Debate to mandate a license for Oregon midwives reignites af

[doggie]

This could ruffle some tail feathers but it should happen.

Nick Budnick, The Oregonian

Published: Sep 15, 2011 6:51 PM

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Randy Everitt, a top state health regulator, calls it "a hornet's nest."

Val Hoyle, a Eugene lawmaker, calls it "a hot mess."

The death of a Eugene newborn as well as pressure from the state medical establishment has revived the debate over whether midwives should be allowed to deliver babies without a license. Currently, 27 states allow midwives; only in Oregon and Utah is a license for midwives optional.

Half of the estimated 150 midwives in Oregon are licensed, an apprenticeship process that requires attending 45 births while under supervision, completing 40 hours of specialized training and passing a variety of exams. About 1,000 home births per year occur in Oregon.

Pressure to mandate licensing for all midwives has repeatedly collided with the sentiment that birthing is not state business.

The debate, however, is changing.

In July after eight days of labor, Margarita Sheikh of Eugene gave birth to a boy who had no heartbeat, according to mediareports. She blames the two unlicensed midwives who helped in the birth, saying they refused to send her to the hospital when she asked, and didn’t appear to know how to give infant CPR after the baby was born.

In an Internet post, she vowed to push for mandatory licensing. Sheikh did not respond to requests for comments. News of her case has even caused some licensed midwives to publicly call for change.

For years, Melissa Cheyney, a licensed midwife and Oregon State University medical anthropologist who chairs the state Board of Direct-Entry Midwifery, has not taken a position on mandatory licensing even as she's studied mortality rates and pushed for better reporting of birth outcomes.

Now, however, she thinks it's time to make licensing required. Sheikh's options to hold her midwives accountable are limited because the state can't investigate unlicensed midwives, says Cheyney, and "I can't really accept that anymore."

Similarly, licensed midwife Laura Erickson of Alma Midwifery in Portland says she no longer thinks unlicensed midwives should be left unregulated. And Colleen Forbes, a licensed midwife in Eugene, agrees with Cheyney that it's time for legislators to make licensing mandatory.

"As a feminist it's a really hard choice for me to make, because I don't think the government should have its laws on my body," says Forbes. "But I also think any provider that's providing that choice should be held to a certain clinical standard."

A crossroads

Studies have found low-risk home births to be safe: in fact, some have shown fewer complications than hospital births. Studies that include higher-risk pregnancies, however, have found home births to be less safe than ones attended by a medical doctor. Higher-risk births include breech births as well as when a woman has previously had a Caesarean.

Certified nurse midwives, who typically attend hospital births, are required to be licensed by the state Board of Nursing. It's the direct-entry midwives, who typically attend home births, at the center of the mandatory licensing debate.

Midwives who oppose mandatory licensing say it could drive some midwives underground, hurt access to training and restricting access to home births.

Home birthing has a devoted following based on skepticism of the medical establishment.

Sue Burns of Portland, manager of a small publishing company, said she intentionally chose an unlicensed midwife, one without access to drugs, to ensure the birth of her daughter last year was as natural as possible. Though she ended up going to a hospital for a Caesarean after 80 hours of labor, she said she's glad that option was a distant last resort.

Burns says mandatory licensing would make home birthing "much less accessible. It potentially could lead down the road to home births becoming illegal, or before that home birth becoming too expensive for people who don't have insurance to afford it. Midwives keep each other accountable and I just don't think the state needs to step in at this point."

Another factor in the renewed mandatory licensing debate: A flood of investigations has driven up costs and stress for licensed midwives, sparking fears that fewer will train to become licensed.

More than 40 complaints were filed against licensed midwives in the last year, compared to an annual average of six or seven in years prior, says Everitt, director of the Oregon Health Licensing Agency.

The complaints required the hiring of three new investigators, he adds. To pay for it, the state is boosting annual midwife licensing fees from $630 to $1,800.

The surge in complaints is partly explained by a 2010 law requiring medical professionals to file complaints if they have concerns over home births transferred to hospitals. But some midwives feel the medical establishment is using the complaint process to eliminate their competition -- reflected in a lawsuit Portland midwives filed against Oregon Health & Science University and the state last year. The case was settled out of court.

