Groups plan to challenge legalized midwifery

KANSAS CITY, Mo. -- Legislation allowing midwives to deliver babies at home in Missouri will likely be challenged in court by doctors' groups.

The measure was approved by lawmakers in May as part of larger health insurance bill signed June 1 by Gov. Matt Blunt. Most of the bill won't take effect until January, but the section on midwifery becomes effective in late August.

Opposition to the midwifery provision is led by the Missouri State Medical Association. The organization's lobbyist, Tom Holloway, said the group expects to file suit to block the provision next week in Cole County Circuit Court.

The association contends the overall legislation violated the Missouri Constitution's ban on bills containing multiple subjects. The title of the bill was "relating to health insurance."

"Midwifery and health insurance are two vastly different subjects, and the former clearly is not expressed in the bill's title," the medical association said in a statement on its Web site. "The deceptive amendment also violates a constitutional doctrine that prohibits amendments that change the original purpose of a bill."

Beyond the constitutional matter, doctors and hospitals have opposed the practice of midwifery as unsafe and fraught with liability problems.

Previous Missouri law made it a felony for home births to be carried out by anyone other than certain nurses working in collaboration with physicians.

"We think the [midwifery] provision is so broad it's a danger to the public's health and welfare, and we think the process by which it was passed was flagrantly unconstitutional," Holloway said.

The bill allows people with "tocological certification" to practice their craft. Tocology refers to obstetrics, and as several angry senators discovered after the bill was approved, was a term used with the intent of allowing the practice of midwifery in Missouri.

As introduced in the Missouri House, the bill dealt with expanding health insurance options for small businesses. Republican Sen. John Loudon, of Chesterfield, inserted the sentence about "tocological certification" while handling the bill in his chamber.

Holloway said the St. Louis Metropolitan Medical Society, the Missouri Association of Osteopathic Physicians and Surgeons and the Missouri Academy of Family Physicians are joining the lawsuit as co-plaintiffs. The American College of Obstetricians and Gynecologists will be assisting on the lawsuit.

Groups supporting midwifery criticized the likely legal challenge.

"There are so many other health-care issues that need attention in Missouri," said Samanda Rossi, area coordinator for St. Louis Friends of Midwives. "Why does the medical association spend so much time trying to criminalize my midwife and limit my access to the birthing service of my choice?"

Mary Ueland, legislative chairwoman for the Missouri Midwives Association, defended Loudon's insertion of the midwifery language into the bill.

"Anyone can look up the definition of 'tocology' and see that bricklayers and professional golfers are obviously not certified in tocology," Ueland said.