Opposing Commentary to SB 85

Published on 10 May 2016 by in Commentary

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TBK Voted this session to support SB 85; however, this does not mean we do not allow for alternative views to be heard as we have done this in the past.  We had an alternative viewpoint on Midwifery presented at the March TBK meeting, than that proposed in SB 85, one that argued the legislation was unnecessary and may limit midwives in Kentucky inadvertently. TBK did not change its possession on supporting SB 85; however, we are not closed to revisiting the idea in the interim. Possibly having both sides present at the same time for a fuller discussion. For those that want to see the pro argument you can go to the Kentucky Home Birth Coalition webpage. Below is a synopsis from an opposing viewpoint on SB 85.

That Pesky Midwifery Bill

The majority of Kentucky midwives are not fighting to be regulated. The push for regulation is by a relatively small group of people as described in this article: http://www.kyfreepress.com/2016/05/home-birth-in-kentucky/.

Some practicing midwives and midwives-in-training have questions and observations, as follows.

  1. Why are licensing and regulation needed?

Midwifery is already legal in Kentucky. The fact that the state won’t give a license — without explanation, mind you — is a failure of the state, not midwifery.

The solution is not to make yet another perfectly natural process be regulated by the state — the idea is preposterous on its face!

  • Has there been an uptick in home birth injuries or deaths? (No.)
  • Has there been an uptick in lawsuits filed by dissatisfied parents? (No)
  • Is there any substantial justification to push KY’s midwives into a national certification? (Not that we can see. Anyone have an answer?)

The solution is to remove the licensing requirement. Midwifery has been practiced safely in KY since the birth of the Commonwealth. Licensing has not made a difference in the slightest.

  1. What will regulation accomplish?

Since home birth is already safe — so safe that doctors in the UK are advocating for home birth over hospital births — what will regulation accomplish? Source

Regulation doesn’t make an activity safer. If it did, hospital and doctor error wouldn’t be the third leading cause of death in the United States. Source

Regulation only makes entry into the regulated profession harder and more expensive to practice. This limits entry which is beneficial for those already under the state’s protection.

Regulation is a shell game… only there’s nothing under the shell for the regulated but headache and expense.

  1. Will unlicensed midwives be arrested?

The group pushing for this bill suggests that midwives will be arrested for helping willing mothers have their babies outside a hospital. Except no midwives have been arrested in Kentucky for practicing without a license that the state refuses to issue. Arresting a midwife in this situation would be a public relations nightmare for the state.

In fact, the last midwife arrested for practicing without a license in IN had her 2014 court date cancelled after a large crowd showed up at her hearing. AFAIK, no other court date has been scheduled. Source

  1. The big lie in the pitch for licensing.

The group pushing for regulating midwives state what its bill will and won’t do. Under the “won’t” section, they list several actions that are in force in other states, but that they say will not be in force in Kentucky. Things like:

  1. Require midwives to work under supervision or in collaboration with other providers
  2. Determine conditions that would be defined as high-risk
  3. Does not limit the location where midwives may practice
  4. Require midwives to carry malpractice insurance
  5. Require pregnant clients to see an OB

Seriously?

Numbers 3 and 5, ok, maybe not. Yet. We’ll see.

Numbers 2 and 4 are pretty much a fait accompli under the guise of protecting mother and child. Kentucky legislators will almost certainly demand that regulations outline which conditions are high-risk, as well as which are too high-risk for a home birth. And of course midwives will be required to carry some kind of malpractice insurance. And does anyone think legislators aren’t going to require that midwives be supervised by someone?

Remember, it costs legislators nothing to require stuff.

