credentials in 1995. Ivy White says, “As a natural childbirth specialist and professional, to have the freedom and recognition to legally practice in my state is a dream that I share with my midwife colleagues in Missouri. It wrenches my heart that there are families who long for midwifery care, and I cannot give it to them.” Contacts: CCBC 573-447-2700; Ivy White 573-356-1059; Kim James 573-424-9115; Elizabeth Allemann 573-268-6946.
• Missouri Midwives Association. An organization dedicated to promotion, protection, support and education for midwives in Missouri. “Generally, parties who want to join a suit want to be on the plaintiff’s side. We are an unusual group with an unusual dedication to our cause. We have joined the State of Missouri as co-defendants so we can have a say in what evidence the court will consider, and ensure our victory,”says Debbie Smithey, President of the Missouri Midwives Association. Contact: Mary Ueland 417-543-4258.

Media inquiries about the Missouri Supreme Court case should be directed to Mary Ueland at (417) 543-4258, better_birth@yahoo.com. Media inquiries about The Big Push for Midwives Campaign should be directed to Steff Hedenkamp at (816) 506-4630, RedQuill@kc.rr.com.#####

“I had both of my children at home in the water and both births were amazing experiences.  Enjoy this picture as we all set eyes on Gwyneth Violet for the first time.”
The Sunday Photo Album is a regular feature of the Safe Birth Blog. If you would like to submit a picture, please email soracolvin@gmail.com.

The Vancouver Sun, a big newspaper in a large Western Canadian city, has a feature article about parenting choices that looks at home birth and midwifery care along with a number of other “controversial” decisions. What’s Best For Baby? also examines the evidence on epidurals, Cesarean sections, spanking, and daycare.

The twist? In Vancouver, midwives have been a regulated part of the health care system for ten years. They attend births in both hospitals and at home and their services are covered by the provincial health care plan.

Since they are a fairly newly regulated profession, Canadian midwives have still not completely won the battle of mainstream public perception, as the article points out. “I feel like some people think I’m kind of a radical for choosing a midwife,” said Hare. “People don’t realize that midwifery is licensed and regulated. They think it’s something hippies do so they can give birth… in the forest.” Many people also assume, falsely, that Hare is going to give birth at home, not realizing midwives are allowed to do hospital deliveries in B.C.

But the Sun article also goes on to point out that not only do midwives in British Columbia have comparable safety records to doctors, whether at home or in the hospital, their rates of intervention are significantly lower. The Sun did not mention that Statistics Canada has also discovered that Canadian women are much happier with their care if they have a midwife. The midwives have not completely won the public perception battle, but they are well on their way. Midwifery is the future of low-risk maternity care in Canada: a profession of autonomous, primary care-providers who are fully integrated into the health care system and who place a high priority on informed choice, continuity of care, evidence-based practice, and choice of birth place for low risk mothers.

This is a guest post from a “Post Modern Midwife.” 

21st century midwives who provide out of hospital maternity services are trained, educated primary care providers who often have relationships with physicians and other care providers to offer full scope care. A post modern midwife accesses technology as appropriate and consults in an independent fashion as necessary to provide evidence based care with great outcomes.

As the Big Push garners more and more visibility on a national mainstream level, and OFSB becomes more visible on a state level, there will be more citizens who see our publicity and legislative efforts and have visions of what I call “Little House on the Prairie birthin’”. We need to make clear that midwifery is not tribal woo woo, nor the practice of medicine, but its own independent field grounded in evidence-based practice.

Women with major health problems such as heart disease and type I diabetes which can cause serious complications in pregnancy and labor are not good candidates for out-of-hospital birth and will either self screen out or a midwife would screen them as too high risk for an out-of-hospital birth.

As well, every prenatal visit with a midwife is in fact a screening visit, looking for potential problems that could risk a women out of home birth. Because of this very intense screening process and preventative model of care, families with major problems or risk factors are not tossing the dice on a birth outside of a hospital.

Midwives monitor mother and baby via intermittent fetal monitoring and other assessment means, just as a hospital does. Problems do not fall out of the sky, they develop with plenty of time for response. The Obstetrical Standard of Care is “Thirty minutes from Decision to Incision”. Out-of-hospital birth with a qualified attendant in relationship with her community health services provides the ability to adhere to this standard.

