We have received word that HB 695 will not make it out of committee, due to “the overwhelming concern from the people”!! Thank you to everyone who called or emailed the legislators, urged your friends to do so, spread the word in any way, or just sent happy thoughts! [Ok, but I'm enough of a cynic and a skeptic to say, "how do you know a politician is lying? - his lips are moving," and to still be holding my breath just in case Sen. Bryan, the Chairman of the committee... has it wrong. We may still go down to Jackson on Tuesday, just to be sure.]
This close call has made those of us who are concerned with home birth realize that we need to be PROactive, and not just REactive, so we’re trying to organize and take steps to get legislation that will make CPMs recognized… and also to be able to be reimbursed under insurance and Medicaid. Any thoughts, tips, suggestions or ideas would be more than welcome!! I can speak only with certainty for myself, but I’m fairly sure that most of us in Mississippi are in the same boat, and that is to say, that we have no experience in this matter, so would appreciate the wisdom of those who have “been there, done that.”
I’ve seen that Oregon has what I would call “model” legislation [not that I've looked in-depth at this or any other state, so if you know of any good states, or know of anything bad about Oregon's laws, please fill me in] — basically, midwives can certify, register, get licensed if they choose, but do not have to. If they are licensed, they can carry and dispense certain medicines legally (like IVs and anti-hemorrhagic medicines), which is good.
Frankly, I don’t know much about the midwives that serve Mississippi, except that in my area, they’re awfully scarce. Since MS doesn’t recognize the CPM credential, there isn’t much reason for a MS-based midwife to spend the time and money getting that credential, other than to say, “I did it.” Looking on Google, I’ve seen some CPMs in Mississippi, but for the most part they seem to be living in other states, and serving areas not too far from their respective state lines. My midwives, who were based in Memphis, traveled as far as 75 miles or so from Memphis, which would get a pretty good chunk of North Mississippi. It seems there is a similar situation with midwives in Arkansas and Louisiana. [CPMs are illegal in Alabama.] However, if Mississippi laws were such that there was a reason to become certified (like, to get insurance reimbursement and/or to legally dispense medication), I daresay that more qualified midwives would choose to get certified. Since I know that some midwives don’t like government interference in their business at all, I wouldn’t want the legislation to make non-certified midwives illegal. I’m enough of a libertarian to think that the government shouldn’t be able to mandate who is allowed to attend our births.
The Memphis newspaper The Commercial Appeal ran a story on the legislation today in which they gave the origin of the bill. Apparently, a baby died in a hot tub last year, which is the reason for Mississippi’s horrible infant mortality rates. Seriously — that’s what the Representative who introduced the bill in the House said:
The Mississippi Board of Nursing suggested the legislation because of the state’s high infant mortality rate. Holland says he believes that rate would go down if more babies were born in hospital facilities.
“We had a baby die on the coast last year being delivered in a hot tub,” Holland said.
Uh-HUH. Riiiiight! Ok, if you’ve been reading this blog regularly for any length of time, you know how I always have to dig a little deeper and get the numbers, relying on the CDC linked birth-death certificate query. No, it’s not perfect, but it’ll have to do. Let’s see how many deaths were due to “other midwife” for the latest years they have available, 2003-2005:
I’ll be honest that I don’t know for sure why there were no results for “other midwife.” This may mean 1) there were no births attended by non-nurse midwives; 2) there were births attended by “other midwives” but no deaths in this time period; 3) birth certificates that should have been marked “other midwife” were instead marked as “other” or “unknown,” (or even possibly but not likely as CNM, MD or DO).
So, next step: check out how many births/deaths happened at term, and where (because some of these babies were born as early as 17 weeks gestation, so it doesn’t matter who the attendant is nor where the birth took place; and no midwife I know of would knowingly attend the birth of a baby before 36 weeks gestation — if the woman seems to be in labor, the midwife would tell her to go to the hospital and/or accompany her there herself, so if she was the birth attendant, it would probably be because she happened to be in the back of the car or ambulance with her on the way to the hospital).
