Rewire Interviews Melissa Cheyney, Midwife

Amie Newman

Melissa Cheyney is a midwife and home birth advocate who has devoted her career to bringing new life into this world and who works to improve relationships between hospital and home birth providers.

Birth is a big part of Melissa Cheyney’s life – especially right now. As a new mother, having given birth in May of this year to a beautiful girl, as well as a practicing midwife and homebirth advocate, Cheyney has devoted much of her life to bringing new life into this world. In fact, the weekend after we conducted this email interview, Cheyney attended her first birth as a midwife since her daughter’s arrival. But it is her work as a professor of medical anthropology and reproductive biology at Oregon State University that recently caught my eye.

In this capacity, Cheyney and her research partner, doctoral student Courtney Evans, explored the effect of midwife-attended homebirths on elevated rates of prematurity and low birth weight in babies born in a particular county in Oregon between 1998- 2003. And though their research disproved the notion that homebirth yields poorer birth outcomes (in fact, just the opposite was true – all of the homebirths studied resulted in successful health outcomes for the newborns), they did uncover something else in the process. When results of their study hit both the hospital provider and homebirth/midwifery communities, “antagonism was…considerably amplified” between the two; leading Cheyney and Evans to examine the ways in which the hospital/ homebirth provider relationship could be improved.

It is no surprise to Direct Entry Midwives (also known as DEMs) or homebirth advocates that many in the hospital-based birth practitioner community believe homebirth to be unsafe and inferior to in-hospital birth. Both ACOG and the AMA have issued statements proclaiming as much. But Cheyney and Evans discovered a “deep mistrust” between the two communities that led Cheyney to want to do something to ameliorate some of the hostility in the relationship. Cheyney worked with her own back-up physician, obstetrician Dr. Paul Qualtere-Burcher, to create a pioneering protocol guiding the midwife/doctor relationship with the goal of creating optimal experiences for both providers and patients alike. The document, “Proposal for Increased Collaboration between Direct-Entry Midwives (DEMs) and Obstetricans for Homebirth Clients,” is grounded in a series of foundational ideas: homebirth is a viable alternative to a hospital birth particularly when facilitated by a skilled DEM with a physician back-up; research supports the idea that homebirth is a safe option for low risk pregnant women; obstetricians and hospital care represent a “safety net,” as Cheyney and Qualtere-Burcher propose, that can contribute to healthier birth outcomes for both mother and baby if complications arise during a homebirth.

Professor Cheney graciously agreed to answer some of my questions about her groundbreaking protocol, her research into the hostility between both home and hospital-based birth practitioners and why it’s critical to women’s health that these issues are addressed.

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Newman: Do you know if there are there similar protocols being developed in other parts of the country between DEMs and physicians (in those states where midwifery is legal!)? If not, would you like to see this replicated?

Cheyney: To my knowledge, this is really the first of its kind, at least one that is being formally implemented and studied. However, in areas where midwifery is legal, these kinds of arrangements exist more informally between individual midwives and physicians that have developed relationships usually over years of working together. I would love to see these protocols replicated and modified to meet the specific needs and goals of the given area. We know that homebirth is safest when it is planned, a trained midwife is present and medical back up is available if needed. It’s really that third criterion that needs streamlining and strengthening in our country.

Newman: Oregon seems to have progressive rules and regulations regarding DEMs – unlicensed midwives are able to practice. Has this been supported by physicians? Has there been resistance, active or otherwise, by OB/GYNs to Oregon’s policy?

Cheyney: Most OB/GYNs in the state of Oregon are unaware of the distinction between unlicensed and licensed midwives. Many refer to us all as “lay midwives” – a term that most DEMs find insulting because it suggests very little or no education. Voluntary licensure is thus, rarely an issue for obstetricians. Place of delivery is much more contentious. Many obstetricians are opposed to homebirth regardless of the practitioner type. However, in my capacity as the state legislative liaison for the Oregon Midwifery Council this year, I did find a few legislators that are concerned about voluntary licensure and they have called for a study session this summer to explore the feasibility of mandatory licensure. I will have a lot to say about that. In addition, a small group of labor and delivery nurses at Oregon Health Sciences University recently addressed the health licensing agency’s board of direct-entry midwifery which I serve on, requesting that the protocols that govern the practice of LDEMs be tightened to exclude breech, twins and VBACs. They are also advocating for mandatory licensure. With these exceptions, I would say that the vast majority of practitioners remain unaware of voluntary licensure status and just oppose homebirth in general.