It is important for the general citizenry to understand that the way to protect families is to provide regulation and mandate minimum standards of training and experience for midwives to ensure public safety. No one is trying to convince anyone who doesn’t want to have a home birth, we are just trying to show policy makers that the best way to protect families who choose out-of-hospital birth is to ensure that their providers are in a regulatory framework.

Newsweek.com has a brand new article about Birth Choices which references The Big Push for Midwives. The article does a good job of briefly analyzing the choices available to pregnant women in the United States and the pros and cons of each provider: obstetrician, certified nurse midwife, or certified professional midwife.

The article closed with this quote:“As a woman and a mom and an obstetrician, I feel strongly that patients should have choices,” says Dr. Anne Foster-Rosales, former chair of ACOG’s international committee. “But I think making it as safe as possible is very important.” Foster-Rosales has worked with mothers around the world, including in countries where most women give birth at home with untrained attendants. Because of what she has seen, she feels that it is important that home-birth providers not feel ostracized so that they can come to the hospital if necessary. Emergencies may be rare, but the course of an individual pregnancy is unpredictable no matter where you choose to give birth. Protect yourself and your baby by learning as much as you can.

Ohio Families for Safe Birth strongly agrees with Dr. Foster-Rosales’ sentiments. A good first step in helping home-birth providers not feel “ostracized” in Ohio would be to license them instead of prosecuting them.

A powerful medical lobby with strong financial backing opposes legislation which would legalize the autonomous practice of Certified Professional Midwives (CPMs) and protect birth choices for women and families. In many states where the practice of midwifery is not yet legal, midwifery bills are proposed in the state legislature every year. Midwives and parents work hard to gain support with limited resources. When their bills, year after year, fail to pass or even to reach the floor for a vote, the reason given is always the same.

“I understand the choice issue, but the only issue for the Department of Public Health is the safety of the mom and the baby,” Alabama State Health Officer Dr. Don Williamson said in a recent newspaper article. (The article on the Anniston Star website is for subscribers only, but the full text can be found here, after scrolling down past the “daily news” links.)

Safety was also the theme of ACOG’s recent anti-homebirth press release, which warned mothers of dire and catastrophic consequences that might result from birthing outside of the hospital and asserted that “choosing to deliver at home… is to place the process of giving birth over the goal of having a healthy baby.”

No evidence is given to support this claim, because none exists. In fact, the existing evidence overwhelmingly demonstrates the safety and excellent outcomes of home birth with professional midwives for normal, healthy pregnancies. This evidence — including the CPM 2000 study, a prospective study of over 5400 planned home births which was published in the highly respected, peer-reviewed British Medical Journal — is dismissed by ACOG as “limited” and not “scientifically rigorous.” 

Ironically, ACOG’s opposition to out-of-hospital birth and animosity toward midwifery itself poses a great danger to the health and well-being of home-birthing mothers and their babies. ACOG’s statement is not entirely mistaken: obstetricians do offer expertise and surgical interventions that are life-saving for the very few mothers and babies who genuinely need them. While 80-90% of planned home births are safely completed at home, some mothers need to transfer to the hospital in order to access necessary interventions. In the CPM 2000 study, only 3.4% of women experienced a hospital transfer that was considered by the midwife to be “urgent”. But in those rare, urgent cases, professional communication between midwife and obstetrician and smooth and well-orchestrated transfer of care may make a critical difference to the health and safety of both mother and baby.

For this reason, countries such as Great Britain and Canada, where home birth has been well-integrated into the health care system, put a great emphasis on coordination between the home birth midwife, emergency response services, and hospital obstetric departments as a key component of safe out-of-hospital birth. For example, in British Columbia, Canada, a midwife attending a home birth alerts the hospital when she is called to the labor so that hospital staff will be aware and prepared in case their services become necessary. Midwives are trained to use and legally carry stabilizing medications and other emergency equipment to treat the mother or baby until they reach the hospital. If an emergency transfer becomes necessary, the midwife remains the most responsible caregiver during the ambulance transport. Obstetricians and midwives interact as colleagues to achieve the best possible outcome for both mother and baby in an emergency situation.

