Committee defers midwife legislation

Committee defers midwife legislation by Susan Smith A bill that would allow women to have a qualified midwife present while giving birth in their homes was deferred to the last legislative day by the House State Affairs Committee Jan. 25.

HB1007 would have provided regulation for the practice of professional midwifery in South Dakota.

The main proponent of the bill, House Speaker Roger Hunt, R-Brandon, said the issue boiled down to whether or not women should be allowed to have their babies at home.

Thirty-four other states in the union have some type of regulation for professional midwives, many of which are not formally trained nurses. Costs of hospital deliveries are making at-home births increasingly attractive to many families.

�The cost to have a child born in a hospital is exceedingly high,� Hunt said. �It costs several thousand dollars to have a child in the hospital compared with several hundred dollars for an in-home birth.�

Hunt served on a summer interim committee that studied the issue. He cited figures from published studies in the November 1996 edition of the British Journal of Medicine. The study showed that in-home births required fewer drugs and procedures, the amount of blood loss was the same and the amount of infant mortality stayed the same ? one child died during an in-home and a hospital delivery, Hunt said.

�Child birth is not a medical procedure, it�s a natural procedure,� Hunt said.

Nine of the 13 committee members weren�t convinced.

Rep. Scott Eccarius, R-Rapid City, a physician and surgeon, said he had problems dealing with the fact that in many cases, midwives are not trained medical professionals. Midwives go through training, some of which is formal book-learning and some of which is on-the-job training, but the philosophy is different than the scientific approach advocated by the medical profession.

Eccarius said he tends to approach every medical situation considering the worst-case scenario. He said he felt most lay midwives would have a hard time dealing with that worst case scenario. He cited figures that show one out of six in-home births result in a transfer of the mother to a medical facility because of complications with the birth.

�You handicap the provider if they don�t have all the tools,� he said.

Jill Kent, who has been a practicing midwife in Minnesota and North Dakota for 17 years, said she thinks the mother intuitively knows how to give birth.

�I feel we�re the guardians of normal birth,� she said.

Unlike in a hospital setting, the midwife remains with the mother throughout the birth process, monitoring the mother and baby. Many traditional techniques are used to help the mother during labor. Moving the mother to move the baby is especially advocated, said Rosemary Wibe, an Iowa obstetrics nurse who has also assisted mothers during in-home births.

She said the tools used by a lay midwife are just as complete as those used by a nurse midwife, they are just two different specialties. Lay midwife techniques that she has used in the hospital have worked better than medical techniques and are safer to do, she said.

The proposed legislation would provide for the creation of a Board of Certified Professional Midwives. The board would be appointed by the governor and would establish qualifications needed for professional midwifery based on core requirements established by Midwives Alliance of North America. They include knowledge, skills and professional behavior in all aspects of pre-and post-natal care, continuing education, referral, medical consultation and professional responsibilities.

It would also oversee the certification, education, certification renewal and continuing education of the state�s professional midwives. Midwives would also be required to take an exam provided by the North American Registry of Midwives. The legislation also provided for disciplinary action that may be needed.

Currently there is an injunction against one South Dakota woman whose actions resulted in a complaint to the South Dakota Board of Nursing. A jury ruled however, that she was not practicing medicine at the time of the complaint.

�They said she was practicing midwifery,� said Emily Stiegelmeier of South Dakota Safe Childbirth Options.

The fact that much of South Dakota is remote and that women in many counties don�t have access to neonatal care was an argument for and against in-home births. While midwives could provide the lacking care, complications that occur 50 or 60 miles from a clinic could also be disastrous.

Dr. Mary Carpenter, who practices family medicine in Winner, said she could cite many cases of births that appeared normal at the beginning, but resulted in complications for the mother or baby before all was said and done.

�I would consider being wrong (that the birth would have complications) far worse in Red Owl than in the hospital when the woman just doesn�t feel comfortable,� Eccarius said.

The issue was deferred to the 41st day of the 1999 Legislative Session. Although this would appear to most to be a defeat, Stiegelmeier declared it a victory. No midwifery legislation has ever made it to consideration of either the full House or full Senate before, regardless of whether or not it was the last day.

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