Newman: What has your experience as a practicing midwife been like as you’ve developed relationships with physicians? Have you experienced the "deep mistrust?" In other words, were you surprised at your findings that there was antagonism, distrust and conflict between doctors and DEMs?

Cheyney: The vast majority of my personal experiences have been positive, largely because I was fortunate early on to establish a relationship with several local obstetricians through my work as a researcher. For the most part, I feel like I have been treated with respect and as a colleague whenever I have transferred the care of one of my clients. However, about a year and a half ago, I did experience a negative transport that was the result of deep mistrust. I had been caring for a low-risk woman who had a straightforward labor, but experienced a severe complication at birth known as a shoulder dystocia. This is where the head is born, and the shoulders become impacted behind the pubic bone. I responded quickly and was able to extract the baby and perform a successful resuscitation. However, this baby suffered a broken arm, which is the second most common complication from a shoulder dystocia. When we transported to the hospital, the pediatrician in the ER threatened me with child abuse and arrest. His attack on me and subsequently the parents who felt judged during their care made a bad situation even worse. The parents still recount the most difficult part of that day being the interaction with this pediatrician. Later when mom and baby were moved to the postpartum ward, we received nothing but support and compassion from the labor and delivery staff who had recently lost a baby to a shoulder dystocia. Thankfully, this baby made a full recovery and ultimately solidified my relationship with this hospital. My quick action at his birth helped to overturn the misconception that direct-entry midwives are untrained. So while most of my experiences have been extraordinarily positive, my one negative transport experience stands out in my memory and made me well aware of what I might find with this study.

Newman: In your proposal, crafted by you and your back-up physician, you write that "Obstetricians acknowledge that there are twenty-nine studies that now clearly indicate homebirth as a safe and viable option for low-risk women." But with the ACOG and AMA both stating, essentially, that the safest setting for birth is in a hospital, do you find it difficult to "convince" OBs that homebirth is a “safe and viable” option?

Cheyney: In the community where the proposal is now being implemented and studied, half of the practices in the county were represented at the proposal meeting. All of the obstetricians present were willing to concede that homebirth for low-risk women was a viable option. The bone of contention lies with how to define low-risk. As addressed in Cheyney and Everson 2009, midwives tend to have a broader definition of risk that includes psychosocial, emotional and social risk, where physicians are more likely to see risk as simply clinical risk. As a result, a woman may choose a homebirth even when at higher risk for a complication because of a past traumatic experience in the hospital. This can be hard for obstetricians to understand during a transport when they are filled with fear about having to attend a higher risk woman that they do not know well. Dialogue around whether a higher risk woman should still have the right to choose a homebirth tends to be very difficult and heated.

One bad experience may also bias a doctor against all home deliveries.
In addition, in my experience, there is often a divide between theory and practice for obstetricians. In theory, they know that their professional organization opposes homebirth. In practice, they are called in with some regularity to assist in homebirth transports. They are also well aware that homebirth, water birth and births with doulas are on the rise. This means that physicians cannot simply ignore homebirthers and continue to vocalize their mistrust of Direct-entry midwives. We are forced, out of necessity, to interact. As physicians come to know the midwives in their community, a grudging respect has the potential to emerge, making it difficult to remain adamantly opposed in some cases.

Newman: How can providers who are already open and amenable to working with midwives help foster a more supportive culture among colleagues, as you suggest in the proposal?

Cheyney: One of the mechanisms for maintaining distrust between midwives and obstetricians is what my colleagues and I have termed “birth story telephone.” This is very similar to the childhood game of telephone where as the story spreads from one individual to another, it grows in nature and the details change substantially. As home and hospital birth stories are told and retold, and filtered through the lens of the teller, details shift to match the preconceived worldview of the teller. For example, a non-emergent transport for a slow, uncomplicated and non-progressive labor can turn into a mother laboring at home for days with poor heart tones and a uterine infection before the midwife reluctantly brings her in. By the time the story has been passed along, mother and baby who were actually never in danger were saved from a near death experience by the hospital staff.

Conversely, hospital births where a woman feels too many interventions were used can be constructed as abusive or traumatizing to the woman after numerous retellings. These stories effectively maintain the home/hospital divide. Physicians and midwives can work to overturn that divide by refusing to participate in “telephone,” by being committed to accuracy and professionalism; sharing only the stories they have first-hand knowledge of. Midwives and physicians who have positive experiences working with one another also need to speak up regarding those positive interactions.

Newman: What are some of the stereotypes or judgements held by midwives about OBs/physicians?

Cheyney: Let me begin with this caveat, midwives often hold fewer misconceptions about obstetricians because we actually get to see hospital deliveries when we transport. We have first-hand knowledge of the model of care that we often critique. However, very few physicians ever attend a home delivery, and yet feel very comfortable critiquing that option.

