Home birth supporters return with new midwifery measure

Thursday, February 7, 2008

JEFFERSON CITY, Mo. -- Home birth supporters returned to the Capitol on Wednesday in yet another bid to legalize lay midwives -- this time without the late-night maneuvers that briefly cost a top Republican lawmaker his Senate leadership position.

A bill sponsored by Sen. John Loudon, R-Chesterfield, would create a state licensing board to monitor midwives who help women deliver babies at home. Similar efforts to loosen the state's midwifery law -- one of the nation's most restrictive -- have been pushed for nearly two decades.

Last year, lawmakers unwittingly approved a lay midwifery law after Loudon inserted an obscure medical term into a broader health insurance bill during the legislative session's frantic final days. The measure was signed by Gov. Matt Blunt but has since been overturned by a Cole County judge. An appeal to the state Supreme Court is pending.

Senate President Pro Tem Michael Gibbons responded to Loudon's tactics by removing him as chairman of the Small Business, Insurance and Industrial Relations Committee. He earned the job back by promising to push a bill repealing the law allowing those with private "tocological certification" to offer pregnancy-related care.

Tocology is a synonym for obstetrics, coming from the Greek root word of childbirth.

On Wednesday, the Senate Pension, Veterans' Affairs and General Laws Committee considered two Loudon bills -- one to repeal the midwifery law, and the other to create a state licensing board to monitor midwives -- but took no action. Loudon did not attend the hearing because of a family emergency.

Under the licensing bill, midwives would have to provide prospective parents with a written disclosure outlining their training, liability insurance coverage, benefits and risks of a home birth, and plans for emergency transport should complications develop.

To renew their state licenses, midwives also would have to take 10 hours of annual continuing education, three hours a year of peer review and maintain current certification for resuscitating infants. They would be prohibited from prescribing drugs and from medically inducing labor.

"There are many families that want an alternative to what's considered the mainstream, or the medical model of care," said Dr. Laurel Walter-Baumstark, of Hermann, who gave birth to her own five children at home. "Midwives have been serving families [in Missouri], but they've done it as felons. They've done it underground."

While home births in Missouri aren't illegal, the practical hurdles are considerable.

Doctors who deliver at home, or who work with lay midwives, face losing malpractice coverage and hospital privileges.

And under current Missouri law, midwifery is a felony crime, punishable by up to seven years in prison when practiced by anyone other than certain nurses working in collaboration with physicians.

Representatives from the Missouri State Medical Association and other doctors' groups have previously opposed decriminalizing midwifery. Dr. David Redfern, a Springfield obstetrician and gynecologist, said Wednesday that the latest proposal lacks several key provisions, including a requirement for mandatory liability insurance.

Home birth supporters said that such a requirement effectively would kill the proposal, because midwives are unable to purchase coverage in Missouri.

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