Monday, September 19, 2011

Midwifery: To regulate or not?

Midwives and consumers of midwifery services divide into two camps:

Those who believe midwives should practice without government interference and those who support governmental regulation of midwifery.

If you speak to a supporter of midwife autonomy, you will likely hear about the age-old tradition of midwives practicing independent of regulation.  These supporters also worry about regulations keeping midwives from attending VBACs, twin and triplet births, breech births and pregnancies that exceed 42 weeks.  Worries include requiring a back-up ob, midwives having to purchase malpractice insurance and phasing out direct-entry midwives, among other concerns.

I get these issues.  Really, I do.  As long as informed consent is practiced every step of the way, I believe a woman and her midwife should be the only ones to decide if she risks out of a homebirth.  I also appreciate that midwives have traditionally practiced free of regulation and that concerns of regulation will limit, rather than expand, a midwife's ability to work with women and babies and I chose a direct-entry midwife to attend Liza's birth.  So yeah.  I understand the worries.

But, I am a firm supporter of governmental regulation of midwifery:

1.  My home state of Mississippi has no law on the books about midwifery.  Yet, every surrounding state has midwifery laws.  Therefore, Mississippi has become a safe-haven for midwives with bad outcomes in other states.  This is not obviously not safe for mamas or babies.

2.  In Mississippi, anybody can advertise midwifery services, regardless of experience or training.  Attend some births......catch some babies.....does not a midwife make.

3.  As the poorest state with the worst neonatal outcomes and the lowest rates of prenatal care and breastfeeding, giving women more access to midwifery care makes a lot of sense in regards to mother friendly/baby friendly care and in regards to a financially viable way to improve healthcare to women in rural areas of the state with little to no access to ob/gyns.

4.  States with birth laws in favor of midwives and homebirths have large numbers of midwives.  Finding an experienced midwife with positive outcomes is a good thing but having the ability to interview multiple midwives to find an experienced midwife with positive outcomes who also meshes with your family dynamics is a great thing.

5.  Currently in Mississippi, face-to-face interviews and word-of-mouth is the only way to validate a midwife's birth outcome history.  The ability to log-in to a database to check for filed grievances against a midwife helps keep women and babies safe.

So, yeah.  I am firmly planted in the pro-regulation camp.  And, that's why I am dedicating my time and service as a board member of Mississippi Friends of Midwives.

Interested in learning more or making a donation to an important cause?
Check out for more details!

Are you a supporter of government regulated midwifery?
What are the birth laws like in your state?


Mandi @ Catholic Newlywed said...

I think that regulation is very important too! If midwives aren't regulated, you only have word-of-mouth to go on regarding training, previous bith outcomes, etc. That worked so well in the past because each community had its own midwife, someone that was a community member and everyone knew about, but that certainly isn't the case anymore! I don't know anyone who ever used a midwife and I certainly don't know any midwives personally, so I rely on regulation to ensure that I'm going to be getting adequate care!

Laura @ our messy messy life. said...

Excellent point about community midwives in the past!

Dale and Holly said...

I am a firm supporter of government regulated midwives. In north dakota, where I am a labor and delivery nurse, i have seen the positive effects government regulated midwifery has. All of the certified midwives I work with are proud of their education, support the laws, and feel confident in the knowledge that they are armed with what it takes to keep mamas and babies safe. The business of birthing is a natural thing, but there are also many natural occurences in which babies and mamas DIE without careful monitoring and knowing when a situation esculates to an emergency. The laws in North Dakota are not restricting - they are freeing, and the midwives I work with are grateful for the protection for everyone. Our lay midwives have a great relationship with certified professionals and women are allowed the freedom to see a practitioner throughout the pregnancy to continue good prenatal care, but then opt to have that homebirth in the end with the woman of their choice. Mississippi (last as usual) NEEDS these laws. WHen I was in school I had to midwife teachers (from other states) who would have loved to practice their true passion, but didn't because MS doesn't have the regulations that the process of being born needs. Keep advocating on that board! And I'm so happy that you found a good midwife in MS - I wasn't even aware that we had any!

amber said...

i'm not sure how i found your blog (obviously through someone else who went to mississippi state too!), but i just love your posts on homebirth. i had to comment on this post, in response to the above comment of not knowing any good midwives were in mississippi. i live in alabama, but used a midwife out of mississippi, renata hillman, who is AH-MAY-ZING. i had a vbac with her at home back in may and the whole experience of midwifery care was incredible!
(oh and your kids are super cute ;-) )

...sarah. said...

I definately agree that midwifery should be regulated: as should any good thing. I also live in Alabama, and I am in the middle of the state so I could choose between 4 states surrounding me where midwives are legal (or alegal, as the case is with Mississippi) from which to shop for midwifery services. However, for the very reason that there is no database or way to hold midwives accountable, I would not choose a MS midwife. For my first birth, I wanted a Tennessee "destination birth" ( I guess you could call it that, right?). In theory, it sounds lovely. In practice, when you go from eating breakfast to pushing in 45 minutes' time, it's simply not practical. I had done my research and picked a wonderful OB, but for my next baby I am totally torn about how to proceed. I pray every day that Alabama legislators will get a clue.