Mississippi Pushes to Legalize CPMs

Current MS law states that [paraphrase], “any woman whose sole occupation and source of income is catching babies is considered a midwife, and is not practicing medicine.” There is really no regulation at all, so I suppose the title of this post is a little misleading, because CPMs aren’t currently illegal. However, they are legal only by judicial interpretation, and I don’t know that there is anything to prevent the next judge in line to make an opposing interpretation, and say that all midwives are practicing medicine, and doing so without a license.

Last year, there was an effort made to make all non-nurse midwives illegal in the state of Mississippi. From what I understand, what happened was that there was one or more bad outcomes when midwives (or a midwife) from another state had come to Mississippi to practice, after she/they had lost licensure in their home state.  One or more nurses and/or doctors involved in the case were appalled, and got a bill passed through the House before any home-birth supporter found out about it, but we fortunately rallied against it, “raised a ruckus” about it, and got it killed in the Senate.

Then we got organized. 🙂

I became one of several board members of Mississippi Friends of Midwives, and we started working with midwives to get legislation passed to legally define midwives in Mississippi, and to have that definition be the CPM. There are several reasons for that, including, as I said above, that we’re possibly one judicial interpretation away from midwifery being defined as a practice of medicine, and midwives being then guilty of practicing medicine without a license. Also, for consumers, knowing that their midwife has been certified means that she has demonstrated her skills and ability as a midwife, so the consumer doesn’t have to just take her word for it. [This may be easy if the mom has 9 months or more to prepare for it, but what if she were recently moved to the state, or decided midway through her pregnancy that she didn’t want to give birth at her nearest hospital because they had a lot of rules and regulations she didn’t want to fight – such as requiring her to stay in bed, have an IV, get Pitocin, baby immediately to the nursery for hours, etc.] Also, no state that has passed CPM legislation has gone back and made CPMs illegal, so we view this as a protection of the CPM and of non-nurse midwifery as well as of midwife-attended home birth. Some states, such as Illinois and Alabama have made it illegal for CPMs and indeed all non-nurse midwives to attend births, and last year, Mississippi was just a few days away from joining their ranks. Since CNMs in Mississippi do not (perhaps legally cannot) attend home births, that would have made midwife-attended home-birth illegal. Since there are only a handful of CNMs in Mississippi, and none in the northern half or more of the state, that would have kept most of the state’s women from having a midwife attend them in labor.

Currently, we have legislation introduced into the House, HB 207, which was approved by the committee yesterday (Jan. 26). We’re not sure when it will come to the floor for a full vote, but based on the legislative calendar, it appears that the deadline for passage is Valentine’s Day, so it may be brought up as early as next week.

We’ve worked hard up to this point, with building support among midwifery advocates and home-birth supporters, and now it’s time to keep working hard, and to get others to work with us. Now is the time when the legislators need to hear from their constituents and from midwifery advocates and supporters. You don’t have to plan on giving birth at home in Mississippi (or anywhere else); you don’t even have to want to give birth at home; you just have to support the right of other women to have midwives legally attend them if they choose to give birth at home.

Last year when we killed the anti-midwifery bill, the state Capitol logged about 5000 phone calls on the issue. Is that a lot, or not very much? Perhaps in some states, that’s not too much, but it was “unprecedented” to the legislators, and perhaps set a record. Every phone call counts. Every email counts. Personal visits are most important. MS Friends of Midwives is working to coordinate visits and phone calls, primarily to make sure that every Representative is contacted in person, and also to make sure we know where the Representatives stand on this issue, and to provide education about what this bill does, what midwives do, etc. If they have any questions or problems with the bill, we want to be able to answer those questions. [So if you support us, please at least join us on facebook so we can better coordinate our efforts!]

Because the legislation was heavily modified and made much more simple in committee (much to our liking! thank you Omeria Scott!!) it is being considered as a “Committee Substitute,” which requires a 3/5 majority to pass, instead of just a simple majority. Now, more than ever, every vote counts. Last year, the anti-midwifery bill passed the House by a large margin; however, I don’t think that the legislators are against midwives. Many of our representatives and senators are older, and they and all their siblings were born at home, so don’t have a problem with it; plus, when many legislators were contacted about their voting for last year’s bill, they were confused by their constituents’ irritation at voting for the bill, because they thought they were voting for midwives and for keeping midwifery legal. They didn’t realize last year that their vote would have made midwife-attended home births illegal in the state of Mississippi.

