Direct Entry Midwives Could Need License

Proposed legislation stirs longstanding controversy

March 24, 2011 -- A bill sponsored by Rep. Mitch Greenlick (D-Portland) would require a license in Oregon for direct entry midwives.

The idea, according to Greenlick and state Health Licensing Agency staff, is that House Bill 2380 would set standards for the profession that will ensure greater safety for women choosing to have in-home births.
Since mandatory reporting of adverse outcomes became required for midwives last year, complaints against licensed direct entry midwives have escalated, said Randy Everett, the Licensing Agency’s director.
In 2010, the agency received 23 complaints against licensed direct entry midwives, 19 of which were filed by non-clients – usually the doctors who end up seeing women who have to be transferred to the hospital after having complications during their in-home birthing process. 
Yet Everett acknowledged that the majority of complaints are so vague and broad that they are impossible to act on.
“I don’t think licensure guarantees safety,” said Melissa Cheyney, PhD, the chair of the state Board of Direct Entry Midwifery and a professor of medical anthropology at Oregon State University in Corvallis.
In 2008, Cheyney did a study [on Oregon midwives]. “I looked at [birth outcomes] for licensed and unlicensed midwives, and there was no big difference,” she said.
Cheyney is opposed to the bill for several reasons. She pointed to the new administrative rules governing direct entry midwives that the Board adopted in January. These rules “protect a mother’s right to choose while also protecting her safety,” she said.
More importantly, Cheyney is concerned that requiring licensure could actually have an adverse effect on home birth safety by “driving midwives underground, and not voluntarily participating in peer review and other things they currently do.”
The overarching issue, said Cheyney, is the conflict between midwives and the medical profession. The American College of Obstetrics and Gynecology openly opposes home births, and Oregon ob-gyns or nurses file the majority of complaints against midwives.
But from Cheyney’s perspective, midwives are essential to providing a safe and satisfying childbirth experience for women, especially those in rural areas.
“Until we have some kind of maternal-child health care for all, these women are on the front lines providing care to those who need it most,” said Cheyney.
The bill, HB 2380, received a public hearing on Feb. 14, but no further hearings are scheduled. It’s not necessarily off the table, however: legislative staffers have until April 8 to schedule public hearings for bills.
“The profession of midwifery is contentious, and there are lots of issues around the safety of home birth,” Samie Patnode, policy analyst for the Oregon Health Licensing Agency told the Oregon Health Plan Medical Directors last week.

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Not surprisingly, Melissa Cheyney opposes any attempt to make direct entry midwives accountable. She is the same person, in her role as Director of Research for the Midwives Alliance of North America (MANA), who is withholding the death rates on the 18,000 birth database collected by MANA. Those death rates can only be obtained by passing a vetting process designed to make sure that the person or organization is planning to use the data for the "advancement of midwifery" and even then the individuals must sign a legal non-disclosure agreement. There is no ethical, moral or legal reason for Cheyney to withhold the death rates of 18,000 planned homebirths attended by certified midwives, just like there is no ethical, moral or legal justification for allowing purported health care "professionals" to operate without licensure. Amy Tuteur, MD

Making it more expensive and complicated to have client-controlled birth experience will lead to birthing tended only by partners. Perhaps over time that is safer. The family can go to a trusted professional to register the birth and stay completely away from those they do not trust.

Oregon's government is 151 years old. Traditional midwifery has been around a little longer. If it ain't broke ... Greenlick is intent on regulating every move I make.

It's interesting that those opposing it are mostly doctors, nurses and OB's who are losing their money from patients who are fed up with them doing whatever they want without any concern for the parents wishes! I know I am fed up with delivering in hospitals. I had a nurse turn my pitocin up so high and tell me to shut it she can legally turn it up so far. It is MY body and I was contracting but she wanted to win a "race" with the nurse next door. The epidural was put in before the numbing meds were working. I am sick of it! If you're so worried about your income LISTEN TO YOUR PATIENTS who know their bodies as long as a mother or baby is not in distress, sheesh. Sincerely, A mom fed up having her first homebirth! No doctor will touch my baby unless there is a true emergency and need for their services - birth is a natural process and NOT a disease!