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Wednesday, February 07, 2007Midwife AmendmentsBy SB 243, Direct-Entry Midwife Amendments, has received a lot of attention. Unfortunately, I believe some of the effects of the bill have been misrepresented. The bill does not eliminate the option of direct-entry midwifery. It does clarify parts of a bill passed two years ago which allows for legal use of a midwife. It defines what is a normal birth and clarifies exactly when a consultation or transfer is required. When a Family Practice Physician is involved in caring for a pregnant woman, there is a clear protocol which explains when the physician needs to seek consultation from a specialist. SB 243 does the same thing for midwives. I had a nice talk about this bill with Jenny Black on Senate Radio.
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20 Comments:
That's funny, the rules in the Midwive's licensure already deals with that sufficiently and according to standard practices of licensing in the state of Utah and acceptable national standards.
Why further restrict a woman's freedom of choosing when, where, and with whom to give birth? I think every woman in Utah should be concerned about your bill, whether they choose to have a hospital birth or home birth.
Your bill also makes it harder for these direct entry midwives to safely practice.
- Jeff Tulley, father of three children born at home, believer in personal freedom.
This Bill DOES stop ALL Direct Entry Midwifery. It DOES apply to all midwives Licensed or not, and will also effect the Birth Center because it defines birth to the point of "not normal". In addition the Utah Medical Association has refussed to comprimise in any way, and disagreement does not mean we are wrong. Our numbers speak for themselves. We are safe, we are not under the Medical board, and once again the UMA is sticking it's foot where it does not belong.
I strongly oppose this bill!
Tara Tulley CPM, LDEM
Research has never proven that hospital births are safer for women with uncomplicated pregnancies.
On the contrary, the Utah Department of Health reviewed planned homebirths in the state of Utah from 1992 to 2005 and concluded that “complications of labor and delivery” were “far less common in home births than in all births,” and “lower rates of adverse birth outcomes were observed among home birth newborns compared to all newborns.”
These conclusions re-affirm peer reviewed research, such as the June 2005 British Medical Journal study involving 5,418 women with planned homebirths in 2000, the September 1998 Journal of Obstetrics and Gynecology involving 1404 with planned home births in 1994-1995, and the meta-analysis in a March 1997 issue of Birth which involved 24,092 women and several home birth studies. All of these concluded that home birth is a safe, viable alternative to a hospital birth, and all of them concluded that home birthing mothers experience fewer interventions, such as episiotomies and c-sections.
Since medical personnel who oppose home birth have no evidence to back their claims of endangerment, one may conclude that they are simply trying to protect their territory. We submit that a more effective approach might be to adopt the practices of midwives which make home birth so attractive, such as spending more time nurturing pregnant mothers and coaching them through their labors.
You say "The bill does not eliminate the option of direct-entry midwifery."
I concede that; however, it *would* have eliminated 96% of last year's homebirth clients from being eligible for homebirth under a direct-entry midwife (licensed or not). Those women (who would not be allowed to use a direct-entry midwife under this bill) had excellent outcomes, as evidenced by the recent report of outcomes - http://www.dopl.utah.gov/licensing/de_midwife_outcomes.pdf
SB243 restricts direct-entry midwives from attending the births of women who have ever had babies bigger than 8 pounds 13 ounces. My second son was born at home. He was 9 pounds 3 ounces. I am 5'3", and approximately 110 pounds pre-pregnancy. My size and my baby's size have nothing to do with homebirth safety. The birth of my first son (8 pounds, 8 ounces) in the hospital was much more difficult than the birth of my second son at home.
There are many other ultra-restrictive and broad conditions in SB243; I have discussed only one of them.
Katie Doyle
katiedoyle@byu.net
No, this bill does not eliminate the choice of homebirth - it just makes the guidelines so restrictive that that almost no one is eligible. I believe that is the intent of this legislation - to eliminate homebirth by risking out almost all women by statute. Some of the restrictions are valid, but are already in place by DOPL rules. Others are just plain ridiculous - history of GBS in past pregnancy.