That said, because midwives often hear stories of hospital births from clients who are unhappy with the experience and are now seeking an alternative, many maintain an outdated view of hospital deliveries as inhumane and impersonal. The vast majority of women, about 70% in the United States, leave the hospital feeling it was a positive experience. Only about 30% leave with regrets or frustrations about their experience and treatment. We as midwives disproportionately serve that 30%. This can prevent us from seeing the work that obstetricians are doing to humanize and individualize birth in the hospital.

Finally, while obstetricians can envision a world without midwives, midwives cannot envision a world without obstetricians. Thus, midwives have a larger incentive to work towards positive relationships with back-up physicians.

Newman: What if a pregnant woman faced with a VBAC or twins does not want to consult with an OB? Is this protocol suggested or mandated?

Cheyney: It is suggested. Oregon law prevents any clinician from forcing a woman to engage in any intervention or procedure against her will. Midwives can strongly encourage it, and because they have a close relationship with their clients, their suggestion is likely to be followed. Midwives who have agreed to participate in this experimental protocol will have to document in their charts that the physician consult protocol was encouraged.

Newman: What happens now with a transport where the midwife and physician have not previously spoken? Do they get a chance to confer? Is the midwife even allowed in the room or does that depend on the doctor?

Cheyney: Before the protocol, non-emergent transports were highly variable and dependent upon the physician on call for undoctored patient. During emergency transports, there is little time for consultation and that will remain the same with this protocol. However, since the vast majority of transports are non-emergent (more than 95%), there is at least the theoretical potential for midwife and physician to meet in the hall and to discuss the case before entering the room together to propose an agreed upon course of action to the mother. The extent to which this happens in practice varies considerably by facility and by physician. The point of our protocol was to help standardize interactions and to help physicians and midwives to create a culture of interaction and collaboration built on mutual trust and respect. See also our discussion of this in Cheyney and Everson 2009.

Newman: You write in the proposal: “Opportunities are made available for physicians to observe homebirths and for DEMs to observe low-risk hospital deliveries.” This is a fantastic idea and I’m surprised that this doesn’t already happen. Are there any classes or opportunities available in medical school, for those who chose to pursue an OB/GYN track, to learn about midwifery and for midwives in training to observe hospital births?

Cheyney: Currently, there are no opportunities for obstetricians to observe home deliveries during their medical training in the U.S. However, this is an option for physicians in the Netherlands; in fact, it is a requirement for all Dutch obstetricians who wish to attend low-risk deliveries. Obstetricians often have exposure to hospital deliveries with Certified Nurse Midwives, however. Because many Direct-entry midwives have been doulas at some point in their lives and because they accompany women who transfer care due to a complication, there is a general understanding among midwives about what happens in a “low-risk” hospital delivery. Further, most transports are for non-emergent cases with low-risk women, allowing them to see many low-risk deliveries in the hospital. The reverse simply cannot be claimed for physician knowledge of homebirth practice.

Newman: On a personal note, you had a baby recently. As a practicing midwife, a researcher of this issue and a mother, do you have any advice for women who are pregnant or looking to have a baby soon and who plan on working with a DEM, about how best to ensure the most comprehensive care for themselves during childbirth? Should they ask their midwife if she has a back-up physician with whom she has an amiable relationship?

Cheyney: Very few DEMs in the United States have formal relationships with particular back-up physicians. As such, if women asks this question, the answer will very likely be no. It may be more helpful to ask what transports are typically like. Because the vast majority of midwives who go into labor intending to deliver at home do so successfully, I would never advise a woman to make a decision about whether a homebirth is right for her based simply on what a transport may be like. It is most important that the woman’s philosophy of care matches that of her midwives. There is a spectrum of homebirth midwifery, from very hands off to more medicalized. Some will do breech births and twins, some will not. Some have antagonistic feelings toward the medical model; others see the relationship as collaborative. It is important for women to take the time to interview the homebirth providers in their area, and when possible, to choose a midwife with a similar perspective.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Politics

Paul Ryan Uses Falsehoods Behind Texas HB 2 to Push Yet Another Abortion Restriction

Ally Boguhn

In a CNN town hall Tuesday night, Paul Ryan agreed with an audience member's baseless sentiment that the Supreme Court had struck down “commonsense health and safety standards at abortion clinics" in its Whole Woman's Health v. Hellerstedt ruling.

