Legal in Missouri

Article from my local paper:

Missouri law delivers good news to midwives
By JASON NOBLE
The Star’s Jefferson City correspondent
JEFFERSON CITY Missouri midwives, who for decades risked prison time to deliver babies in their clients’ homes, can now do their work openly and without fear of prosecution.
The state Supreme Court on Tuesday reversed a lower court ruling and upheld a 2007 law allowing midwifery in the state. Missouri was one of about 10 states that didn’t allow the practice unless the midwives were certified nurse-midwives — registered nurses who worked with a doctor.
“This is a victory for Missouri families,” said Anita Woods, a certified professional midwife from Leavenworth, Kan. “This has been a hard-fought battle for something that Missouri families have deserved for decades.”
The law allows midwives who have earned certification through a nationally accredited organization to practice in the state. Previously, midwifery was a class C felony and carried a seven-year prison term.
The exception was the certified nurse-midwives who usually deliver babies in hospitals. They could do home deliveries, but only if they had a collaborative agreement with a doctor. The majority of Missouri doctors don’t agree to that arrangement, according to the Missouri Midwives Association.
Midwives and their advocates cheered the 5-2 decision, while doctors groups mulled their options for a challenge.
The law in question, which allows certified midwives to provide prenatal, delivery and post partum services, was slipped into a larger bill concerning health insurance in the waning days of the 2007 legislative session. Gov. Matt Blunt signed it into law before most people realized it was included.
Once it was discovered, several state physicians’ groups sued to block it, arguing that doctors could be held legally liable for cooperating with midwives who lack professional licenses.
In August, the Cole County Circuit Court ruled in their favor, throwing out the midwifery language on constitutional grounds.
The state constitution limits each bill passed by the legislature to a single subject that is clearly expressed in its title. Including the midwifery language in the larger health insurance bill violated that law, the circuit court said.
The Supreme Court took up the case earlier this year. The opinion handed down on Tuesday reverses the lower court, ruling that the physicians’ groups lack the legal standing to sue. Without proper standing, the court ruled it could not consider the facts of the case.
Judge William Ray Price Jr. issued a dissenting opinion, in which he said the doctors did have standing and agreed with the lower court’s constitutional interpretation.
Lawyers for the doctors’ groups are deciding how to proceed, said Jeff Howell, general counsel for the Missouri State Medical Association.
Price’s dissent clearly shows the doctors’ arguments were legitimate, he said, if only they had the right to argue them.
“I really think we were denied our day in court,” Howell said.
The doctors’ groups have 15 days to apply for a rehearing.
Sen. John Loudon, the St. Louis County Republican who originally slipped the midwifery language into the 2007 bill, said the decision — even if appealed — marked an opportunity for further discussion between doctors and advocates of midwifery.
Before the ruling, doctors refused to negotiate on the matter, believing they had the upper hand, Loudon said. Now things are different.
“At this point, the table is level, and it’s time for everybody to sit down and negotiate a bill we all can live with,” he said. “That’s always been my desire.”
Some midwifery advocates, however, interpreted the decision as a firm scolding for the health care industry.
“The real significance for both Missouri and nationally is that this tells big medicine — or organized medicine — that it has no legal right to speak for the consumer,” said Debbie Pulley, director of public education and advocacy for the North American Registry of Midwives.
Midwives and their supporters have waited for this day for decades, said Mary Ueland, the grassroots coordinator for Friends of Missouri Midwives.
There aren’t a lot of certified midwives in Missouri now, although with their services legal, Ueland said midwives from across the country could soon make their way to Missouri.
“I’ve heard from a number of midwives in other states that grew up here and got training elsewhere…,” she said. “I think there’s a lot of people across state lines waiting to come back to their home state if they can only practice.”
Home births account for between 1 and 2 percent of all births, although the numbers vary greatly from place to place, Pulley said. There are more than 1,400 certified midwives nationwide. Numbers specific to Missouri are harder to come by because midwives cannot advertise their services openly.
Woods, the Kansas midwife, said the ruling brought the state into line with the rest of the country.
About 40 other states, including nearby Kansas, Nebraska and Oklahoma allow midwives to practice.
“In Arizona, New Mexico and Washington State, you can open the yellow pages and find a page and a half of midwives,” Woods said. “I’m so happy Missouri has stepped into the 21st century where that’s possible for the average Missouri family.”

