My note on facebook which I slightly altered into a letter to the Mississippi Senators:
I was shocked to find out today that HB 695 which would amend current Mississippi state law to restrict the practice of midwifery to only Certified Nurse Midwives (CNMs) has passed the House and is in the Senate. This is a historic and unwelcome revision of long-standing Mississippi law which has always allowed for the free practice of midwifery.
There are only about 25 CNMs in the state (as of 2008) [Update – someone told me that there are only 2 CNMs that she knows about, both hospital-based and in the far South], and most serve the lower third of the state. This leaves the rest of us without the benefit of a legal home-birth attendant. Tennessee, Louisiana and Arkansas allow for CPMs (Certified Professional Midwives), and some may even allow for non-certified or “lay” midwives to legally practice (as current Mississippi law does). When I was pregnant with my son, now three years old, I was unable to find a local Mississippi midwife close enough to attend my birth, so chose a CPM from Tennessee. If this bill becomes a law, I fear that that option will no longer be available. What then? My choices will be limited to an unassisted birth or giving birth in a hospital.
A midwife is a safeguard of normal birth — monitoring the mother throughout pregnancy, just like a doctor (only better), and monitoring the mother and baby throughout labor. In most hospitals, this one-on-one labor care is nonexistent, replaced by machines monitoring the mother and baby, with nurses checking in only rarely. Sure, it’s more cost-effective since there can be a higher patient-to-nurse ratio, but it’s not better! With the close “with woman” care that homebirth midwives can give mothers, they can pick up on indications that labor may not be progressing normally, and take steps to put it back on track at home, or make an appropriate and timely transfer to the hospital.
Without homebirth midwives, women such as myself will be forced to give birth at home without a midwife in attendance, or to give birth in substandard conditions in a hospital. There are no baby-friendly hospitals in Mississippi. Our fair state consistently ranks at the bottom of most health criteria, including breastfeeding (see also this link). Home-birth is very “baby friendly” — what we need is more encouragement for women to have home birth, not less! This is just one of many benefits to babies of home birth. Among the many benefits to mothers are a much lower rate of interventions, including C-sections, epidurals, inductions, augmentations, episiotomies and vacuum- or forceps-assisted births.
Home birth is not for everyone. Many women would not choose it if they could; and some who want to give birth at home have risk factors that cause them not to be good candidates for a home birth, so give birth at a hospital. Yet most women are low-risk, and about 90% of women who plan on giving birth at home do so (and only a very small minority of the 10% who transfer to hospitals do so in an emergency; most are calm, routine transfers for pain medication or labor augmentation).
CNMs are wonderful — I had one during my first pregnancy (I lived in Illinois then). CPMs are likewise wonderful — I had one during my second pregnancy. As far as practice style went, there was no difference. The main difference between CNMs and CPMs is that CNMs are Registered Nurses who go on to complete midwifery training — training which is very similar if not identical to the midwifery training that CPMs complete.
With midwives already in short supply, changing the law to an even more restrictive one will be counterproductive. If you care about home birth, midwifery, the right of mothers to choose where and with whom to give birth, or just plain don’t like government interference, please contact State Senators and urge them to vote against this legislation! And for good measure, contact Representatives and express your disappointment that this bill passed.