Midwifery concerns

By Dr. Eric G. Morton

I read with some angst the article "Midwives, others applaud new law." State Sen. John Loudon of Chesterfield inserted the midwifery provision into a bill that was totally unrelated to the practice of midwifery, which was deceptive on Loudon's part. Midwives have been trying to get a bill passed by the Missouri Legislature for some time, and it was always defeated due to the weakness of the proposed legislation.

The language inserts by Loudon on Page 48 of House Bill 818:

376.1753. Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 r-6 (b)(4)(E)(ii)(I).

This section relates to pregnancy, including prenatal care, delivery and postpartum services.

This, essentially through the back door, got the midwifery language passed. Most senators had read the bill before it the midwifery language was inserted, and this is why the bill passed. Local legislators are against this midwifery bill and were unhappy to learn what had happened.

Mary Ueland, legislative chairwoman of the Missouri Midwives Association, stated that this kind of language is inserted every day. Senator Loudon wrote a letter of apology to his colleagues for his actions. From what I understand, he has been removed from his position as chairman of the Small Business, Insurance and Industrial Relations Committee.

There is another reference from Terry Aultman of Blue Springs, Mo., who is a registered nurse as well as a certified nurse midwife. Aultman says midwives differ from physicians because midwives go out of their way to help a mother fall in love with her baby and to be a good parent. This statement insinuates that I don't do everything I can to help mothers become good parents as well as deliver adequate prenatal and postpartum care. This is an insult to me and other physicians in Missouri.

I am not sure why Aultman feels this way, but I do everything in my power to ensure that the labor, delivery and postpartum process is what the mother and the family request. It is my most frequent wish to have the mother fall in love with her child and to be a good parents.

Aultman also says that if you mess with an animal giving birth that the mother will either neglect or hurt the baby. I have no idea where she gets this idea. We are not wild animals. We are human beings. If a mother is going to hurt her child, she is going to do this regardless of the birth process or place.

Aultman also says that in a health center women are required to stay 48 hours, which is expensive, plus there is a time when the mother is separated from her baby. At our local hospitals, mothers have all the opportunity in the world to have their babies in the room with them. There are times when the babies are removed for examinations by pediatricians, but the rest of the time the mother has the option of having the baby with her at all times.

Furthermore, there is no requirement for a mother to stay for 48 hours. There is a federal law that mandates insurance must pay for 48 hours for a vaginal delivery and 96 hours for a Caesarean section, but women can go home sooner if they feel comfortable and are stable and doing fine and if their baby is stable and doing fine.

There is another statement by Kirsten Frueh of Columbia, Mo., stating that it is difficult when you are at a hospital to get to know your physician on a personal level. As a physician, I make it a point when I see a patient in the office to extend my hand, shake her hand and call her by her first name. I got into medicine so I could get to know people on a personal level and so I could follow them for the rest of their health care, not just labor and delivery.

If Frueh's physicians are not this way, she should find a new physician. However, I believe most physicians are compassionate and caring and provide an adequate birth experience. They get to know their patients on a personal level.

Every woman in Missouri should have a right to choose the birthing method she desires. Certified nurse midwives are usually adequately trained and experienced and can handle most circumstances, including routine vaginal deliveries. My biggest concern would be if a complication should arise. Would a less-than-adequately trained lay midwife be able to recognize this and be able to get the patient to a hospital so she and her baby would receive the best outcome? I am not so sure that is always going to be the case. I think it is a large risk to take with someone else's life.

That is what you are doing if you have someone who is poorly trained. According to HB 818, someone who has ministerial or tocological certification should be licensed to practice midwifery. Essentially, this means practicing medicine without a license if your are not a certified nurse midwife.

I think this bill is bad for Missouri. Senator Loudon should be admonished for inserting this language into an unrelated bill and for slipping it through the system without adequately thinking about what is best for women. This bill is not about freedom. It is about looking at a small special-interest group that wants to practice medicine without a license or malpractice insurance.

Who is going to responsible for these mothers and these babies if a bad outcome occurs? It is going to be the physicians of Missouri as well as the hospitals. I want to go on record that I am adamantly opposed to the bill, and I hope the repercussions to women and their children are few.

Dr. Eric G. Morton is a Cape Girardeau physician at OB-GYN Specialists of Southeast Missouri.