The Direct Entry Midwives already have a solid bill that went up unopposed by the Utah Medical Association two years ago. The midwives have a rules committee and are practicing in accordance with those rules. The first year reporting showed remarkable statistics. Hospitals, doctors and the UMA (should be) are embarrassed, they know that future reports are going to show that practicing medicine during birth is dangerous and midwifery model of care is superior in outcome for both mothers and babies.
I would have not been eligible for a homebirth based on baby weight that this new bill is proposing. The only way I was able to have an intervention free birth was to go home. I had interviewed several doctors and my doctor promised me to allow me the give birth the way I needed to, but then controlled the outcome entirely. My homebirths changed me as a mother, a parent and as a woman. No one has the right to legislated how where or with whom I give birth, the least of which the Utah Medical Association and Sen. Margaret Dayton who has in her own right a very personal stake in this seeing as her husband is an obstetrician.
I am a mother of two--both hospital births. I am not a midwife nor do I have any relatives who are midwives. But I am a concerned person who finds it highly unsettling to see the rights of Utah's women so trampled upon.
Whatever happened to the limited government and freedom the Founding Fathers fought so long and hard to ensure?
Utah's licensed midwives already have clear rules in place which define which clients they must refer. But they would be so excessively regulated by this bill as to make their practices virtually impossible to maintain. Somehow what is being defined as "normal" only includes a very small percentage of pregnancies. And that fact severely limits the freedom of choice of all of Utah's mothers.
I am concerned that Senator Dayton and those responsible for this bill have so little faith in mothers. I am concerned that they do not respect women enough to expect that they can make responsible decisions for themselves and their babies. Even if you disagree about the safety of homebirth, it is not your place to infringe upon mother's rights and require that they do what you may think is best. You say you are not restricting women's rights to choose, but the ramifications of this bill will do exactly that.
Thousands of unnecessary c-sections and other questionable medical interventions occur every day in hospitals in this country--putting mothers and babies at increased risk. So do not tell me that you are doing this out of concern for safety. If the medical community was really concerned about safety, hospitals would completely revamp their policies and most obstetricians would completely revamp their practices. We aren't so behind in the world's infant and maternal mortality rates because we've been making the safety of mothers and babies a priority. We certainly haven't made it a priority.
The issue here is not whether hospital or home is the safer place of birth. And I don't believe that is why the bill was initially created. The issue here is will we uphold freedom and have respect for the women and mothers of Utah, or will we trample upon their freedoms by essentially legislating their place of birth because we feel that they are incapable of acting responsibly?
I too am outraged at this bill. I am the mom to a baby girl born at 34 weeks, weighing 2 pounds 13 ounces, by C-section.
I believe in freedom, less government, and less regulation.
I am amazed that because of conditions specific to that pregnancy I will not be able to home birth. Even if my next pregnancy were to be determined to be a healthy and normal pregnancy, I would not be allowed to home birth as I have a prior c-section, premature birth, and a small baby.
For the record, I would never choose a homebirth for myself, however I am a strong supporter of those who wish to birth at home. I want my daughter to have the ability to chose where she wants to birth, at her home or at the hospital. I also want her to be able to have a trained attendant at that birth, and I feel that this bill will make midwifery so restricted a woman will have to chose between birthing unassisted or birthing in a hospital.
I listened to the interview with Sen. Dayton. She makes the point that family doctors have guidelines on when to refer/consult HOWEVER this is not written into Utah State statute. These guidelines are set as she stated by governing bodies over the doctors. Is this bill the start of turning all governing bodies rules into law? In the future will my OB next have to refer me to a specialist solely because they law requires her too?
I am opposed to this bill as I feel it is one more regulation over the citizens of Utah. I want less government intrusion into my life not more.
The original bill created lawful requirements for being a midwife. I fully believe that trained and educated people can make the correct decision. Some of the proposed restrictions on home birth are currently blocked by the DOH rules over midwives. There are many situations where a home birth would be irresponsible, and I feel the DOH and DOPL rules do a fine job of covering these.
