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Unda' the Rotunda

Let Loose the Midwives: Legislature considers midwife licensing


On the evening of Feb. 9, 2005, my wife and I went out for a stroll. We walked up Valencia Street in San Francisco's Mission District, got a potato samosa at our favorite Indian ice cream shop and returned home.

For the next 16 hours or so, some kind of birthing instinct took over our little apartment, steeling my wife for the awesome task of pushing out our daughter.

There are some things that we human Americans still know how to do on our own. And giving birth is one of them.

Most American women think they need a doctor to tell them they are pregnant. A machine to tell them how big their fetus is. A medical team to deliver their babies, and a candy company to make their baby food.

And American men, well, we never knew much anyway.

About 13 hours into her labor, I stuffed my wife in the back of our car and drove a few blocks to the hospital. When we got there, she was presented with a raft of paperwork and a preemptive IV hookup.

Thanks, docs, way to ruin the mood. She's not sick. She's just pregnant.

We declined the tape-on needle, put the clipboard aside and waited for our midwife to arrive. As the birth progressed, two midwives attended to us, creating a bubble of calm that stretched about 5 feet. Outside the bubble stood a very competent pediatrician and a nurse whose institutional training should have been subtly broken down with each natural push. They could hardly contain their contempt for our little bubble.

We had our first baby on a mat on the floor of a hospital room with a veteran midwife who was a nurse with a master's degree to boot. Yet the "traditional" hospital staff could not stand the thought of it.

Across Idaho, there are dozens of midwives delivering hundreds of babies a year. Some of them have professional training. Some have lay training or apprenticeship experience. For the second year now, they are asking the Legislature to offer a state license for their profession.

The midwives give a few reasons for the request: They want to be able to carry some key drugs to births, to submit insurance claims, to make childbirth in Idaho safer and give prospective parents more choices.

But the move to set up a midwifery board is also a play for legitimacy. While obstetricians and maternal fetal medicinists consider themselves "traditional" birth attendants, that has not been the case for very long. Hospital birth has been status quo for less than 100 years.

And midwives still deliver babies all over the world, often getting as good if not better results than U.S. doctors. The United States is ranked 28th in the world for infant mortality rates, and 15 other nations have fewer mothers die in childbirth.

The growing popularity of midwifery and other alternative childbirth options in the United States has caught the attention of hospitals. Many hospitals, including St. Alphonsus Regional Medical Center in Boise have established posh birthing centers with nurse midwife attendants, saunas, massage therapists and beepers for baby daddies, seeking to emulate the experience of having a child in the comfort of the home.

So midwives in Idaho understandably want to keep their piece of that action. The authentic piece. The Idaho Midwifery Voluntary Licensure Act sets up standards for midwives in the state, defines a broad list of medicines licensed midwives would be able to administer and lays out disciplinary actions for bad midwives.

The Idaho Medical Association opposed the bill last year and will try to block it again this year.

"We have very strong concerns about this legislation, and they do center on patient safety," said Susie Pouliot, CEO of the association who helped defeat similar legislation in Wyoming last year.

Chief among the doctors' complaints is the voluntary licensing. The Idaho Midwifery Council decided that the license should be voluntary since there are already established midwives legally practicing in the state.

Doctors argue that gives the license few teeth.

"They're only saying regulate some of us for certain things," Pouliot said.

Rep. John Rusche, a Democrat on the Health and Welfare committee and a pediatrician from Lewiston, says that midwives offer lots of value but the voluntary licensing concerns him: If the board strips a midwife of her license, she can still go deliver babies the next day, he argues.

But Pouliot acknowledges that even if the licensing were mandatory, docs would still have concerns about midwives' training.

Rep. Margaret Henbest, a Boise Democrat and nurse practitioner, said her trade went through the same thing years ago. Nurse practitioners were highly trained and serving a key public need but were seen as stepping on doctors' toes with their stethoscopes and prescription pads.

But Henbest also thinks a professional license for midwives or any other trade should be mandatory.

"This compromise they've made with their own rank and file is a mistake," she said.

The perception is that most women using midwives in the state are highly educated and slightly hippie, but the coalition backing the voluntary licensing is anything but.

Rep. Paul Shepard, a Riggins Republican who owns a sawmill and has nine children, calls the bill a "truth in advertising" measure. Shepard had his first four kids at St. Luke's Boise Medical Center, the next two at home with a doctor and the last three he caught himself after the wife had him take a natural childbirth class.

"I think we shouldn't live in fear of everything we do," he said.

The bill's sponsor, Janice McGeachin, an Idaho Falls Republican who does not like excessive government regulation, said the voluntary nature of the bill will lend midwives who choose to get a license more credence with consumers.

"The unlicensed ones won't be able to provide the higher level of service," she said.

During a hearing last week to introduce the bill, Paula Wiens, a certified professional midwife at Treasure Valley Midwives, listened in.

Wiens assured the House Health and Welfare committee that the main purpose of the bill is to allow women who choose to have midwives deliver their babies access to things like oxygen and stitches—items that midwives are not currently authorized to provide.

Wiens, coincidentally, will likely deliver our second child soon after the Legislative session ends. We hope to have the baby at home.

Anybody have a mat we can borrow?