Ironically, the perception that any home birth transferred to a hospital will draw a complaint risks making midwives afraid to seek medical help, worries OSU professor Cheyney.

"Midwives should not be afraid to transport to the hospital," she says. "That should be clear to both sides."

Changing perspective

With passionate and eloquent advocates on both sides, what happens next may come down to "one mom with a dead baby," predicts Forbes, the Eugene midwife.

A 13-year member of the Oregon Midwifery Council, she stopped paying dues in May to protest the professional group's hiring of a lobbyist to battle mandatory licensing.

In light of the Sheikh case, she thinks mandatory licensing is inevitable. "As a profession, we should be driving this decision, and not the Legislature and not the anti-midwifery proponents."

The council will meet later this month to discuss the issue.

Meanwhile, advocates of mandatory licensing are active as well. An OHSU nurse is organizing a meeting between lawmakers and mothers with complaints about midwives.

And Stella Dantas, an OHSU doctor who supports mandatory licensing, thinks the cause will be helped by a study expected to be published later this year showing Oregon has a high rate of infant mortality during labor.

Licensing advocates are itching for a legislative rematch.

Earlier this year, Rep. Mitch Greenlick, D-Portland, introduced a mandatory licensing bill only to meet a storm of opposition. The bill was changed to improve reporting of birth outcomes involving midwives. Now, Greenlick expects a new push.

"There's big stirrings going on now," he said. "It's being raised again."

His Eugene colleague, Hoyle, said she wants to find a compromise, "to ensure that we have a system that allows women to make appropriate choices -- and to understand who's qualified and who's not qualified."

-Nick Budnick

[Turtle]

My only issue with licensing is that people associate having a license with competency, which can be really misleading. There needs to be not only a requirement to have a license, but also high licensing standards for midwives.

[Austin]

My only issue with licensing is that people associate having a license with competency, which can be really misleading. There needs to be not only a requirement to have a license, but also high licensing standards for midwives.

I don't disagree, but that could be said of any profession. Licensure for doctors, nurses, teachers, and a whole host of other professions means something. Licensure may not mean they're the best around, or even that they're fully competent (we all have our own examples of this), but it also means that they didn't just take some correspondence course or college minus or whatever. To be eligible for licensure, there is usually some minimum accredited education in that field that is required. This cannot be a bad thing, in my view.

[YPestis]

We license day care sites, teachers, doctors, lawyers....it seems odd people would object to licensing and ensuring quality of people who deliver babies at home, where there is little oversight by others.

If there's such opposition to mandatory licensing, perhaps the key is to make sure all midwives represent themselves properly. If they have no license, they should be required to state that. The pregnant woman can then make an informed choice, rather than assuming that all midwives who call themselves as such have undergone similar basic training. It's really appalling that the midwive who delivered the lady's dead baby didn't know infant CPR! Shouldn't that be a basic requirement?

[MonkeyMomma]

A great blog if you are interested in this topic is http://oregonmidwifereviews.blogspot.com/

Link not broken 'cause I don't think she'll mind.

[docmom]

We require hairsylists to be licensed in most states and I don't think anyone would argue that it has driven the profession underground. The opposition to licensure seems to come mainly from those direct entry midwives who do not posess the credentials necessary for licensure. I have no real problem with homebirth for the healthy, normal pregnancy (didn't do it myself, but I was born at home), but the statistics used to support its safety come from countries where mid-wives are very well trained and stringently regulated. If we want to keep homebirth as an option (which seems to be the objection of the non-licensure group) then we need regulation. If more women and babies die because of unqualified mid-wives the legislatures will respond by banning the practice.

[Kitten]

In July after eight days of labor, Margarita Sheikh of Eugene gave birth to a boy who had no heartbeat, according to mediareports. She blames the two unlicensed midwives who helped in the birth, saying they refused to send her to the hospital when she asked, and didn’t appear to know how to give infant CPR after the baby was born.

Okay, I think people who represent themselves as midwives should have to demonstrate some minimal knowledge and skill by some form of examination and licensing (heck, my hairdresser has a license!!!).

BUT...