It appears to me that the guidelines make nearly all pregnancies "not normal". One of the beliefs of midwifery is that pregnancy is a normal process not an illness or disease. I took an informal poll in my office, all the women would have been risked out of home birthing at some point because of a condition which arose in their pregnancies, mainly the upper weight at birth.
I feel this bill is unneeded and intrusive.
Wow this in outrageous!!
I am planning a homebirth with an amazing midwife this summer. My last homebirth was an amazing experience that could not even be touched by a hospital setting and my baby was a healthy 9lb 15oz. Why is it that my choice to give birth in what I feel a safer environment such a hassle because of ignorant lesgilative people who don't understand the power of a woman having her child at home?
Drop this bill and let women have a safer birthing option OUTSIDE a hospital setting!
This bill describes a first-time mother, who has no history of any genetic abnormalities, is in impeccable health, 5'5", 125 lbs, blah, blah, blah! What does the Utah Medical Association expect us all to be? Barbie?! Which in any case Barbie would follow in the steps of Britney Spears and go to the hospital for a C-section so as to not damage her perfect vagina.
Guess what Senator Dayton? None of us have perfect health, or perfect bodies and just by that puts us in a high risk category. Good grief!!! Us women are not dumb, we understand this new amendment perfectly and we understand UMA's intent.
I swear if this passes I'm taking my GBS diseased, hypothyroidism body that births BIG healthy babies and going Unassisted!
This bill is ill-conceived, unnecessary, and harmful to Utah's women. It will make homebirth LESS safe rather than safer, for those few who would still be able to access care through a homebirth midwife.
Homebirth has been shown, in study after study, to be as safe or safer in the majority of circumstnaces for the mother and the baby as compared to birth inside a hospital. The recent numbers collected by the state of Utah confirm that these favorable statistics are true here as well -- women having babies with direct entry midwives have fewer complications and "healthier" deliveries than those in hospitals.
This bill therefore makes no sense. If it's goal is to make homebirths safer for women, it will certainly backfire. Women may choose to forego certain tests to avoid being "risked out" of a homebirth (such as gestational diabetes testing), they may be forced to lie or hide their past medical histories from their midwives, or they may choose to go unassisted rather than be forced into a hospital setting when it is not necessary. The number of qualified, expert, direct entry midwives will also drop, since there will be fewer and fewer clients that fit the perfect model of health that the bill requires for a homebirth.
Direct entry midwives are experts at what they do, and their fabulous statistics for the health of the mother and baby show that to be true. These midwives are fully capable of making wise and sound decisions about whether a particular woman, based on the nuances of her particular circumstnaces, medical history, nutrition, temperament, etc., should be transferred into the care of an OB. Forcing every client of a midwife into a matrix of health risks, based not on the individual health risks of the patient, but based on generalized legislative categories, is not the way to practice safe and effective health care. There are many women over 35 who are much better candidates for homebirth than some 24 year olds. That number alone should not trump. Neither should something like GBS status, and many of the other "risk factors" listed in the statute. Risk factors are a living, moving target, and should not be treated as hard and fast rules. No OB is expected to practice in that way, and no midwive should be forced to do so.
Having my baby at home was one of the best parenting decisions I have made. I will continue to have my babies at home, unless, based on my own and my midwife's judgement, something should arise that would make that homebirth less safe. But the decision should be mine and my health care providers...not someone in the state legislature.
This bill should be soundly rejected as harmful to women.
This post has been removed by the author.
Am I to understand that as a woman I am too stupid to make my own decision in birth matters? That because my body doesn't fit into a specific mold I have been rendered incapable of selecting a home birth?
This bill smacks of misogyny of the most backhanded kind. I resent the implication of intellectual incapacity by virtue of pregnancy. I am urging my senator to ignore this specious bill.
I am a mother of six grown children, all hospital births, and a grandmother of 12-and-counting grandchildren, also hospital births to this point, but I am outraged by this bill, on principle. I defend other women’s freedom to plan, with their families, the best scenario for them.
