Legality of home births in question

by Liz Shirey
THE POST

Childbirth.

The word evokes a variety of responses in women. Some look back fondly on the miracle they experienced, while others associate the time with pain and fear. Some women identify childbirth with a physician in a hospital, but others picture a midwife in their homes.

There are two types of midwives practicing in the United States and Athens - certified nurse midwives and direct-entry midwives. All 50 states and the District of Columbia permit the practice of nurse midwifery. However, direct-entry midwifery is legally recognized in only 29 states, and certification is available in only 17 states.

Midwifery, a German word meaning "with woman," has a long history in the United States. It has seen many changes and has been met with much resistance, but it still is practiced in various forms today.

When the Europeans immigrated to America, they brought midwifery with them, said Sue Wamsley, visiting assistant professor of history and women's studies at Ohio University. The birthing process in the early colonial years was more of a ritual and a celebration for women than it is now.

The late 18th century saw the professionalization of medicine, which stressed the importance of trained doctors, Wamsley said. During this period, tension developed between midwives and doctors, both being equally prominent in the medical community.

"Often, when there were complications, either during the birthing process or with general health issues, the doctors would attempt to help, and if they couldn't, a midwife would be called in," Wamsley said. "If someone died, the midwife always would be blamed, and their once-valued position began to erase itself."

By the American Revolution, midwives seldom were used, she said. The medical profession began to make credentials and schooling a prerequisite for practicing. For reasons unknown to Wamsley, the United States saw the re-emergence of midwifery, especially in rural areas, in the late 1960s and early '70s.

Carol Roe, public affairs consultant for the Ohio Board of Nursing, said there is no regulation for any midwives in Ohio other than certified nurse midwives. She said there are about 200 certified nurse midwives in the state.

"Certified nurse midwives are in collaboration with physicians and are prepared to handle normal kinds of situations, including post- and pre-natal care and preventative health care in terms of women's health," Roe said.

Certified nurse midwives are trained in nursing and midwifery, Roe said. All have either a one-year certificate or a two-year master's in nursing, public health or midwifery. The American College of Nurse Midwives approves all certifying programs.

There are many graduate programs for certified nurse midwives in Ohio, including one at Ohio State University and one at Case Western Reserve University near Cleveland.

To be eligible, students must have a degree in Resident Nursing, and some programs require a bachelor's degree in nursing before admittance, Roe said. The Ohio Board of Nursing regulates all certified nurse midwives.

Although these midwives are legal and regulated in Ohio, the rules at hospitals vary, said Angela Cross, a non-nurse midwife apprentice and doula for various hospitals in Athens. A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and after birth in a hospital.

"Certified nurse midwives are working at the whim of the physician who signs the protocol," Cross said. "Some insurance companies won't pay for births with only midwives present, and doctors don't give them much respect. In the rest of the world, midwives are teaching the doctors."

Unlike certified nurse midwives, direct-entry, or non-nurse midwives, have an a-legal status in Ohio. Cross said there is no recognized certification and direct-entry midwives are forced to practice without any type of regulation.

"As a licensed medical professional, you have a board of your peers who judge you when a problem or question arises," Cross said. "Direct-entry midwives do not have a board to regulate them, so they are subject to being judged by the legal process."

Cross said there are midwives being prosecuted, and even if they win the case, they often lose their practices and even their homes because of the tremendous legal fees.

Training for direct-entry midwives usually includes apprenticeships and some schooling, Cross said.

In 1997, the Senate Advanced Practice Nurses Bill, Issue 154, was put on the Ohio Congress' agenda. Cross said the Medical Board tacked on a last-minute provision to make it illegal to be, use or aid a direct entry midwife.

"No one was aware that this section had been included in the bill until the law was about to be passed," Cross said. "People from all over the country and from every single walk of life came to stop the passing of the bill and to support direct-entry midwives."

Former Gov. George Voinovich put together a study council that met for one year to examine the bill's section on direct-entry midwives. The council examined non-nurse midwifery and laws regarding their practice in other states. Each member of the council made a recommendation to the governor.

The Ohio Board of Nursing recommended the practice of midwifery by persons other than certified nurse midwives should be prohibited unless those non-nurses can demonstrate the same competencies and equivalent educational preparation as certified nurse midwives, Roe said.

The recommendations were submitted and opinions were heard at public-input hearings, Cross said. The final recommendation in 1998 was that non-nurse midwives are required to provide informed consent - full information of their qualifications, abilities and the scope of their practice - to anyone who asks. They should also be allowed regulation by their peers, and their status under the law should be clarified.

"As of now, the Medical Board has not allowed direct-entry midwives to have state regulation, and the law concerning direct-entry midwives has not been clarified," Cross said.