Fierce Debate Over Midwifery Licensure

Pamela Merritt

Currently, Missouri midwives must have a nursing degree and work under a doctor's supervision -- otherwise, they are committing a felony. A Senate bill under consideration would expand women's birthing options -- but the Missouri State Medical Association is fighting back.

A friend of mine is expecting her first child and when I last spoke to her she was in the midst of putting her birthing plan together. I have to confess that I was a little alarmed, since this is the same friend who ended up with three binders full of information and a battle plan complete with multiple exit strategies when she got married. But as our conversation progressed I realized that, with so many options to consider and some serious decisions to make, a birthing plan is a pretty good idea.

One of the birthing options many people consider is whether to use a midwife and, as Barbara Kantrowitz and Pat Wingret pointed out in their Newsweek piece The Delivery Debate, making that decision can be very confusing. Beyond the basic medical and personal considerations, some states are debating legislation that may impact access to midwifery care. Here in Missouri, State Senate has been debating Senate Bill 1021, which "changes the laws regarding midwives and the practice of midwifery." The debate over whether to regulate midwifery, how that regulation would take place, and which body would oversee that regulation has been fierce.

Currently, Missouri midwives must have a nursing degree and work under a doctor's supervision — otherwise, they are committing a felony by overseeing the care of a pregnant patient. But Senate Bill 1021 would

"create a 'Board of Direct-Entry Midwives' [midwives who begin their education in midwifery directly rather than after completing a nursing program] within the Division of Professional Registration. The board shall have the power to issue licenses and to suspend, revoke or deny the license of a direct-entry midwife. The board shall develop practice guidelines regarding the practice of midwifery established by the National Association of Certified Professional Midwives, including the development of collaborative relationships with other healthcare practitioners who can provide care outside the scope of midwifery when necessary."

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Steff Hedenkamp of The Big Push for Midwives Campaign, a group pushing for the regulation and licensure of Certified Professional Midwives in all 50 states and the District of Columbia, was in Jefferson City, Missouri, during the recent Senate debate. Hedenkamp said that she talked to a lot of Senators and Representatives who support Senate Bill 1021 because they like the compromises made and the way it will address concerns about liability, education, certification and licensing.The bill passed out of committee five to one which is proof, according to Hedenkamp, that there is political will to pass it if it were brought to the floor for an up-or-down vote.

Protecting and defending the ability of certified midwives to provide legal and safe healthcare is an essential part of the reproductive justice movement, as Amie Newman explored in her article A New Life For Midwifery Care. Amie argues that "restricting access to a full-range of health care providers, especially those known to improve health outcomes for maternal and newborn health, is not healthy for women and babies."

Yet those opposed to legislation like Missouri's Senate Bill 1021 claim that protecting maternal and newborn health is also their motivation. As reported by Michelle Munz of the St. Louis Post-Dispatch, the Missouri State Medical Association is lobbying for greater doctor supervision of midwives, stating a concern for public safety.

The group wants midwives to have written collaborative-practice agreements with a physician that will justify regulation by the Board of Healing Arts. An amendment proposed by Senator Graham, D-Columbia, would place the regulation of midwives under that physician registration board. But 24 other states license midwives and the majority of them do so without physician involvement with direct-entry midwives, instead licensing and certifying them through midwifery boards or committees.

Advocates for Senate Bill 1021 point out that regulating midwifery through the Board of Healing Arts would set a dangerous precedent of having one profession regulate another. Hedenkamp feels that the Graham amendment guts the bill and that the physician-based board would simply not issue licenses, effectively regulating midwives out of existence.

As things currently stand, Senate Bill 1021 may not go to the floor for an up-or-down vote. But midwifery advocates pledge to continue the fight. Hedenkamp says that "we will continue to work hard, continue to tell our stories, continue to shine light on and give voice to what Missouri families want: legal access to licensed Certified Professional Midwives in the state, and now."

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