Ohioans for the Preservation of Traditional Midwifery

I. Distinguishing Fact from Fiction in the Licensure Debate Debate

    As you may  know, a bill is going to be submitted that will license Ohio midwives. While we believe that the bill is being submitted with good intentions, we also believe that submitting such a bill will have negative consequences for the practice of midwifery in Ohio. We also believe that there is currently a lot of misinformation floating around with regards to this bill and the supposed climate in Ohio that has resulted in the need for such a bill. We'd like to clear up some of the misconceptions in hopes that Ohioans will be better informed and thus better able to decide whether or not  licensure bill will benefit Ohio homebirth families and midwives. We have included links, when possible, in order to verify our claims. We ask that you follow these links so that you can make an informed decision about whether or not Ohio midwives should be licensed. This is no time for ignorance and blind acceptance in the Ohio homebirth community!

II. Fact or Fiction?

First, it is important to know that the pro- mandatory licensure movement on Ohio is supported by a national pro- licensure group who is unaware of the climate in Ohio towards midwifery and is ignorant of the needs of Ohio families. OPTM believes that Ohio, like all US States, is unique in its culture and ethnic/ religious/ political composition and therefore needs to be looked at as an individual entity rather than part of a  homogeneous conglomerate composed of U.S. States. OPTM further believes that Ohioans are best able to speak for their needs when it comes to the licensure of midwives and thus believes that National Organizations ought to have little say in a midwifery bill that will effect Ohioans.

A. So, on a National Level:

Fictional Claim #1: The AMA and AGOC are trying to ban midwifery.
Fact: The AMA and ACOG do not make laws and are thus incapable of banning midwifery nationally or in any particular state. What the AMA and ACOG can do is block midwifery laws or lobby to impose restrictions on midwifery laws. They have as much right to do this as midwives have to submit bills. In addition, the AMA or AGOC have never openly stated, in any resolution, that they intend to criminalize homebirth. What they have said is that they do not agree with or support the practice of homebirth and that they will attempt to block midwifery bills or oversee the practice of homebirth in states that are proposing bills. Essentially what the AMA does is sit around and wait for midwifery groups to submit bills and, after a bill is submitted, they attempt to block or amend the bill. In Ohio, the AMA is not currently messing with the practice of Ohio midwifery; to submit a bill would only be provoking the AMA to take action. Please read the AMA resolutions yourself rather than believing anyone elses' biased interpretation of them. An article on the AMA and homebirth is currently being written and will be posted ASAP.

Note:  While the AMA resolutions in question are no longer available online, the ACOG "Year In Review" and can be found at: http://www.acog.org/departments/stateleg/MidwiferyYearinReview2007.pdf. An article about the AMA and Homebirth is currently being written by an OPTM member and will be posted as soon as it is completed.

Fictional Claim #2: Licensure will make homebirth readily available to those who birth at home for religious reasons.

Fictional Claim #3: Licensure will make homebirth safer.
Fact: Please scroll down to #2 under "On a State Level".

A. Fiction On a State Level:

Fictional Claim#1: Midwifery is illegal in Ohio.
Fact: The practice of midwifery is not illegal in Ohio; the practice of carrying/ administering drugs (like pitocin) IS.  Currently, the practice of midwifery in Ohio is "not legally defined, but not prohibited" (Citizens for Midwifery). Since the formation of Ohio Midwives Alliance in 1984, there have been only two midwives prosecuted in the state of Ohio. One midwife admitted to carrying and using pitocin, an anti- hemorrhage drug that is a controlled substance. This midwife is practicing once again. The other midwife, recently new to Ohio, was bothered due to outside circumstances surrounding her particular situation- NOT because she was a midwife! In Ohio history, there has never been a midwife charged with practicing midwifery.
    In 1998 the State of Ohio paid a formal legislative committee to research the practice of midwifery in Ohio. The Study Council findings suggested that midwives should have the opportunity to register with the State and that any legal ambiguities regarding the practice of midwifery be remedied. The Study Council did not find that the practice of midwifery was illegal, only that there were legal ambiguities when it came to the practice of midwifery in Ohio (link). There is currently no Ohio law in existence that forbids the practice of midwifery. Note: the Legislative Study Council did NOT recommend licensure.

 Furthermore, midwives in Ohio are able to fill out birth certificates without hassle and are able to verify (in a court of law) pregnancy and live birth. In addition, midwives are given newborn screening kits from Ohio (county) Health Departments- further evidence of the fact that midwifery in Ohio is currently NOT illegal.
    Also, some of the biggest proponents for this bill are midwives associated with CHOICE midwives, who advertise online. Why would anyone advertise illegal services online? This makes no sense!

