Top court reinstates midwifery law

Wednesday, June 25, 2008

JEFFERSON CITY, Mo. -- The state Supreme Court has reinstated a law letting certified midwives work in Missouri without fear of potential criminal charges.

The 2007 measure legalizing the trained but unlicensed practice of midwifery had been struck down by a Cole County judge. She ruled it violated the state constitution, because the midwives provision was unrelated to the bill's titled subject of health insurance.

But the Supreme Court overturned that in a 5-2 decision Tuesday.

The court's majority said the Missouri State Medical Association and three other medical groups had no legal standing to sue in the first place.

"This is a great day for home-birth families and personal freedom," said Sen. John Loudon, R-Chesterfield.

Loudon sneaked the midwifery provision past legislative opponents by inserting an obscurely worded section into the health insurance bill he was handling. His measure superseded an existing law subjecting midwives to felony charges punishable by up to seven years in prison.

Despite that threat, Missouri already has a network of unlicensed midwives who deliver babies, often in mothers' homes.

Until now, Missouri was among 10 states and the District of Columbia that prohibited "direct-entry midwives" -- those who enter the profession directly without medical or nursing degrees, according to the North American Registry of Midwives.

Doctors groups predicted dire consequences as midwives gain new freedoms in Missouri.

"That's just bad news for the patients," said Tom Holloway, a lobbyist for the medical association. "The way this law is written, any person that has some sort of very undefined certificate to practice anything related to child birth is going to be able to provide unlimited services related to pregnancy -- C-sections, drugs, epidural anesthesia and even abortions -- without any state regulation or oversight whatsoever."

Loudon called such assertions a "serious misinterpretation" of the law. Midwives generally aren't trained to do epidurals, Caesarean sections or abortions and wouldn't be approved to do so from the private, national groups that issue certifications, he said.

The doctors groups that sued claimed that allowing unlicensed midwives to practice medicine could put physicians who cooperate with them at risk of professional discipline. They cited existing state laws allowing the Board of Registration for the Healing Arts to discipline doctors who aid others in the unlicensed practice of medicine.

But the Supreme Court said that argument overlooks the fact that the 2007 law exempted certain privately certified midwives from the prohibition on practicing medicine, and thus freed physicians from potential discipline for aiding or encouraging them.

"This court holds, therefore, that plaintiffs cannot predicate standing (to sue) on the perceived risk that their physician members will be subject to discipline," Judge Stephen Limbaugh Jr. wrote for the majority.

In dissent, Judge William Ray Price Jr. said the physicians groups did have the legal standing to sue. He based that on their claim that the use of midwives would result in an increased need for emergency health care and thus affect both the physicians' medical practice and the health of their patients.

Price said he would have upheld the lower court ruling striking down the law. He was joined by Judge Patricia Breckenridge.

Joining Limbaugh in the majority were Chief Justice Laura Denvir Stith and Judges Richard Teitelman, Mary Russell and Michael Wolff.

The Supreme Court heard arguments on the case in March. While awaiting its decision, midwifery supporters and physicians groups attempted to negotiate a compromise measure that would have repealed the 2007 law and set up a state licensure system for midwives. Although a bill cleared the Senate late in the legislative session, it never came up for a House vote.

The physicians groups had an advantage in those negotiations, because the status quo at the time was that the law had been struck down. But Holloway acknowledged the advantage had shifted to midwifery supporters with Tuesday's court ruling.

"We have always wanted to sit down with the doctors and work out a bill that everyone can agree on," Loudon said. "That hasn't changed. The only thing that's changed is now they have an incentive to come to the table."

Case is Missouri State Medical Association v. State of Missouri, SC88783.

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