Midwives Call for Licensure
I blogged a couple of weeks ago about the North Carolina midwives who want the state to license them. Here’s an article about Massachusetts midwives who have followed suit. A state representative argues in favor of occupational licensure:
If the bill passes, they would have to apply for licensure and pass a series of requirements to practice legally in the state. “It will give any of the births currently being done more regulation and oversight,” Khan says.
This push for licensure might just be a strategy to legalize midwifery. Many Missourians, especially in rural areas, had a positive view of midwifery before the state allowed the practice. The legislation was controversial, but there hasn’t been public outcry about the fact that a private organization is licensing the midwives here. In states where the population is more wary of midwives, establishing a state board to oversee the profession could be the only way to legalize it.
On the other hand, lobbying for state oversight could be a way for the midwives to keep out competition and earn more money. The article notes that home birth with a midwife is much less expensive than seeing a doctor in a hospital. It doesn’t draw any connection between that and all the bureaucratic hurdles doctors have to jump through to be certified. If midwives have to go through a similarly long and costly certification process, you can expect the price for their services to jump.
If Massachusetts midwives need a state board to be recognized as legal, then I guess that’s what they have to do. But licensure should be a last resort.
Missouri Lay Midwives (CPMs) do not have any regulatory oversight. In other words they have NO ACCOUNTABILITY. Recently a “new” midwife counselled a patient with a previous C/S to labor and deliver at home.
The baby was emergently transported to a local hospital but only after severe neurologic damage had occurred.
The American College of Obstetrician Gynecologists recommend that women with a prior C/S be cared for in a hospital where an immediately available physician and capability to perform Cesareans can be done in a timely fashion.
The baby in this case will no doubt receive medical care at tax payer expense due to the lack of regulatory oversight in the statute. No one thinks twice about licensing doctors———-if midwives want to practice medicine then they should be licensed, should have written emergency transfer agreements and collaborative practice agreements with physicians—the midwives vehemently refuse to do this in Missouri, let alone be responsible enough to carry professional liability coverage.
Comment by papsmear — September 18, 2008 @ 10:15 p.m.
David, while this sort of anecdote works well as a scare tactic, the plural of anecdote is not data. If you want to highlight worst-case scenarios for midwifery, you can’t leave out the terrifying cases that have played out in hospitals. Adults should be able to choose their own level of tolerance for risk — and the statistics demonstrating favorable outcomes for midwife-attended births speak for themselves.
Besides, regulatory oversight by government agencies is not necessarily the most effective means of ensuring quality in health care provision. It’s almost ironic that you posted your comment here the day after the release of a new study showing how “Consumers would benefit were states to eliminate professional licensing in medicine and leave education, credentialing, and scope-of-practice decisions entirely to the private sector and the courts.”
At any rate, you yourself wrote last year that the issue with Missouri’s new midwifery law wasn’t about statistics, but constitutionality:
“The matter before the court is the constitutionality of Senator Loudon’s actions–it is not on Senator Graham, midwife statistics, or homebirth. All of the celebrities in the world will not change the basic facts before the court.”
So, after the court found — by a wide margin — that your organization didn’t have standing to challenge the law’s constitutionality, you return to a strategy of bluster and scare tactics. I think people will see through it.
Comment by Eric D. Dixon — September 19, 2008 @ 12:29 a.m.