This bill MUST NOT pass! It is an ALARMING affront to the intelligence of women, and is EQUALLY ALARMING in its usurpation of one of the most basic of human rights--excluding ALL BUT A FEW from the freedom to make a very personal decision: where, how and with what kind of trained personnel to experience childbearing.
Sen. Dayton--a former labor and delivery nurse -- and those of the UMA who helped write this bill, have not done proper research into modern midwifery and home birth or are unwilling to accept the statistics that conflict with their prejudices.
This bill will do more harm than good.
May I ask exactly what the intent behind this proposed bill is? Who is benefitting from it? Whom does it protect? What is your personal interest in proposing further limitations? What research have you done on the unbiased benefits of home birth vs hospital birth?
Have there just been a grossly overwhelming amount of home birth mishaps and midwife misjudgments that warrant further investigation?
In preparation for the birth of my first child this year, I read MANY books and watched MANY videos, visited birthing centers, 3 hospitals, interviewed 2 nurse midwives and one DCEM. In a short period of time my husband and I were able to determine, without a doubt, that a home birth was the best option for us and our baby. If I recall correctly, an officer of the World Health Organization said that the US would have better infant/mother mortality rates in childbirth if they gave the vast majority of normal pregnancies to trained midwives (and empowered that network of skilled professionals).
Contrary to popular belief, skilled and trained DCEMs have just as much interest in their clients' safety as anyone else and are all about risk-prevention.
My midwife was excellent, competent, amazing, wonderful.
So, after having given birth at home, I am quite certain that IF, due to these proposed restrictions I am 'prohibited' to do so in the future, what I would like to know is:
Would my future OBGYN have the time and patience to massage my perineum during delivery to help prevent tearing?
Would my future OBGYN sit with me while I labor for 15 hours or so, allowing me to move around as I please, to ensure MY comfort?
Would my future OBGYN allow me to deliver in a birthing tub, where I am most comfortable, and allow me to eat and drink during the process if that was what I wanted to do?
Would my future OBGYN answer my phone calls any time of night or day for the next 6 weeks or so to any questions I have about my body's postpartum healing process or give motherly advice about caring for my child?
I am just wondering...
I have three suggestions for lawmakers and citizens considering this issue:
#1 read Henci Goer's "The Thinking Woman's Guide to a Better Birth"
#2 why don't we consider each mother on a case by case basis before ruling out homebirth. This would be as easy as employing something like a modified Hobel scale (see
http://www.obfocus.com/questions/qanda13.htm)
to assess whether or not women should homebirth. Instead of listing all kinds of crazy limits, why not just require midwives and mothers to assess risk within a numerical given limit. And then, like all other advice, the mother can decline or take the advice. Perhaps the ultimate responsibility should be with the mother. (Makes sense since it is her body. Since the Supreme Court guaranteed her right to an abortion, I think it would probably hold that she has a right to decide how she gives birth. Though a legal fight might be interesting.) You can have every mother fill out, sign, and file a Hobel scale/waiver if you want, acknowledging that she understands her particular risk profile. I do take issue with someone else deciding for me what intervention/medical care I need. I have studied it well and I don’t take anything lightly. I see risks at home, in a birthing center, and in a hospital. Each mother needs to know very well what her risks and options are.
#3 I would like some definitions:
Does GBS disease mean that the mother is simply a carrier or that she or a previous child had an active GBS infection?
On what measure is the weight limit placed?
The following article seems to indicate that 4000g is somewhat arbitrary.http://www.aafp.org/afp/20010115/302.html
Just for the record, my last baby was born at the Birth and Family place, was 9#2oz and was born with her hand first. Thanks to a well-trained, amazing midwife, neither I nor the baby experienced any trauma. She coached me so well through 2nd stage that I didn’t tear one bit. I was leery about having a midwife at first but that won me over forever. Unless I have a huge emergency, this is the way for me. Not maybe for everyone, but for me. And I think my husband and I should be able to make that choice, not someone in the State Legislature. Again, if the constitution guarantees me the right to choose to abort my baby (which I don’t agree with but nonetheless it is law), it must in turn grant me the right to choose how my baby is delivered
Let’s lose the emotions and turf wars and talk about reality. Many women within a close distance to a good hospital can safely birth at home and it is much more economical and less stressful. My first two children were born in hospitals, the third in the birthing center, and the fourth will be at home. (Thanks to the deliberative nature of the legislative process, I’m not worried about this particular pregnancy.)