Maybe women who want to get pregnant should have to have a license for common sense!!!!!!! If I were in labor for EIGHT days, I would be thinking, Hmmmm, maybe something's not quite right here. And if I ASKED to go to a hospital and someone refused to take me, I would PICK UP A DAMN PHONE AND CALL 911!!!!

It's not just unlicensed, and obviously stupid, "midwives" who were the only culprits here - it was also an ignorant women who abdicated all her decision-making to them. If the purpose of a home birth is to be in control of your own body, then TAKE THAT REPONSIBILITY SERIOUSLY. So many "home birthers" like to complain about "doctors who think they're God," but this woman gave that same power to some unlicensed women, and now she wants to complain about it?

Yes, I've had children, so don't give me that "She was in labor and unable to think clearly." She thought clearly enough to ask to go to the hospital, so I'm guessing that unless they had her tied to a bed, she could've made her own phone call. She has to bear at least some (most, IMO) of the culpability in this case...

[Austin]

A great blog if you are interested in this topic is http://oregonmidwifereviews.blogspot.com/

Link not broken 'cause I don't think she'll mind.

Holy crap!

Some of these women are crazee. Clearly, these direct-entry midwives who have built up lucrative "practices" are pushing back hard against any sort of licensure or oversight. I wonder why. :roll:

[formergothardite]

I'm shocked that there is a debate over this! Common sense says that midwives should be licensed.

[Beeks]

I find the debate sort of weird as well....there's no debate over licensing other medical professionals, is there?

Also, that poor woman was in labor for 8 days?! Dear God.

[gpaparella]

Okay, I think people who represent themselves as midwives should have to demonstrate some minimal knowledge and skill by some form of examination and licensing (heck, my hairdresser has a license!!!).

BUT...

Maybe women who want to get pregnant should have to have a license for common sense!!!!!!! If I were in labor for EIGHT days, I would be thinking, Hmmmm, maybe something's not quite right here. And if I ASKED to go to a hospital and someone refused to take me, I would PICK UP A DAMN PHONE AND CALL 911!!!!

It's not just unlicensed, and obviously stupid, "midwives" who were the only culprits here - it was also an ignorant women who abdicated all her decision-making to them. If the purpose of a home birth is to be in control of your own body, then TAKE THAT REPONSIBILITY SERIOUSLY. So many "home birthers" like to complain about "doctors who think they're God," but this woman gave that same power to some unlicensed women, and now she wants to complain about it?

Yes, I've had children, so don't give me that "She was in labor and unable to think clearly." She thought clearly enough to ask to go to the hospital, so I'm guessing that unless they had her tied to a bed, she could've made her own phone call. She has to bear at least some (most, IMO) of the culpability in this case...

I just signed up here to say this. I've been on one board online with a RN friend of Margarita's, who told more about exactly how this happened. She had been laboring for six days, something her 2 midwives urged her to not be concerned about, and in the last of those six, her labor got stronger and her water broke. Darby and Laura then insisted that everyone leave. Margarita's friend suspects that this was because of the troubling color of the water that indicated meconium, something she and another friend at Margarita's house noted and reacted to with alarm. Something to the effect of "even animals are permitted to labor in peace." Their theory was birth is natural and always safe and they were sticking to it.

Margarita, now alone with these 2, the doors locked and pounding on the door downstairs ignored or the friends turned away at the door, decided she wanted to go to the hospital. The midwives persuaded her out of it. Over the next two days, knowing things would only get worse, she decided she really did want to go to the hospital. They took away her cellphone. They told her friends at the door to leave.

Margarita's nurse friend called the police, and the police said that because she had changed her mind the first time they wouldn't get involved. The best she managed after multiple calls was an adult protection safety visit, which didn't happen in time. One of the midwives made a 911 call when her son was born dead, before the safety visit took place.

I might have a couple details off, but that's pretty close to how this happened. Because she changed her mind the first time, alone with these two trying to talk her out of it, she wasn't allowed to change her mind back to transferring, at least according to Eugene PD. And taking away her phone so she couldn't call for help or an ambulance? I haven't heard about kidnapping charges being filed, I guess that's okay with the law too.

