Thursday, October 31, 2013

Legalization without regulation - midwifery in Missouri

Recently we became aware of the tragic death of a baby at planned home birth in Missouri. A Missouri CPM took on the care of a woman expecting twins, and one of the twins died due to a cord prolapse during the birth. You can read this story here:

Midwives practiced underground for many years in Missouri, the practice of midwifery was explicitly illegal, and any midwife openly practicing was arrested and investigated for breaking the law. Read this story about how not only midwives, but clients used to conceal the identities of their midwives when planning home births.

In 2007, Missouri legalized the practice of midwifery. But as of today, midwives practicing home birth in Missouri do not have licenses - the state has virtually no oversight or regulations over the practice of midwives.

The law stipulates that if one holds the NARM credential, one may legally practice midwifery.

This is very, very little oversight or regulation of a 'profession' that holds the lives of women and their children in their hands.

Presumably, the legalization of midwifery in Missouri allows midwives to attend any and all births that they deem appropriate for OOH care. Like a twin birth.

And when a birth ends tragically with the death of a baby in a state with no licensing, what is the recourse for the midwife? 

Is her license reprimanded? No, she has no license.
Does a professional board evaluate the midwife's practice? No, there is no professional board.
Do her malpractice insurance premiums increase? No, she is not required to carry malpractice insurance.
Does she lose her credential from NARM? Possibly, though NARM appears to be more interested in promoting midwifery than disciplining dangerous midwives.
Or does she keep on practicing like nothing ever happened, because the state allows this, because there is no oversight?

We've heard the nonsensical argument from some Michigan midwifery advocates that legalization of midwifery should be pushed for, not licensing.  We believe Michigan women and their families deserve better than a state-sanctioned free-for-all in the realm of midwifery where any form of risk-factor (breech, twins, VBAC, post-dates) can be "supported" in the out-of-hospital setting, and legally attended by midwives who can wash their hands of the responsibility when there is a bad outcome.