Fictional Claim #2: Licensure of Ohio midwives will make homebirth safer.
Fact: There is no evidence to support this claim and there has never been any study done that proves that licensed midwives provide safer care than unlicensed midwives. On a State level, many women who would otherwise be unable to birth naturally in a hospital setting are given the opportunity to birth at home with a midwife. Should a licensure bill pass, regulations may be placed on midwives as to whom they can and cannot attend to as maternity care providers. OPTM believes that this regulation will put Ohio women at risk because of:
    1)  Limited availability of HomeBirth After Cesarean (HBAC). This will either force women to undergo an unnecessary and potentially dangerous (sometimes life- threatening) surgery or labor unassisted, which is a practice not entirely condoned or thought to be safe by OPTM.  While a few states allow for HBACs, most do not.  OPTM encourages readers to investigate for themselves how many states allow for HBAC: please see http://cfmidwifery.org for an in- depth study on a state- by- state basis- to access this information.

    2) Constraints regarding breech and twin births. Again, two situations that will either force women to have surgery or to labor alone. (Please investigate state laws regarding the legality of homebirth in these cases; it is seldom legal- you can investigate this on the Citizens for Midwifery site ).

    3) It is necessary to remember that many Ohioans birth at home in order to escape State interference during birth. Some people wish to avoid state interference for religious reasons an others for personal or political reasons. Regardless of why families choose not to invite the State to their births, families who now free to make this choice may be unable to do so in the future. Once again, this may force some women to choose to birth unassisted. Please see comment below.

    On a national level, the US has one of the most regulated health care systems in the world and we also have one of the worst! We have the highest infant and mortality rate out of any other developed country even though our nurses and physicians are licensed and undergo many years or education. Regulation does not always result in safer practice.
    Closer to home, it is alleged by pro- licensure groups that licensure will make homebirth safer. If this is true, then is the current practice of midwifery in Ohio not safe? if so, why, then, work to license a practice that is not safe, anyhow? You can't have your cake and eat it, too!

Fictional Claim #3: The climate is hostile in Ohio towards midwifery.
Fact: While there are hotspots in Ohio where midwives are not treated with respect by hospital personnel during transfer, these hotspots are regional and do not represent the climate of Ohio as a whole. The Medical Model of Care and the Midwifery Model of Care are distinctly different. Many medical personnel do not agree with the practice of homebirth, in accordance with the AMA and ACOG resolutions.This does not mean that all midwives who transfer are in danger of being burned at the stake by the medical community. While doctors and nurses may not be as cheerful and open- minded as we would all like, they are certainly not behaving in a menacing or threatening way towards midwives and their clients, either. Again the numbers speak otherwise; only two midwives have been charged in Ohio and these charges were not because they were midwives! Many midwives transfer with their clients and only two have been prosecuted in Ohio.
    Midwives and doctors do things differently; they operate under different models of care. It is important that midwives realize this while dealing with the medical community!

Fictional Claim #4: Licensure will enable cooperation between the medical community and the midwifery community.
(There is absolutely no proof of this and no studies have been done to support this claim. )
Fact: The Medical Community is not supposed to support homebirth practice (!). There is absolutely no guarantee that licensure will cause the medical community to work with homebirth midwives.  We believe  that the medical community will become increasingly hostile to midwives should they become licensed because a turf war may ensue. One thing the AMA does not like is when people want to be treated as " licensed health care professionals" when, by AMA standards, they are not. In addition, due to the AMA resolutions regarding homebirth (to which AMA doctors are supposed to adhere), homebirth is not safe and ought not to be supported. Therefore the chances of finding a doctor supportive of homebirth to provide co- care are slim. It is important, also, to remember that malpractice premiums (already at an all- time high in Ohio) may go up should a doctor choose to provide co- care, causing even sympathetic and supportive doctors to refuse to cooperate with midwives as far as providing co- care. While the pro- licensure groups will assure you that this is not the case since only doctors with hospital privileges must carry malpractice insurance, common sense tells most people that a doctor would be nuts not to carry insurance in todays sue- happy society.
 
Fictional Claim #5: Licensure will ensure that midwives are not prosecuted.
Fact: Midwives, regardless of licensure, will always be subject to prosecution in civil court should a family decide to take legal action. Moreover, licensed midwives in other states have been prosecuted by the Board of Health in their particular state (as evidenced in Florida and West Virginia). Should a client or baby die, licensed midwives will be just as likely as non- licensed midwives to be investigated and prosecuted by the State.
    In addition, Midwives who choose not to be licensed will be prosecuted simply for being midwives whereas up until now a midwife in Ohio has never been charged with being a midwife!

