Thursday, July 10, 2008

Cul-de-sac


First, a mini history lesson:
A few years ago, a group of direct entry midwives (DEMs) came to the state of Utah requesting licensure. You see, while their practices weren't illegal, they weren't "legal" in a way that their practices had state approval either. This year, with the Big Push for Midwives, midwives are trying to get protective legislation in more states, but with what I witnessed yesterday, I wonder if women are really benefiting from midwifery legislation.

The problem with licensure is that once you ask for it, you get regulations. Earlier this year, it was propsed that Utah's Direct Entry Midwife bill be amended- making it illegal for a DEM to attend a breech, VBAC, or a birth with multiples. After some "compromising" the midwives gave up fighting for breech and multiple gestations, and are limited in what sort of VBACs they can attend. One of the main arguments made was that CNMs can't attend those births without a physician, so DEMs shouldn't be able to.

That was all in February- I listened to the debates online yesterday before I went to the meeting so I would have an idea of what was going on.

Yesterday's meeting was with the Rules Commitee- they were going through the bill and deciding what should be brought up at next year's State Senate session. The Committee was made up of an OB/GYN, 2 CNMs, and 3 DEMs. Let me tell you something- if you want to do something, don't go through a committee. It started almost 15 minutes late and the first half hour was a discussion on when they should meet next (September 4th, it was decided). There were also introductions at the beginning where they went around the room and everyone introduced themselves. There were many licensed and unlicensed midwives in attendance, a representative from ACOG, a representative from ICAN, and the rest of us were representing the general public. I want to say a representative of the UMA was there, but I don't remember exactly. After 1/3 of the time was spent introducing everyone and planning the next meeting, they finally got to talking about the bill. It was so frustrating- I hope that my presence didn't say that I'm backing the midwives- because I don't agree with what's going on at all.

What frustrated me the most was that there we were in a meeting- deciding what choices women can have in the future. NO ONE should be able to decide they have other people's agency in their hands- but they do. The midwives just completely gave up about women's rights and were discussing little bits of formalities and wording in the bill. One midwife in attendance- representing general public- came a long way to this meeting to bring up the fact that the mandatory referrals to a physician in certain cases (breech, multiples, etc) were difficult in her area because the physicians wouldn't take on a woman who had been planning a home birth. While this is a legitimate concern, she stated that "These [VBACs, breech, multiples] births aren't my bread and butter" implying that she wasn't too concerned about losing those women in her practice because they aren't the majority.

It's that sort of attitude that bothers me. It bothers me that a pregnant woman is just a walking dollar sign- to OBs and midwives. These are women. Living, breathing, loving human beings- not revenue! It's like the midwives are just happy that they can practice and don't care that women are being prevented from choosing the care they want. It doesn't matter that those women are the minority- they are still important human beings.

Early on in the meeting, the OB/GYN in the committee said that he feels that the rules and bill should be minimal- that less is more. Of course they all agreed, but they continued doing just the opposite. As I was sitting there, I came up with a great bill that fit his "minimal" criteria.

Women of Utah and the rest of the United States, if I could make a bill concerning birth, it'd say this:

A woman has the right to choose to birth wherever, whenever, and with whomever she wants. She has the same right in choosing prenatal care.

I think that covers it. It definitely takes care of the "CNMs can't attend these sorts of births, so DEMs shouldn't" case. With this, everyone can if that's what the mother wants. It just seems so logical to me that women should be able to birth where they want to.

Why do committees feel that they can take a woman's rights away from her? It's not constitutional to determine where and with whom a woman has to give birth. All these darn laws should be demolished. Instead of getting protective legislation, the Big Push should focus on birth choices in general, because I think that getting state licensure is really just hurting women.

A committee is a cul-de-sac down which ideas are lured and then quietly strangled. -Sir Barnett Cocks

4 comments:

  1. I hear and share your frustration. However, your explanation isn't entirely accurate.

    Legislators don't view this as a woman's right to choose the birth she wants. They view it as regulating a profession, and they (perhaps wrongly) believe that because midwives are required to have less formal education, they should not do higher risk cases. (And regardless of how you feel about it, it's true there is greater risk in vbacs, esp. primary, twins and breeches.)

    The end result is that women with the risk factors mentioned (and a few others in Utah or other states), do end up denied the care they want. On the other hand, there's not hard evidence to support DEM care for these. Look at the CPM2000. It addresses singleton vertex healthy women. Sadly, the evidence about home breech, twins and first time vbacs is not published. So legislators go with what they can see proven.

    Compromise is how politics works. It's not pretty. But bashing people on the front lines won't help, either. In fact, it'll just make ACOG/AMA's job easier if we bash each other. Then they won't have to.

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  2. In reference to committees making rules regulating child birth, I think it helps to see their point of view if you think of speeding: Of course there are many reasonable people out there who can either drive safely at any speed or who can choose their own speed wisely, but for the few people that can (and who happen to ruin it for the rest of us), speed limits need to exists for the overall saftety of everyone. So not letting the midwives attend certain births, etc, I think is the way that the committee uses to keep the dangerous drivers away from trouble. Though since you were very informed and much safer in your birth, I imagine it is hard to comprehend people who are completely uneducated about such things, but they must be out there or all these laws wouldn't be in place. I agree that women as a whole should have freedom regarding their own bodies, but when a committee is necessary for whatever cause that occured in the past, they usually have a difficult time making a decision that will be best for everyone. I think it's wonderful that you participated, or at least attended, a committee focused on one of your strong beliefs. It is much easier to just sit at home nowadays :)

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  3. "These [VBACs, breech, multiples] births aren't my bread and butter"

    I think you have totally misunderstood this comment. The OBs seem to believe that midwives want the right to attend these births for financial reasons only. This midwife was probably trying to show that finances were not her motivation. I wasn't there, and I'm not even 100% sure which midwife you are talking about, but I really doubt she feels that women are just revenue.

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  4. I understand where you are coming from, and I have many of the same frustrations with the regulation of midwives... but... On the the other hand, If you were a mama with a breech baby or twins, wold you want the midwife who was definitely trained, or the woman who wanted to catch babies, and therefore called herself a midwife?
    Dont get me wrong, I really do belive that women do need the choices in maternity care that just arent available to them in many states, and the regulations that some states make are really inane..(in AK midwives cannot attend VBACs, Breech, multiples, or women who have gone beyond 42 weeks gestation.) I personally believe that DEMs (CDMs (Certified Direct-Entry Midwives) in Alaska) should be regulated by NARM and MANA, instead of individual states pushing for different legal status for midwives. I agree with you about the choice that women need to have in their maternity care. In a perfect world, midwives and OBs would work hand in hand to provide the best maternity care possible, tailored individually for each woman and her family, where OBsTake care of truly Hige-risk women,and those women who want a hospital birth, and midwives care for the rest... But This is not a perfect world unfortunately, and OBs seem to be threatened by midwives...

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