Sunday, June 29, 2008

Legal in Missouri

Article from my local paper:

Missouri law delivers good news to midwives
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.”

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