Home birth supporters seeking legalization of midwifery in Missouri

COLUMBIA, Mo. -- Sarah Linsenmeyer never thought she would have to risk aiding a criminal to become a mother.

When daughter Willa, now 5, arrived via Caesarean section in a traumatic hospital birth, the 36-year-old former social worker was determined to greet her second child on decidedly different terms.

So 16 months ago, Linsenmeyer and her husband filled a converted cattle stock tank with warm water, perched it on their backyard deck and, with the help of a Columbia doctor who specializes in home births, welcomed baby Pearl to the world surrounded by friends and loved ones. The birth proceeded without a hitch.

Yet had Linsenmeyer relied on a lay midwife to deliver Pearl, her postpartum bliss could have been interrupted by sheriff's deputies and child protection workers ready to declare her an unfit parent -- as was the case for another Columbia mother 15 years ago whose delivery was supervised by a Lake of the Ozarks midwife.

Since 1959, when midwifery in Missouri was classified as the improper practice of medicine, home birth parents and practitioners have lived under a cloud of deceit, the specter of legal punishment tarnishing what they call a natural, life-affirming process that doesn't always require medical intervention.

Efforts to loosen the Missouri midwives law -- one of the nation's most restrictive -- have percolated in Jefferson City since at least 1989. Bills to decriminalize lay midwifery have passed the state House at least five times, most recently last year, before dying.

A similar effort is underway in the new legislative session that began last week, with bills in both the House and Senate.

This time, supporters hope an unusual alliance of backers -- a coalition that includes college-town feminists, pro-life lawmakers and Mennonite farmers -- will make the difference.

"I thought it would be a certain kind of person," said Elizabeth Alleman, the Columbia physician who attended Linsenmeyer's birth and by her own estimation has delivered nearly 400 babies at home since 1990.

"It's young people who wear tie-dyes and dreadlocks and university professors and doctors and evangelical Christians," she said.

The midwifery bill's House sponsor is Rep. Cynthia Davis, R-O'Fallon, who bills herself as one of the capital's most "pro-life" lawmakers. A veteran of seven C-sections herself, Davis calls the issue a matter of women's rights as well as excessive government regulation.

"We have effectively eliminated all the practitioners," Davis said. "That's state government going too far."

Home births in Missouri aren't illegal -- the state Department of Health and Senior Services recorded 719 out-of-hospital births in 2004, or fewer than 1 percent of all live births that year.

But the practical hurdles to home births are considerable. Doctors such as Alleman face losing malpractice coverage and hospital privileges.

Alleman said she knows of just two other physicians -- a second in Columbia and one in St. Louis -- who deliver babies at home.

State law allows certified nurses trained in midwifery to deliver at home, provided they have the approval of an affiliated doctor located within 30 miles. According to Alleman, there are just two such nurse-midwives statewide.

In response to objections raised last year, the new legislation requires lay midwives to be certified by the North American Registry of Midwives and provide prospective parents with a written disclosure outlining their training, experience, liability insurance coverage and plans for emergency transport to a hospital should complications develop.

The House bill, along with a companion bill filed by Sen. John Cauthorn, R-Mexico, requires lay midwives to have attended at least 40 births at home or in "other out-of-hospital settings." They must also take 10 hours of annual continuing education, three hours a year of peer review and maintain current CPR certification.

Opponents call the proposed legislation an improvement, to a point.

Tom Holloway, a lobbyist for the Missouri State Medical Association, criticized the legislation for failing to include any provisions outlining penalties for midwives who fall short of those requirements or who commit medical neglect.

"There's no way to hold that person accountable," he said. "It's just not enforceable (if something goes wrong). There must be rigorous training. We just can't afford to lower the standard of care for childbirth."

Home birth advocates call that a double standard.

"If there's a bad outcome at the hospital, the presumption is everybody did the best they could," said Alleman. "If there's a bad outcome at home, the presumption is somebody committed a crime."

The bill has 15 co-sponsors in the House. And unlike in previous years, the bill has a Senate sponsor, supporters noted. Gov. Matt Blunt has not taken a position on the legislation, a spokeswoman said.

On Sunday, about 70 home birth parents, infants, toddlers, teens, doctors and midwives rallied at the Boone County Courthouse. On Tuesday, midwifery supporters came to the Capitol, part of a lobbying effort Linsenmeyer called "women in skirts versus men in suits."

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Midwifery bills are HB974 and SB637.

On the Net:

Legislature: http://www.moga.state.mo.us