Midwives May No Longer Need To Be Licensed
Midwives providing in-home births would not longer need to be licensed under legislation that’s moving to the House floor
April 15, 2011--A bill sponsored by Rep. Mitch Greenlick (D-Portland) will no longer require direct entry midwives to be licensed in Oregon.
The House Health Care Committee moved House Bill 2380 out of committee Wednesday. It will now move to a vote on the House floor without the requirement that direct entry midwives be licensed by the state Health Licensing Agency to provide in-home births. Currently licensure is voluntary..
“I can sadly relate that the only thing I really cared about was amended out of this bill,” Greenlick said.
Pointing to the lack of standardization, Greenlick said it doesn’t make sense for some midwives to be licensed, while others are not. His legislation would have included a requirement that all midwives be licensed through the Oregon Health Licensing Agency, which would have ensured, he said, greater safety for women choosing to have in-home births.
“That’s the only way you can regulate their practice,” Greenlick said.
The bill was amended because otherwise the bill wouldn’t have moved out of his committee, said Greenlick who admitted [the bill] “still serves a very useful function.”
Under the legislation, midwives can still conduct confidential peer reviews and use legend drugs and devices.
Licensure is currently optional for midwives; approximately half are licensed. Only licensed midwives can be paid by health insurance companies for their services.
Melissa Cheyney, a licensed midwife who chairs the Board of Direct Entry Midwives, is thrilled the bill was amended. “This is a wonderful outcome,” she said.
Requiring midwives to be licensed would have made the practice less traditional and broken down its cultural value, Cheyney said. Some practitioners would have resisted licensure been subsequently pushed “underground.”
The original version of the bill would also have been difficult for midwives to access medication, participate in continuing education and pursue other valuable resources to do their job, Cheyney said.
The Health Licensing Agency had created licensure standards associated with the bill that would have restricted the work of midwives. One such standard would not allow midwives to handle in-home births for women who had had more than two C-sections in the past.
In 2010, the agency received 23 complaints against licensed direct entry midwives, while 19 of those complaints were submitted by non-clients – usually the doctors who ended up seeing women transferred to the hospital after having complications during their in-home birthing process.
“I just want to make sure home births are safe,” Greenlick said. “The standards the board created are still pretty good standards.”
For The Lund Report’s prior coverage of midwives, go here
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Your headline --Oregon Midwives May No Longer Need To Be Licensed-- is misleading. Direct entry midwives DO NOT CURRENTLY NEED TO BE LICENSED to practice in Oregon. They DO need to be licensed in order to receive payment from OHP. This bill, as originally written, would have required licensure by 2016; but, as Rep. Greenlick stated, was not viable.
This bill DOES require that proceedings of peer review for direct entry midwives be confidential. It DOES eliminate one of the two DEM Board positions held by certified nurse midwives. It DOES eliminate from law the specific list of approved medications used by DEMs, and allows the DEM Board to decide upon what medications are allowable.
After a surprisingly partisan vote in the House (Democrats for, Republicans against), the bill has gone to committee in the Senate.
Patricia Barnes, CNM
Legislative Liaison
Oregon Affiliate of the American College of Nurse Midwives
I love midwives too -- so much so that I believe every birth should have one. But Washington state tightened licensing of all midwives after a spate of mortalities related to home births about 20 years ago. Warm fuzzy home births aren't so much fun when mommy or baby dies or has injuries. Adopt better standards so you can get liability insurance and then public pressure will force hospitals to include midwives and bring them into the mainstream.
Dear Amanda Waldroupe, You mean our legislators after careful attention to testimony have decided that the way Oregonians have been doing things for centuries is fine to continue? I support mothers and families right to choose where how and with whom to give birth. Criminalizing midwifery is not a step forward, thank you very much.
Pushing midwives underground or out would be a poor outcome.
Already, women choose to give birth without attendants. Putting barriers in the way of attended birth is not going to make better outcomes.
People wanting to regulate things need to look forthrightly in a direction of supporting consumers as the free agents that they are, in practice.
Iatrogenic risks of added stress or exposure to unfamiliar surroundings and germs must be considered as part of the whole picture regarding childbirth.
It needs to be legal for women to decide what risks are the most serious for them from their individual perspectives. Fear and worry can interfere with labor, and this is not a minor consideration.
Adopting this outlook will trigger in-patient facilities to jazz up their customer service. This was one of the outcomes of the hippy/home-birth phenomenon of the 70's and 80's.
Childbirth is not a pathological process. An inclusive attitude, as opposed to a punitive attitude, can distinguish Oregon from other places. People used to fly to Colorado to give birth with Dr. Bradley, whose Husband-Coached Childbirth was a ground-breaking book. I do not know if Colorado is still on that edge, but Oregon can choose to be famous for honoring the choices women make concerning such a private matter.