Fictional Claim #6: Licensure will protect midwives from the AMA.
Fact: ACOG has stated that it has every intention of waiting for midwifery groups to submit a bill in order to swoop in and block such a bill. The AMA SOP clearly states that all "licensed health care professionals" should be subject to AMA rule and regulation. If massage therapists and chiropractors are facing AMA interference, why would Ohio midwives believe that midwifery would be exempt? Recently, Wisconsin has been used to justify and glorify licensure. It is important to keep in mind that many other states started out with decent licensure bills that mutated over time. In Alaska, for example, HBACs are now illegal whereas they used to be legal. Pro- licensure groups used to use Florida as a model for licensure but, after a few years of existence, the licensure bill continues to do less and less of what it was supposed to do for midwives and Florida women. Unfortunately, State laws are only as good and as safe as those who are running the State. Florida had a good thing when they had a pro- midwifery governor. Now, however, Florida is run by an anti- homebirth governor and things are getting rough there. Should a licensure bill pass, Ohio midwives will be forced to work under a governor- appointed midwifery board. Should Ohio's governor become anti- homebirth, our law (if it is any good to begin with) will also be subject to mutate in a negative way.

Fictional Claim #7: Licensure will enable Ohio midwives to practice in an autonomous fashion while still being overseen and regulated by the State. (Does this make sense?)

Fact: Evidence shows that good midwifery bills do not always stay good. Midwifery bills are not safe from corruption from the AMA, the State Board of Health under the AMA, and anti- homebirth legislators and governors (see #6). In addition, there is already in existence a group (NARM) that provides peer review and minimum standards of care for Certified Practicing Midwives (CPMs). NARM was formed by midwives for midwives and is not affiliated with any governmental agency. In addition, NARM allows for the greatest amount of autonomy possible while still ensuring the competency of its members and thus the safety of homebirth. Because of the existence of NARM and the possibility of becoming a CPM, State regulation is unnecessary and IS an infringement upon the autonomous practice of individual midwives and the individual rights of their clients.

Fictional Claim #8: This Bill includes a religious exemption that allows for unlicensed midwives to legally attend to clients who birth at home for religious purposes.
Fact: OMAs bills religious exemption only holds so long as both client and midwife are of the same religion; this severely limits the availability of homebirth for most Ohio women who choose to birth at home for religious reasons. Please see "On Avoiding the State for Religious Reasons" below.

Half- Fictional Claim #9: This bill will make homebirth more affordable for Ohio families.
Fact: While Ohio families eligible for Medicaid may receive homebirth assistance at little or no cost, Ohio familes who are not eligible for medicaid will continue to pay what they are currently paying or may have to pay more. To date, no study has been done in Ohio with regards to how many people eligible for medicaid participate or would participate in homebirth practices. In many urban and suburban areas, the majority of women who birth at home are middle class while in rural areas many homebirth clients tend to be less financially advantaged. However, this does not necessarily mean that these families would qualify for medicaid; currently (due to economic cutbacks), it is not easy to be found eligible for medicaid.
    It is important to note that midwives will have to pay fees in order to be licensed; there will be an initial licensure fee (of unknown amount) that will have to be renewed ever year; there will be the fees involved with having to become a Certified Professional Midwife (CPM)- which are around $1,400.oo and there will be Continuing Education Fees (cost unknown). In addition, if a pharmacology course is needed (as it very may well be), there will be a fee for this as well. These fees will likely be passed on to clients, making homebirth too expensive for some or many Ohio familes. Because there is no way of knowing what the total cost of fees will be, there is no way of knowing whether or not homebirth families will have to pay more. Also, while OMA has assured concerned Ohioans that malpractice insurance will not be mandatory, the midwives who wish to carry it will have to charge more in oder to recoup the cost of carrying it. In the sue- happy society in which we live, it is plausible that midwives may want malpractice insurance; this is evidenced by the fact that there are companies who provide such insurance for midwives. 

    It has also been suggested that this bill will enable Ohio midwives to receive insurance reimbursement from private insurance companies. There no proof that this will happen because insurance reimbursement is not contingent upon whether or not midwives are licensed in a particular state. The decision to reimburse cannot be controlled by the State (even if midwives can); it is up to individual insurance companies to decide whether or not they will reimburse for homebirth services. 

On avoiding the State for religious reasons: The bill to be submitted allows for the unlicensed practice of midwifery or religious purposes so long as a midwife and client are of the same religion. This makes no sense. There are several religious denominations who are underrepresented in the midwifery community and also there may be no midwife of one's religion a safe distance away. For example, I am Roman Catholic; the only midwife I know of who is Roman Catholic lives 5 hours away. My midwife happens to be a Quaker, under OMAs bill, I would not be able to hire her if either she chose not to be licensed or I chose not to hire a licensed midwife. Another example, many Amish use "English" midwives because they like that English midwives have access to cars and phones which may save a life if need be. This exemption is absurd and is a feeble attempt to appease religious groups and organizations that defend religious and individual rights.

"YOU CAN FOOL SOME PEOPLE SOME TIMES BUT YOU CAN'T FOOL ALL THE PEOPLE ALL THE TIME... STAND UP FOR YOUR RIGHTS! "
- Bob Marley