Missouri Supreme Court Ruling Makes Midwifery Legal

By Rachel Walden — June 25, 2008

Yesterday, the Supreme Court of the State of Missouri reversed a lower court ruling in a 5-2 decision and upheld a 2007 law that would allow legal midwifery in the state. The law states that “any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services” – this would include both CNM/CMs certified by the American Midwifery Certification Board and CPMs certified by the North American Registry of Midwives.

After the bill, which dealt with numerous health issues as well as including the midwifery provision, was passed and signed into law by the Governor, the Missouri State Medical Association, The Missouri Association of Osteopathic Physicians and Surgeons, Missouri Academy of Family Physicians, and the St. Louis Metropolitan Medical Society filed suit to invalidate the section that would allow legal midwifery practice in the state. The lower court invalidated the statute, but an appeal was filed by the State of Missouri along with Friends of Missouri Midwives, the Missouri Midwives Association, and other parties.

The medical associations seeking to invalidate the law had claimed standing for the challenge by arguing that physicians may be subject to disciplinary actions if they cooperate with midwives, and that they should be allowed to challenge the law on behalf of patients as their representatives. The Court disagreed on both of these matters and indicated that the groups had no standing to challenge the Constitutionality of the law. They therefore reversed the lower court decision, allowing the law legalizing midwifery in Missouri to stand.

Organizations supporting midwifery in Missouri issued a press release in response to the ruling, stating that

“Today’s Missouri Supreme Court decision is a tremendous victory for Missouri families, who have been working for 25 years to gain legal access to professional midwives. The ruling increases access to maternity care in the state and allows women and families more birth options and affirms their ability to exercise their rights to choose how their babies are born.”

This ruling closely follows recent AMA/ACOG statements in which the organizations express intent to support legislation restricting or preventing both home birth and non-CNM midwifery. Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives, stated:

“This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth last week—physicians do not have the right to speak for patients when it comes to deciding who delivers their babies.”

Our Bodies Ourselves was among those who submitted an amicus curiae (friend of the court) brief in support of reversing an injunction against the law and thereby making midwifery legal in the state. Judy Norsigian, Executive Director of OBOS, also addresses the central choice issue:

Many women’s health advocates working on pregnancy and birth issues are deeply concerned about current trends in childbearing, especially the strange way in which “choice” is selectively used. More obstetricians now promote the acceptability of medically unindicated cesareans (“elective” cesareans), while at the same time fewer obstetricians are working to preserve the option of vaginal birth after cesareans (so-called “VBACs”), which are known to pose (overall) fewer serious risks to the mother than planned repeat cesarean sections. In fact, ACOG (the American College of Obstetricians and Gynecologists) has a position that calls for the 24/7 presence of an anesthesiologist if a hospital is to offer VBACs.

Ironically, organized medicine is now spending considerable energy to oppose the licensure and regulation of Certified Professional Midwives (CPMs, now officially recognized in 24 states), and in mid-June, the American Medical Association passed an anti-homebirth resolution (proposed by ACOG) that many believe is a step towards an attempt to make homebirth ultimately illegal. Despite the absence of evidence that planned homebirth with trained caregivers is any less safe overall than hospital birth, the AMA and ACOG apparently don’t apply the principle of reproductive choice when it comes to this arena of decision-making for a pregnant woman.

Similarly, in our recent post on the AMA/ACOG issue, we included a letter from Dr. Andrew Kotaska, who argued that “Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scienctific evidence or the pre-historic musings of dinosaurs.” Another obstetrician, Dr. Lauren Plante, has generously granted permission to publish her recent letter to ACOG on the same topic:

Dear Colleagues,

I was dismayed to read the recent ACOG statement opposing home birth and specifically disallowing any support for individuals that advocate or support home birth. While I understand ACOG’s concern for mothers and babies, any reasonable support for patient autonomy–which the College favors when it comes to cesarean upon maternal request–would have to include autonomy in choosing a birth place. Many of us would not agree that choosing to labor and deliver at home subordinates the goal of a healthy baby to the process. As you know, home birth remains a viable option in several developed nations where birth outcomes for both mother and baby are excellent. Many ACOG members have backed up home birth providers in the past, and a few have attended a home birth. I personally know of several ACOG members who themselves have chosen to deliver at home. The recent ACOG statement further marginalizes both our patients and our members.