Isn’t that interesting? From 2003-2005 there were 3 deaths among babies born at term in an out-of-hospital situation… but there were either 87 or 243 such births, and I don’t know why there is a three-fold difference between the “total” (243) births attended by “other” and the subtotal (87). If somebody knows, I’d appreciate a little illumination. There is a slight discrepancy (51 births) between the bold total of the in-hospital births and the sum of the subtotals, and this may be attributable to weighting, but I’d say that a three-fold difference is more than the slight difference I would expect from weighting. The only thing I can reason I can think of would be that “other midwife” attended 156 out-of-hospital births with no deaths for these three years. [The reason I suggest that is that I remember doing a query quite some time ago, and realizing that if there were zero deaths in a category, the births just weren't included in the subtotals, but were in the totals. The query was trying to see how many births shared common factors with my first son's birth -- a home-birth with a CNM in Illinois in 2004 -- and when I changed it to "boy only," the line disappeared because no boys died in such circumstances that year.]
Now for the causes of death for these three babies:
In case you can’t read that, there was one death at 40 weeks, with the baby dying within an hour of birth, due to P21.9 (Birth asphyxia, unspecified); one death of a baby born at 40 weeks gestation, the death occurring after the first month of life, due to R95 (SIDS); and one death in a baby born at 42+ weeks gestation, after the first hour but within the first 24 hours of birth, due to R99 (Other ill-defined and unspecified causes of mortality). While each of these deaths is sad and tragic to the families who lost these babies, it is not realistic to believe that every baby will survive. Yes, it’s possible that these babies may have lived had they been born in the hospital, but that is no where near certain. There were 7 other babies born in the hospital with an MD attending, during this term period (5 at 39 weeks and 2 at 40 weeks) who died of the same code P21.9; and there were 193 babies born in the hospital (with a variety of attendants) from 37-42+ weeks who ultimately died of SIDS in the first year of life; and 9 hospital-born babies who died of ill-defined/unspecified cause of mortality (all with an MD in attendance at their birth).
So, back to the article — apparently some nurses got this legislation sponsored under the pretense that Mississippi’s high infant mortality rate (it’s #1, which is the worst, except for Washington, D.C.) is due to all these babies dying in out-of-hospital births. Who are all these babies dying after having been born outside the hospital?
That’s right — 12 total deaths after an out-of-hospital birth from 2003-2005: 3 “unknown” gestational age, 3 term births, 2 very preterm births (probably had a 65-75% chance of living, with the best possible care, at that gestational age… but they had a doctor for the birth attendant, which makes me wonder if it was really out-of-hospital), 1 extremely preterm birth (a 50/50 chance of living at that age, regardless of what is done), and 3 babies born at 20 weeks — no reasonable chance of living, regardless of what was done. The causes of mortality are prematurity for the two 20-week babies and one of the “unknown”; hydrocephalus for the 24-week baby; breech extraction and “ill-defined/unspecified” for the 27 & 28 week babies attended by doctors; the three causes of death for the term infants previously discussed above; and for the remaining two unknown gestational age, one died by assault (perhaps a teen mom strangled or smothered her newborn baby?), and the other died from some unspecified cause of the perinatal period.
There were a total of 127,602 births during that period in the whole state, with a state-wide infant mortality rate of 10.74 [11.46 for just 2005]. The hospital-birth infant mortality rate was 10.67 [11.40 for just 2005] — still worse than the #2-ranked state for infant mortality in 2005. And that’s assuming that all of these babies who died would have lived if they had been born in hospitals (which is false), and assuming that these births were all attended by midwives, rather than being either planned unassisted or unplanned unassisted births (in a taxi? on the side of the road with EMTs? who knows — you can’t tell from this data). So, leaving out the premature births, there are a total of 4 possible deaths that maybe, just maybe, were possibly somehow due to an intentional planned home-birth with a non-nurse midwife. Nope — four deaths does not change the numbers or ranking for Mississippi when it comes to infant mortality.