In sum, I suggest putting together a modified Hobel scale and require all mother’s fill it out, have all risk factors adequately explained to them (the suggested review board can even make their own education material explaining possible complications of each risk factor and require that the mother read and sign off on each), and then let the mothers decide. Honestly, most decent midwives won’t deal with most of that stuff anyway. It’s out of their realm and they know it. I have come to understand that midwives have a place in the childbirth process and the most important thing is to have them trained, licensed, and available to all women who qualify for and choose their services. That way, you ensure that the women who do choose midwives receive adequate care.
Sincerely,
Rebecca Watt
I am dismayed about this bill. I have 6 children. The first one was with an OBGYN. The next four were with midwives at the hospital. The last one was a home birth in a birthing tub. All but 2 of my children were over the weight limit allowed by the bill. I have run the gamut of types of births, except C-section. My last daughter's birth at home was by far the best one of them all. Please don't pass this bill.
Outcome statistics for homebirth speak for themselves. Homebirth is a safe,informed choice and one that the residents of Utah deserve to make for themselves. Sadly, the only thing that this bill looks at is the bottom line..Doctors don't make money from homebirths and they make more money from c-sections. The midwife bill has worked great for the past 2 years...if it aint broke, don't fix it!
The real question is why this bill is needed at all. Is there a big problem with home birth's being unsafe? The objective answer is no. Therefore as a legislator you feel you need to take care of us because we must be too stupid to do it on our own or you need to make a name for yourself somehow by sponsoring a bill.
You call yourself a Republican and you come from the most conservative county known to man but you're nothing but a big government liberal at heart. Step 1. Invent a problem to make people afraid Step 2. Pretend government can solve that problem 3. Take away freedoms to further your own power.
Unfortunatly we've seen more of the same from so-called conservatives at every level of government. Get out of our lives--we don't need you to run them.
I made the mistake of assuming that this bill would be debated on its merits. The bill, instead, has been debated publicly and in the media as a bill against home births.
I do not oppose home birth.
Home births have always been part of our Utah Culture, and I expect that they always will be.
I acknowledge that not only does home birth allow choice, home birth options also provides some level of care for some communities (the polygamous community and others for example) that may not otherwise have care.
So again, I state that this bill does not eliminate home birth as a choice.
So what does SB243 do? SB243 addresses licensure.
Two years ago, for whatever reason, a small group of Direct-entry midwives (one of three levels of functioning midwives in our state) asked for – requested – even pleaded and lobbied for licensure from the state. Licensure involves state regulation and oversight. Whether the licensee is a beautician, an attorney, a contractor or a chiropractor, any group that is licensed has regulation and oversight and a definition of practice. SB243 defines scope of practice for direct-entry midwives which was not fully defined at the time Direct-entry midwives requested and received licensure.
When this small group of direct-entry midwives asked for licensure, many other midwives who preferred to remain under the radar were resentful of the attention brought to home deliveries.
This bill affects only that small group of direct-entry midwives who are Licensed. This year’s licensure clarification bill, SB243, has been portrayed by the dozen or so direct-entry midwives affected as an elimination of home birth as a choice for Utahns. They have stirred up the home-birth community to attack this bill and its sponsor. I have been the target of some very unlady-like attacks.
I acknowledge that some of those mean-spirited letters to the editors and less than flattering emails were the result of emotions, and I bear no ill will. As a matter of fact, as I have visited with several of the midwives who have not asked for licensure, those who do not want licensure, and those who do not want attention brought to home deliveries, they have been frustrated to learn that SB243 was misrepresented to them, and the bill is now becoming more of a midwife vs licensed midwife bill.
I continue to seek for workable resolutions that meet the state’s obligations to those that it licenses.
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