Petition

There is a petition to support homebirth has been started in response to AMA and ACOG. You can sign it here.

Must Read

You must read Navelgazing Midwife's post on her response to the updated ACOG statement against homebirth. It's a marvelous read. She lays out 11 suggestions for MDs for wooing women back to hospital birth. I love her suggestions. It also made me realize that if OBs are fighting this hard, they must see homebirth as a real threat (not to public safety as they claim, but to their political status). The victory in Missouri also reminds me that Goliath doesn't win every battle. Am I feeling the beginnings of a shift in attitude about birth that I've long waited for, or is it just last night's burrito testing my intestinal fortitude?

It's a Wrap

According to Families for Missouri Midwives, the MO Supreme Court overturned the ruling yesterday that outlawed the new midwifery law- so CPMs are now legal in Missouri! I can scarcely believe it. This has been such a long time coming- more than 20 years in the making. Go to FOMM to read the details. This is a huge victory for the families of Missouri and for MO midwives. The Supreme Court found that AMA (American Medical Association) had no standing in the case and set aside their appeal that blocked the new law. Wow. How this will all play out, I have no idea, but this decision is huge. You can also read about it at Big Push. Now the real work begins: how will CPMs be regulated, and by whom?

AMA - WTF?

Okay, so I grieved for all of three days. The rest of this time I've been prepping for my summer job- teaching OB/Peds nursing at a local college. This should be an adventure. I'm also finishing my powerpoint for next month's presentation on Maternal Child Health During a Disaster. I'm looking forward to visiting Las Vegas, but I'll be stressing about my students since school will have started. Anyone hear what the AMA (American Medical Association) is up to in regards to homebirth? I would love to see some documentation on this if anyone has some links.

Flying from the nest...

We are having some great dialog on pay scales for midwives. I especially appreciated Molly's point. Consumers are mostly shielded from the true cost of healthcare by third party payers, so when something comes out of pocket (like homebirth fees) it feels like a lot more than it really is. I'll chime in a bit more later in case there are other comments. Right now I'm having a sad week because my 20 year old has left the nest. He caught a plane yesterday to Washington DC to do his summer internship. When he returns in August he will be attending college about 2 hours away. I miss him terribly already. His siblings are expressing their grief by moving into his old room already (he's only been gone 24 hours!). Let me lick my maternal wounds and I'll be back shortly.

Calling all midwives...

A commentor has got me thinking. She mentioned how midwives are compensated less than physicians, which got me thinking- should this be so? What parameters are used by midwives (of all types) to set their fees. Is it years of education, years of experience, the going rate for your community? The reason I ask is because I get the impression that doulas, midwives, childbirth educators and the like are expected to get less than 'market value' for their services.
So Dear Readers, who fall into these categories, don't leave me to my ignorant guessing. How do you feel about clients asking you to reduce your fees or even asking you to serve them for no fee at all? What criteria do you use to set your fees. Do you feel that you get fair compensation for the work you do? Midwives, should you be making less than your physician collegues? (I once saw a 60 minutes segment where nurse practitioners made a compelling case for charging the exact SAME fees as physicians.) Do you feel your service is valued by the community you serve and is that value reflected in the fees you recieve? (What about that good 'ol Americanism, 'you get what you pay for' where a higher value is assigned to a higher price tag?) Do you feel yours is a spiritual calling and therefore don't feel right taking money for it at all? I would love to hear your thoughts on this topic. Then perhaps I'll chime in from a nurse's perspective, but for now, the floor is yours.