By contrast, the recent raid of an Ohio midwife’s home described in last week’s City Beat article was the result of a complaint filed against the midwife when she transported a laboring woman to the hospital. The midwife in question has many years of experience and, as a CPM, has obtained a rigorous, national credential which is legally recognized in many other states. The transfer was necessary for the health and safety of the mother and baby; the midwife acted appropriately in bringing them to the hospital; and a good outcome was achieved because of the midwife’s timely transfer. Had the mother been without a skilled attendant monitoring her labor at home, the situaton could have been tragic.

This midwife now faces prosecution, not because of any negligence of action on her part, but because a doctor believed that the birth should not have been attempted at home to begin with. Other women who would have benefitted from her skill and expertise may now face the unwelcome choice of birthing at home unattended because their midwife is barred from practice. Communication between midwife and physician is a vital step when transfer of care is necessary, but now, midwives attending women who need hospital care may be afraid to accompany a laboring woman to the hospital lest they also come under fire.

The prosecution of unlicensed midwives, though undertaken by the State, is initiated and urged on by the same medical interests that work tirelessly to oppose legislation that would enable midwives to practice legally in Ohio and elsewhere. While there are individual physicians who work with midwives in a collegial manner, respect their abilities, and support their continued provision of a much-needed service, the profession as a body seems intent on stamping out the “competition.”

In Ohio, nearly 1000 babies are born at home each year. Despite ACOG’s best efforts, families continue to choose home birth. If the safety of mother’s and babies was truly ACOG’s goal, they would take a position of working with midwives to ensure that no communication gaps or professional animosity prevents access to needed obstetrical expertise for those who cannot safely continue a planned home birth.  ACOG has systemically chosen to place their political agenda and business concerns above “the goal of having a healthy baby.”

“Rachel, my youngest daughter, was an active participant in the birth of William.  She stood with the midwife and held the flashlight during the final stages of labor.  When the midwife drew the bath with the beautiful flowers, Rachel could not resist climbing in to be with her mama and new baby brother.  While we were enjoying the bath Ashlyn came to check on us.”The Sunday photo album is a regular feature of the Safe Birth Blog. If you would like to submit a picture for the album, please email soracolvin@gmail.com.

There will be a screening of The Business of Being Born at Kent State University (KIVA- Student Center) in Kent Ohio on February 21st at 8pm. Admission is only $2.00 and KSU Students get in free. 

This parody of ACOG’s recent statement against home birth first appeared on the Mothering.com discussion board and is rapidly going viral.

HBACM Statement on Home Births (parody)

Fresno, CA – As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes.

I acknowledge ACOG’s right not to support programs that advocate for, or individuals who provide, home births, but I do not support a system that denies families the essential information to make informed decisions regarding maternal care. Nor do I support a system that lacks the resources to make VBAC a viable option for all women and ensure the quality of the mother-child dyad immediately after birth. 

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk.

Advocates cite the lack of rigorous scientific studies as one justification for promoting hospital births. Consistent dismissal of existing Level I evidence defining the risks of unnecessary interventions such as episiotomy, epidural anesthesia, and amniotomy has concerned proponents of natural childbirth for the past several decades and we remain committed to changing this. Birth advocates throughout the world use childbirth education, grassroots childbirth networks, and recently, the media to provide mothers and caregivers with the evidence. Multiple factors are responsible for the persistent exceptions to evidence-based medicine in maternal care, but emerging contributors include a fear-based climate that skews mothers’ decision-making abilities and forces caregivers to follow “standards of care”that ignore the scientific evidence.

The availability of a birth attendant to provide continuous labor support and of a midwife to provide expertise and intervention may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. I believe that the safest setting for labor, childbirth, and the immediate postpartum period is one that respects and trusts the birthing process, that meets the Baby-Friendly and Mother-Friendly standards jointly outlined by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Coalition for Improving Maternity Services(CIMS) and is supported by birth advocacy groups.

It should be emphasized that childbirth comes with inherent risks. Implying any guarantee otherwise is misleading and unjust to a birthing mother and her family.Although able to perform live-saving emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures. They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as “dystocia” and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby.

I encourage all pregnant women to get prenatal care and to make a birth plan. Safeguarding the process of giving birth promotes a healthy and safe outcome for both mother and baby. Every woman should seek balanced information to guide her decisions throughout pregnancy, childbirth and parenting. For women who despair in the lack of choices, they should look for hope in mothers who have navigated this climate of fear successfully. We are here.

City Beat, a Cincinnati weekly paper, has a great article today on midwifery in Ohio, referencing our website and organization.