Pro-Choice, Pro-Midwife

If you care about a "woman's right to choose," then you need to know about a little situation ongoing in Missouri: a woman's right to choose a midwife.
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If you care about a "woman's right to choose," then you need to know about a little situation ongoing in Missouri. Yes, abortion is still legal there. It's not that situation (not today, anyway). This is about a woman's right to choose a midwife.

Independent midwives, called Certified Professional Midwives (CPMs for short), attend laboring women outside of the hospital, most likely in their own homes. They're not nurses or doctors; they don't give epidurals or perform cesareans. Rather, they are trained to provide primary care for normal pregnancy and childbirth and transfer to the next level of care (obstetricians) when it's necessary.

This division of labor works fabulously in the countries where it's the norm, and the largest international study of CPMs to date, published in the British Medical Journal, found that it works remarkably well here in the states as well: among 5,000 low-risk women who planned home births with CPMs in North America, 95 percent had spontaneous vaginal births, and their babies did just as well as those delivered by obstetricians in the hospital. The mothers, meanwhile, came out far healthier -- fewer than four percent had major surgery and hardly any were induced into labor or had episiotomies (a surgical cut to the vaginal opening).

Compare that to the national numbers: 30 percent of U.S. women have C-sections, more than half are induced into labor or sped up with powerful drugs, and one in three who give birth vaginally are cut, even though routine episiotomy has been debunked by research.

So it's unfortunate that in 10 states and the District of Columbia, these trained midwives are legally prohibited, which pushes them to practice out of state or underground. This was about to change in Missouri, thanks to a crossover coalition of activists, from fundamentalists to feminists, and a state senator who pulled a fast one just before summer recess and snuck an amendment recognizing CPMs into a widely popular health insurance bill.

Governor Matt Blunt signed the bill on June 4, and if the measure takes effect, midwives who attend home births in Missouri will no longer be subject to a felony prosecution.

The Missouri State Medical Association, however, would rather it be a felony. The physician group is fighting the legislation in court, and recently won a temporary restraining order. Its argument has been twofold: the measure makes birth less safe for women and babies, and its inclusion in the insurance bill was unconstitutional. I could go out on a limb and say that these medical professionals aren't bothering to sue over legislative formality, but I'll go even further and say that their concern isn't exactly women's safety either.

They need only look to the 2005 CPM study, and several others preceding it, to see that midwives do a superb job of midwifing -- that is, supporting the normal, physiological birth process. What threatens safety is criminalization: when midwives and their clients are discouraged from transporting to the hospital because it will result in a criminal investigation, an arrest, or worse; when higher-risk women stay home because they can't get supportive care at the hospital; and when women stay home and go "unassisted," without any trained provider at all, because they don't want to put a midwife at risk.

The physicians are simply guarding their turf. Not only for those practicing in Missouri, but for OBs everywhere (The American College of Obstetricians and Gynecologists is now involved in the suit). After all, what if all 50 states looked like, say, New Mexico, where CPMS are legal, encouraged, and covered by Medicaid? Well, a third of women would give birth with a midwife, for one. There would be more midwives in practice than obstetricians. And home birth would be an option rather than a crime.

On August 2, the physicians will be in court again arguing for an injunction. Whether or not the legislative move was kosher will sort itself out, but there's a much larger question that needs answering: do women have the right to give birth with the provider of their choice, in the setting of their choice? Because in states like Missouri, women are being told they don't.

This is one question that state senator Chuck Graham, a pro-choice Democrat, especially needs to answer. He has been the chief opponent of licensing midwives. And he's now in the awkward position of being shown up by a political enemy: Senator John Loudon, the one who wrote in the midwifery measure, turns out to be an anti-abortion Republican. Talk about crossover.

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