And I guess the group’s members weren’t listening to the Health and Welfare Committee’s discussion of the bill. Senator (Dr.) Ralph Alvarado, an obstetrician, was licking his chops at the prospect of clamping down on the practice of midwifery. His list of wants — after he takes time to study the bill, safety concerns, you know — include but are not limited to:

  • “more meat” re. regulations, wants an amendment to the bill
  • more “connection” with medical community (sounds like oversight to me)
  • bill is creating a new area of medical professional, this concerns him
  • likes other state’s requirement of 3 years training plus residency
  • more requirements, like a midwife providing a list of 20 births, etc.
  • “health promoting and preventative care that is evidence-based” (evidence-based usually means conventional medicine)
  • an obstetrician on the board
  • limits on high risk (see #4 above)
  1. The unintended consequences.
  • A registry of all midwives and their customers… so yes, a registry of all moms who had a home birth. Addresses, kids’ names and birthdates, all of it. And a home inspection… did I mention that already?
  • Home inspections by a government agent — otherwise, how will regulators confirm all sanitary requirements have been met? Maybe just spot checks. You better let them in, too.
  • Does anyone think CPS won’t get in on the game here?
  • Primary medical and continuing education for doctors and nurses, as well as the studies and “science” is paid for by pharmaceutical companies. How long before that is the case with midwifery classes and CE courses?
  • How long before a vaccination discussion is required at a home birth? Most home birth parents are not on board with the vaccination schedule.
  • Will the sanitary requirements include certain disinfection procedures? Over-disinfecting is what created nosocomial infections, like MRSA. Nosocomial means hospital-acquired.
  1. What’s the biggest downside to regulating midwives in Kentucky?

In a nutshell: “A Kentucky woman has two children at home; one car, which her husband takes to work 6 days a week for 13 hours at a time; and zero wiggle room in the budget. The nearest hospital, which is over 90 minutes away, has a Cesarean rate of over 50% and this woman knows from friends and relatives that admittance there means she loses any say over how she gives birth. While the children’s grandparents are happy to help with childcare when they can, they work full-time, too. For this family, an unnecessary surgery and extended hospital stay or re-hospitalization would be devastating. In Kentucky, 76 out of 120 counties have no obstetricians and many areas where women must drive at least an hour to reach one; there are zero birth centers, and few legal home birth midwives. Because home birth options are so limited by law, there is little transparency about who this family might hire to assist them outside of the hospital.” Source

The training required will make becoming a midwife very expensive and time-consuming. How will midwives who practice in the poorer counties afford to get licensure?

Plus there is no school offering this training in Kentucky. Wanna-be midwives and those already practicing will have to MOVE to get the required training!

  1. The problems with an oversight board (a problem inherent to regulation).

The current plan calls for the legislature to “Create a Board of Midwifery tasked with writing regulations and overseeing applications, setting peer review standards, creating a public complaint process, and is comprised of three CPMs, one CNM who has experience in OOH or collaborating with home birth families and one community member who has utilized OOH care from a midwife.”

Don’t forget that obstetrician Dr. A wants to include.

This is how most regulating boards are set up — real estate, hemp, liquor, medicine, etc: those already in the profession are given the power of permission. Even though we’re talking about midwives and mommies, it’s still a “fox guarding the hen house” scenario.

Having regulatory boards doesn’t make the world a safer place. Witness medical error being 3rd leading cause of death, realtors still taking advantage of naive buyers and sellers, hemp and liquor limiting competition… Boards just give power to a very few to wield over their less-fortunate brethren.

In Conclusion

This might be news to Prissy, but birthing babies is not rocket science. It’s perfectly normal and happens most of the time without a big to do. In fact, a GOOD midwife does very little during the birth!

Midwifery predates medicine as a profession. In other countries around the world, midwives actually outnumber doctors. Source

Even well-intentioned regulations require sanctions to enforce them. Begging for regulation is asking for legal fines and jail time, compliance at the point of a gun. Meanwhile, life hardly gets more private or personal than childbirth. Let’s leave that to moms and dads and the woman there to help.

 

Regulation taken to its logical conclusion: https://www.youtube.com/watch?v=64SPF_o7gzU

 

Sources

 

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2 Responses to “Opposing Commentary to SB 85”

  1. Sally says:

    Thank you for printing this. We are stumbling around forgetting that control over every aspect of our lives it NOT a good thing. The government is NOT here to help 😉

  2. Mary says:

    So much misinformation in this commentary! Where to even begin….

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