Midwife bill passes House; waits for Senate vote

The bill, HB 36, sponsored by Rep. Cynthia Davis, R-O’Fallon, was passed by the House April 19.

“Women should have the autonomy to self determine what kind of birth they want,” Davis said.

Lay midwives, also known as empirical and direct-entry midwives, are different from certified nurse midwives. CNMs are trained through approved programs of the American College of Nurse Midwives in the disciplines of nursing and midwifery. CNM programs usually are affiliated with a university or medical school, with either a one-year certificate program, or a two-year master’s program. There are more than 4,000 CMNs in the United States, and six in the state of Missouri, according to the ACNM, and Davis said there are six CNMs in Missouri.

Lay midwives, on the other hand, receive their training through various routes, including self-study and apprenticeships. HB 36 is designed to outline criteria for lay midwives so that they can practice midwifery without fear of criminal charges.

“Missouri law has criminalized anybody who was a (lay) midwife. It’s illegal in eight states in the U.S., and Missouri is the only one where it is a felony. You can go to jail for helping with a birth,” Davis said.

The new law would not affect CNMs, who in some cases can obtain hospital privileges, and in some states, are allowed to prescribe medications.

“Women who would like to have a home birth (without a CMN) don’t have a choice,” said Davis. “They can either have a hospital or a home birth with no attendant. There are over 1,000 births in Missouri each year where no one is listed as the attendant. That puts women in a position that is less healthy. If there is an emergency and she goes to a hospital, she cannot have her midwife with her to communicate vital information that could be very helpful. We have to look at the net result of what is accomplished through our laws.”

Davis added that state laws should respect the traditions of the Amish and Mennonite communities, which only use lay midwives.

According to Davis, the United States ranks No. 27 worldwide for infant mortality.

“Missouri is number 42 of 50 in maternal mortality. Something’s wrong here, and we should be getting better outcomes,” she said.

Studies show that home births are usually safer, Davis said. “Midwives do not take high-risk patients. It’s not for everybody, but for a healthy woman with no high risk, why are we not giving them a choice?”

As a mother who has had seven Caesarean sections, another concern Davis has is the 35 percent to 40 percent of unnecessary C-sections performed. Davis believes a lot of surgical births could be prevented for women who have the setting and caregiver of their choice. “That’s because of the degree of care,” she said, because a midwife teaches women to take control of their own health care and provides prenatal care, as well as supervision of the pregnancy and postpartum care. “Women who choose midwives are far more educated than the average woman. They know what they’re doing. We need to trust the women,” Davis said.

Donna Stewart, who had her children ,Anakin, 4, and Bellatrix, 9 months, at home with a CNM, isn’t quite so trusting that lay midwives have the training that they need.

“My second child turned breech, and if I’d not had a (certified nurse midwife), I could have been in trouble,” she said. “My midwife was able to look at me and say, ‘When did this baby turn?’ She knew. Without that knowledge, I’d not have been able to deliver her. We may not have been able to get to the hospital and have a successful delivery.”

Stewart added that while there are lay midwives who know what they’re doing, circumstances such as a breech birth can be difficult, and can result in head and neck trauma for the baby.

“I fear without that training and certification, we’ll wind up with babies hurt,” Stewart said. “Not all moms understand what can go wrong.”

Stewart’s CNM, Lori Link, of Mt. Vernon – who did not return calls by press time – is an obstetrics nurse who worked with an Ob-Gyn in a hospital for nearly 20 years before becoming a CNM. In addition, Stewart has a degree in child development and felt she was able to make an educated decision.

After talking with a woman who had a positive experience with a midwife, Stewart considered and read about midwifery for several years before calling Link.

Stewart learned that none of the Springfield hospitals allowed midwives to attend a birth. “That made me nervous,” she said. Still, after reading about home birth from the view of the baby and the difference in how the newborn is actually handled, Stewart decided that would be a great gift to give her child. “I was planning on a natural birth with no drugs anyway,” she said. “It would only be different in that it would be at home.”

One fear Stewart had was if something went wrong. “You just identify what you’re afraid of and the midwife will tell you how to deal with it,” she said. “Ninety percent of what midwives do is absolutely exceptional prenatal care to determine if something would come up.”

A Senate committee held a public hearing May 3 on HB 36; no action has yet been taken.