To give a little background, 2 years ago a law was passed in UT legalizing direct-entry midwives (DEMs), and giving them the opportunity to be licensed with the State of Utah. It was a big breakthrough in the homebirth community here. It is now legal for midwives here to attend homebirths, and administer oxygen, medications to stop hemorrhaging, etc. as needed, making homebirth a safe and good option for women. Now, Senator Dayton is trying to get this bill passed that would regulate DEMs to the point where almost no woman would "qualify" for homebirth anymore. In fact, 96% of all homebirths in UT last year would have "risked out".
Here is the bill.
Group B Strep, a previous big (over 4000g) or small (under 2500g) baby, history of 3 or more miscarriages, and prior c-section are just some of the conditions that would risk a woman out. In fact, I would not qualify for homebirth because I've had Group B Strep before. Nevermind the fact that my pregnancies and births were all completely uncomplicated, and I feel homebirth is a very safe option for me. Besides this personal point, though, why do we need to regulate midwives even further than they are already regulated? DEMs are trained professionals. They know birth, the know normal birth, and they know when something is not normal. They know when a woman requires a transfer, prior to or after the birth of the baby. They know how to handle emergencies. I don't believe they need a law to tell them to transfer in case of a prolapsed umbilical cord, or a uterine rupture. These women have had extensive training and experience with birth. They take the time to get to know the women they attend, much more so than any OB ever will. They take the time to be with the mother during her birthing time and to offer support, unlike OBs. DEMs carefully screen the mothers who ask them to be their caregivers, and they won't take women who they feel shouldn't give birth at home. They know their scope of practice. If they feel comfortable accepting a woman who's had a prior c-section, or a woman carrying twins, or delivering a breech presentation, who's the UT legislature to tell them they can't do that? Senator Dayton's bill refers to peer-reviewed medical literature, which I suppose is meant to support her bill. I'm wondering if Senator Dayton ever read the latest research that supports the safety of homebirth? And the fact that the rules that are in place now are enough to make homebirth a safe option?
Report of Outcomes of Utah's Licensed Direct-Entry Midwives
Utah Department of Health Report
British Medical Journal Study
Or should we assume she's completely biased, seeing as she's an L&D nurse with an OB husband? Whose interest is important here? The freedom of women to choose where to give birth, and who to have in attendance? To be able to choose homebirth, which has proven to be as safe, if not safer, than hospital birth? To have a midwife in attendance who trusts the body's natural ability to give birth without medical intervention? Or the OB's, who often sees birth as an emergency waiting to happen, as a medical event that requires intervention more often than not? Don't get me wrong, I'm glad we have trained medical professionals who are able to handle true emergency situations. I just don't believe that the medical model is superior when it comes to the normal, natural process of birth. Midwives trust women, they trust birth, and they know how to handle emergencies in case they do arise. They won't hesitate to transfer a woman to a hospital. The midwives I've talked to are grateful for physicians who are willing to back them up, knowing that should a transfer be necessary, the mom will be in good hands. Midwives know their scope of practice, they don't need another bill to tell them what they can and can't do. Women in the State of Utah do not need more regulation in this area. We need care providers who trust us, and the freedom to choose what we feel is best for ourselves and our babies. I don't believe women are careless. After all, who wants their baby to get seriously sick, or die - an argument used freely against homebirth? Not one woman I know who has chosen homebirth is uneducated, doesn't know about birth, or doesn't care about herself or her baby. If anything, the opposite is the case. These women are childbirth educators, doulas, or have done extensive research regarding birth. They are loving mothers, who care very much about their babies. Not one midwife I know is careless, untrained, or reckless. They all care very much about the women and babies they serve. That's why they became midwives in the first place. :o)
ETA: Really, the more I have thought about this over the past week, the more upset it has made me. Realistically, what is more risky? A woman birthing at home when her baby is ready to come, or an OB inducing a woman at 37-38 weeks for non-medical reasons, such as picking the date to fit the parents' schedule, or inducing the mom because she's tired of being pregnant, etc.? Or an OB performing an elective c-section because the mom doesn't want to go through labor, or "protect" her, um, you know? OBs freely using pitocin or other medications and procedures to augment labor, performing unecessary episiotomies, performing unecessary c-sections (no way do I believe almost 1/3 of births in this country necessitate the use of surgery), having to use forceps or vacuum extractions because mom's too paralized to change positions to better accomodate birth of a bigger or slightly malpositioned baby (thanks epidural), using cord traction to "help along" a placenta that is "taking too long"? Reading through the Report of Outcomes, and then considering the fact that 96% of the women in this study would have risked out of homebirth under this new law clearly raises considerable doubt as to whether "safety" of mothers and babies is really Senator Dayton's motive behind this bill...