[Kitten]

With all due respect and sympathy to this woman, I still say that she had to allow those midwives to kick everyone out. If I had been one of those concerned friends pounding on the door, I would've broken down the door or gone in through a window to help her. I probably would have never left in the first place - what were they going to do, physically eject me? I think not, and if they had called the police, then all the better.

This whole event, no matter what the exact details, is just wrong on so many levels.

[Beeks]

With all due respect and sympathy to this woman, I still say that she had to allow those midwives to kick everyone out. If I had been one of those concerned friends pounding on the door, I would've broken down the door or gone in through a window to help her. I probably would have never left in the first place - what were they going to do, physically eject me? I think not, and if they had called the police, then all the better.

This whole event, no matter what the exact details, is just wrong on so many levels.

Kitten, I don't know what stage of labor this woman was in, but if her water broke she could have been pretty far along. Add in the fact that she had been laboring for DAYS (almost a freakin week) before that, and I can be certain that if these people wanted to keep her from going to the hospital, there wasn't a whole lot she could do about it. Trust me, if you're in hard labor, it's really hard to speak, let along argue with anybody or physically stop somebody from kicking your friends out. I agree that maybe he friends could have done more, but for the mom herself, I give her a break at this point in the whole thing.

[Buzzard]

Margarita, now alone with these 2, the doors locked and pounding on the door downstairs ignored or the friends turned away at the door, decided she wanted to go to the hospital. The midwives persuaded her out of it. Over the next two days, knowing things would only get worse, she decided she really did want to go to the hospital. They took away her cellphone. They told her friends at the door to leave.

Margarita's nurse friend called the police, and the police said that because she had changed her mind the first time they wouldn't get involved. The best she managed after multiple calls was an adult protection safety visit, which didn't happen in time. One of the midwives made a 911 call when her son was born dead, before the safety visit took place.

I might have a couple details off, but that's pretty close to how this happened. Because she changed her mind the first time, alone with these two trying to talk her out of it, she wasn't allowed to change her mind back to transferring, at least according to Eugene PD. And taking away her phone so she couldn't call for help or an ambulance? I haven't heard about kidnapping charges being filed, I guess that's okay with the law too.

Kidnapping requires asportation - which means that she needed to be moved from one place to another against her will. Not one room to another, but for a criminal purpose. There is no kidnapping here. Margarita is an adult who made the decision to be alone with these two rocket scientists. She chose to allow her life and the life of her child to be in the hands of two women who clearly had no clue. So now she was kidnapped? No, its called a moronic decision. The police arent there to force people to make good decisions or even to question the tragically flawed logic she demonstrated. She was perfectly able to change her mind and go to the hospital had she communicated that to the police, but they simply cant go back to question an adult because someone else thinks they should.

These morons shouldnt be allowed within 500 feet of a woman in labor and Margarita probably shouldnt be raising any kids herself if she thinks she bears no responsibility. Another example of an innocent child suffering at the hands of adults who think they know better than everyone else in the universe.

We license bus drivers and the people who do my fucking nails. Hell, even my dog groomer has a license. Anyone who has ANYTHING to do with a life or death decision should be licensed and provide minimal competance.

[NurseNell]

The midwife programs I'm familiar with require you to be a R.N. with a B.S. in nursing. The midwife education is a master's level program that takes 2 years. I have no problems with nurse midwives delivering babies but I do have a problem with lay midwives. My 3 grandsons were all delivered by a nurse midwife.

Nell

[DistantStar]

I would think any midwife would want to know enough to pass some sort of licensure test. Were I to be a midwife I'd want to know everything I could possibly get my hands on about the subject! If were to have a baby, which ain't gonna happen, I'd have to be knocked out for a c-section due to medical/orthopedic issues. I wouldn't mind having a midwife help out with pre- and post-natal care, but the actual delivery? I'd need a doc. And I'd need a doc monitoring me through the whole pregnancy as well.

I do think having specialized midwives for otherwise normal pregnancies and births is a great idea. My mom, for one, would have done fine going that route. But I can't imagine anybody using one who doesn't have some level of certification. You don't get much more important than the birth of a baby! And that seems such a stupid sort of chance to take.

[VVV]

What state was Mamaant's daughter laboring in? She had unlicensed midwives and they refused to let her go to the hospital for days. It's a miracle that we didn't read about that birth in the news.