Lauren Plante, MD, MPH, FACOG
Associate Professor, Obstetrics & Gynecology
Thomas Jefferson University
Philadelphia PA

Our sincere appreciation goes to those physicians who are willing to openly share their dissent, and all those working to preserve choice for women.

7 responses to “Missouri Supreme Court Ruling Makes Midwifery Legal”

  1. Oh, I love that letter from the doctor at the end!

    I am so worried about becoming a practitioner and being ostracized for wanting to work cooperatively with midwives. I am so happy she said she has attended a homebirth and implies that many other members of ACOG also support home birth and midwifery.

    I think she made excellent points very concisely in her letter, also, about maternal autonomy and how homebirth is safely integrated in other countries with lower maternal and infant mortality rates.

  2. I’m glad that Midwifery is legal in MO. I plan on having another child very soon and don’t want to be stuck in a hospital bed with an IV. I’ve birthed 2 children without problems, so I don’t see the problem with a home birth for me. I have tested positive for Group B Strep and need antibiotics so my child doesn’t get sick but I’ve found out that I can have a home birth and the antibiotics so that’s the route I’m taking. Even if midwifery were still illegal, I would choose a home birth over a hospital.

  3. What the good doctor, Lauren Plante, has left out of her piece is that she elected to deliver her own pre-term son by home birth and that he required admission to an intensive care nursery after that experience. It is inappropriate to make public only half of this story and her letter should be removed before others are misled.

  4. I lived in Texas, where midwifery is legal, and had a midwife to provide prenatal as well as labor and delivery, if possible, as I was pregnant with twins. I had my first son in the hospital and I ended up having to have a ceserean section. Doctors seem to want to do cesereans instead of letting the patient have the child naturally. Doctors are aware that Dimerol will slow down labor, but still use it as their first choice for pain medication.

    In addition, I have never heard of nor have I experienced any Obstetrician who will call you weekly to make sure you are eating nutritious meals/snacks. She had me keep track of everything I had eaten per week and insisted I keep myself as healthy as possible with diet and exercise.

    My appointments were much more thorough and actually lasted more than 10 minutes. And the cost was considerably less, $900 for a singlet and $1400 for multiples. I am sure these rates have increased in the last 20 years. But it beats the hell out of the $285,000 the hospital charged.

    To be fair, I went into labor early and did deliver my twins in the hospital, at my midwife’s request. Her reasoning was even if I had the twins at home they would have to be taken to the hospital due to their prematurity. She was a very responsible midwife and wanted to keep both babies as well as myself as safe as possible.

  5. The fact that Lauren Plante had a home birth that required her to go to the hospital only further helps the home birth clause- when hospitals work WITH midwives in the event that a rare emergency occurs there is a much better outcome for both mother and baby. The fact that she still encourages home birth even though she had an emergency is applauded in my book.

    Her entire point is that the woman should choose where she gives birth and needs to weigh the risks for herself. Did you not read the letter?! Read it again!

    It still stands that home birth is as safe or safer than hospital delivery for low-risk women.

  6. So what if DR Plante had a homebirth? Are you saying her baby would have avoided the nicu had he/she been born in the hospital? No, she did the right thing and admitted her own child. SOunds like the system works to me.

  7. Many Hospitals across the country employ Midwives and I have no problem with that. What I take issue with is this… after speaking with a staunch supporter of home births she was so misinformed when it came to a home delivery that went badly. She stated that ‘we’ feel we have about a 30 minute ‘window’ to get the baby to the hospital. I don’t know where she got her info but the fact that she believes that is frightening! What I got a sense of is that they want the practice deregulated so they can deliver at will with little or no ‘interference’ from the State. Personally, I would never risk my baby’s health by having a home birth. Not when I can deliver at a Hospital where everything is at my Doctor’s disposal should complications arise.Things like IV’s, and blood tests, meds, and immunizations are not the enemy. They are why infant mortality in the United States has decreased so much.

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