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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Mar 24 2011