Under the Dome

Midwife bill surfaces again

A bill filed Tuesday would create a new regulated category of midwife. Currently, state law requires home births be handled by licensed nurse midwives under the supervision of physicians.

Sen. Thom Goolsby’s bill would create certified professional midwives, who do not have to be nurses but meet certain training requirements. They would be overseen by a new state council comprised of other certified professional midwives, a nurse midwife, a physician and a “home birth consumer.”

Last session, a bipartisan bill regulating midwives failed to make it out of committee.

Goolsby, a Wilmington Republican, calls the bill the Home Birth Freedom Act. It says people should have the freedom to choose the manner of birth, and that there are current insufficient midwives to meet the demand.

The bill is SB106.

Update: Goolsby tells Dome this evening: "My two daughters were both born with the help of midwives. I want to see it that certified professional midwives are regulated by the state and can provide their services to expectant mothers. South Carolina and Virginia have similar practice statutes. North Carolina needs one, too. Women deserve a choice to have their babies at home and receive proper care, if they so desire."


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Certified Professional Midwives

Thank you, Sen. Goolsby, for your leadership in the sponsorship of the two midwifery bills that would allow homebirth families to access Certified Professional Midwives for their care. These midwives have and still do attend most of the homebirths nationwide. The other 27 states who have chosen to legally recognize CPMs as quality providers have found their service to be beneficial to the communities. This progression towards the national recognition of the CPM has been moving forward for almost two decades now, and no state has chosen to sunset any passed legislation that recognized this model of care. The Certified Professional Midwife credential is accredited by the National Commission for Certifying Agencies (NCCA) which accredits many healthcare credentials, including that of the Certified Nurse-Midwives. The American Public Health Association issued a resolution in 2001 that acknowledged the need for increased access to out-of-hospital maternity care through state regulated and nationally certified direct-entry midwives, of which the CPM model qualifies. Notably, CPM practice and homebirth safety was the focus of a prospective study published (2005) in the British Medical Journal which evaluated over 5,000 births that occurred in 2001.

The development of the CPM credential was done with much research and consultation from accomplished and respected midwives, physicians, academics, the public health community, epidemiologists, and legislators. The scope of practice of the Certified Professional Midwife is different than that of the Certified Nurse-Midwife, as is the case for other types of providers. The didactic and skills preparation of the Certified Professional Midwife is focused on caring for informed, self-motivated and pro-active families who are committed to birthing at home and are in agreement with healthy guidelines for consultation and emergency back up plans. Their training specifically concentrates on the out-of-hospital setting and the challenges that may be encountered there. Many CPMs work collaboratively or in partnership with Certified Nurse-Midwives and , in such, find that one credential can complement the other in quite a balanced way and neither is mutually exclusive of the other. The ultimate decision about where and with whom to birth should be left up to the discretion of the families. Legislation should be in place to facilitate this principle.

With all due respect to the writer who suggests that all births should be handled in the hospital with a physician, he/she has neglected to realize that most babies worldwide are born into the hands of midwives. The U.S. falls flat behind many other countries (approximately 24) in infant mortality in spite of all their advances in modern technology. These other nations who have far better results than we, overwhelmingly have a system which has integrated midwifery into the health care system. In addition, perhaps that writer is unaware that currently Certified Nurse-Midwives are licensed providers in every state and attend hospital, birth center and some births in the home setting.
Nancy Koerber, CPM

27 states currently allow

27 states currently allow families access to CPMs. Another 12 are in the legislative process. Birth is not a medical procedure; it is a natural function of the human female. No one should be forced into the care of any provider. Home birth is legal in all 50 states - NC is irresponsible in not allowing access to the only midwives specifically trained in out of hospital care for those families who choose to have their children at home. No state or medical organisation is legislating to make homebirth illegal therefore the right thing to do is regulate those who are trained and certified to provide care.

Middling whiffery

By all means, let's keep trying to live up to South Carolina, which peaked in 1861.

The foolish push for deregulated midwifery is backward and unsafe. Medical procedures -- including births -- should be overseen by professionally trained and licensed doctors.

Or how about this, Sen. Goolsby, professionally trained and licensed attorney: Let any old amateur practice law, including criminal defense, DWIs, product liability, mass torts, wrongful death, and death penalty cases.

Because both of my parents wrote their own business contracts, mortgage agreements, wills, and advance directives without hemorraging.

Clearly, North Carolina's 10 million men, women, and children deserve a choice to draw up their own legal rights, responsibilities, commitments, and obligations at home and receive proper representation, if they so desire.

When, sir, will you file that bill?

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