During a CNN town hall on Tuesday night, House Speaker Paul Ryan (R-WI) pushed falsehoods about the anti-abortion provisions at the center of the recent U.S. Supreme Court decision in Whole Woman’s Health v. Hellerstedt being necessary for patient health and safety. Ryan nonsensically then used the decision as a launch point to promote House Republicans’ Conscience Protection Act, which passed in the House Wednesday evening and supposedly shields those who object to abortion from discrimination. The only things Texas’ provisions and the legislation have in common, however, is that they’re all about blocking access to abortion care.

Town hall audience member and executive director of New Jersey Right to Life Marie Tasy claimed during the event Tuesday that the Supreme Court had struck down “commonsense health and safety standards at abortion clinics,” in its landmark ruling against two provisions—the admitting privileges and surgical center requirements—of Texas’ HB 2.

“Absolutely,” Ryan said in response to Tasy’s remarks. “I agree with that.”

But the provisions of the law in question were not about keeping anybody safe. As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

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Despite this, Ryan then used the falsehood at the center of HB 2 as a call to action for yet another anti-choice restriction: the Conscience Protection Act. After fielding the question from Tasy about how anti-choice issues could be advanced in Congress in the wake of the Court’s decision, Ryan pivoted to claim that the government is “forcing people to conduct [abortion] procedures”:

Actually, tomorrow we are bringing a bill that I’ve been working on called the Conscience Protection Act. I’m pro-life. I think you probably know that. And I would like to think we could at least get consensus in this country that taxpayers shouldn’t be funding abortions. That the government shouldn’t be forcing people to conduct procedures, especially health-care workers, against their own conscience.

Our First Amendment is the right of conscience, religious freedom. Yet our own government today, particularly in California, is violating that right and not allowing people to protect their conscience rights, whether they’re Catholic hospitals or doctors or nurses. Tomorrow we’re bringing the Conscience Protection Act to the floor and passing it. It’s Diane Black’s bill. And it is to give those citizens in America who want to protect their conscience rights their ability to defend those rights. That is one thing we’re doing tomorrow to protect the conscience, because I believe we need to cultivate a culture of life. And at the very least, stop the government from violating our conscience rights.

Ryan would go on to make similar remarks the next day while speaking on behalf of the bill on the House floor, though this time he added that the “bill does not ban or restrict abortion in any way …. All it does is protect a person’s conscience.” 

As Rewire‘s Christine Grimaldi previously reported, the Conscience Protection Act would codify and expand on the Weldon Amendment. According to the Department of Health and Human Services (HHS), the amendment prohibits states that receive federal family planning funding from discriminating against any health care entity-including physicians, health-care professionals, hospitals, and insurance plans, “on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.”

The Weldon Amendment currently must be passed each year as part of annual appropriations bills.

Grimaldi noted that the act “would give health-care providers a private right of action to seek civil damages in court, should they face alleged coercion or discrimination stemming from their refusal to assist in abortion care.”

Ryan proposed similar conscience protections as part of his recently released health-care plan, though, as Grimaldi wrote, “the Conscience Protection Act goes a step further, allowing providers to sue not only for threats, but also for perceived threats.”

But those whom Ryan and his colleagues are claiming to defend already have protections that impede access to abortion care, according to critics of the measure.

Ryan, for example, suggested in both his CNN appearance and his House floor speech the next day that California’s requirement that insurance plans must cover elective abortions under “basic health services” violates “religious freedom.” But a June investigation by the HHS Office for Civil Rights into whether California’s requirement violated the Weldon Amendment rejected similar complaints by anti-choice group Alliance Defending Freedom.

“Let’s be very clear—right now, current law says that hospitals, insurers, and doctors may refuse to perform an abortion or provide coverage for abortion, which already greatly limits women’s access to legal procedures,” said Rep. Jan Schakowsky (D-IL) Wednesday, speaking after Ryan on the House floor during remarks before the Conscience Protection Act passed.

“More importantly, when a woman’s health is in danger, providers would not be required to act to protect the health of that mother. This bill would allow them to refuse to … facilitate or make arrangements for abortion if they have a moral objection to it,” continued Schakowsky. “They could also refuse to provide transportation to another hospital if a woman is in distress if that hospital provides abortions.”

Debra L. Ness, president of the National Partnership for Women & Families, explained in a statement following the passage of the legislation in the House that the measure is about blocking access to abortion. “The Conscience Protection Act is dangerous, discriminatory legislation designed to block women’s access to abortion care,” said Ness.

“For example, a hospital could rely on the Conscience Protection Act to turn away a woman in an emergency situation who needs an abortion or refuse to provide a woman information about her treatment options. This legislation is a license for providers to discriminate against women and undermine their access to essential, constitutionally protected health care,” Ness said.