The very good thing about Mississippi, is that we are a rural state, and apparently the legislators still realize that they were elected to represent their constituents, so finding out that one of their constituents supports a bill is worth a lot to them. In fact, in a recent meeting  with one of the legislators, when asked why the legislator voted for the anti-midwifery bill last year, the legislator said that s/he was contacted by a constituent asking him/her to vote for it. One person. Never underestimate the power of one!

What can you do to support our efforts and this bill? Many things!

  • If you are in Mississippi, you can call and email your Representative [full list here; find out who is your Rep here], telling him or her that you are a constituent, and that you support HB 207 [and if you’re not in Mississippi, or you are contacting other Representatives, you can leave off the “constituent” part ;-)].
  • If you know anybody in Mississippi, you can pass the word along to them so that they can call and email (and if possible, visit!) their legislators, asking them to support this bill. If you hear back from any of the Representatives, please pass the information along to our organization [our email is info at msfriendsofmidwives dot com], so that we can keep up with who has been contacted and how everybody is voting.
  • Also, donations would be greatly appreciated (even just a few dollars will help)! Mississippi is not a very populous state but it is a geographically big one, and it takes most of us on the Board a minimum of 3 hours (all highway time!) to drive to the state capital; it’s over 200 miles for me , and takes me close to 4 hours to get there, and 4 hours to get back home. As you may realize, it takes a lot of gas to drive 400+ miles, which costs money. We on the Board are just moms, and in addition to doing all this on a completely volunteer basis, spending quite a bit of time on this, all of us have given above and beyond that, including paying for things out of our own pockets when it was necessary. It would be nice to have some of the cost of gas or a hotel room offset by your generous donation. Really, no donation is too small!
  • Please join our newsletter! This is the single best way to get the information you need to know about this bill. While we update our facebook page often, you know how it is when you have several hundred friends plus probably another several hundred other groups and pages you like — it’s easy to overlook an update on your news feed. But the newsletter is sent to your email address, so will be there until and unless you delete it after you’ve read it. [And of course, your information will never be given or sold to anybody — this is strictly from us to you; and we only ask for your address (which is optional) so that we know who your elected representatives are, so we can urge you to contact them as a constituent, if necessary.]
  • You can also become a paid member on our Big Tent group (memberships start at only $15), follow us on Twitter, read our blog, and watch us on YouTube.
  • Finally, you can blog about it, share this post or other information on facebook and Twitter, and invite your friends to join our facebook group — all that social networking stuff we’re all so addicted to these days. 😉

A few years ago, Wisconsin was the first state to pass the CPM legislation on the first attempt. We hope to be the second. Thank you all so much for your support!


Updated to add: Here is a link to a spreadsheet with all the Representatives’ office email addresses and phone numbers.

“We’ve never heard such a ruckus”

That was the quote from the Senate Chairman when talking about the recent Mississippi legislation (that died in committee), that would have made all non-nurse midwives illegal in our state. With over 5,000 phone calls, the response was unprecedented. While that may not seem like a lot of phone calls, apparently, it was! Considering that our whole state population is somewhere around 2.5 million, that is 0.2% of the population calling (assuming that each phone call was by a different person, which we know was not the case, since many people called every Senator, or at least, every Senator on the committee).

What started the bill? I’m not sure, but apparently, there was a midwife (perhaps living in Louisiana, perhaps just down in that area of MS) who attended a birth in which the baby died. It’s possible that it was just one of those things, but it’s also possible that she was not as well-trained as she could have and should have been. Since I know no details, and have only a rough idea of what happened, I most certainly cannot pass judgment. Regardless of what happened or “what might have been,” this case led the Board of Nursing to get with a legislator to introduce a bill to make non-nurse midwives illegal. As far as I know, nobody knew about it until it had already passed the House and was in the Senate. Then we spread the word, and “raised a ruckus,” and got it defeated. Yay!

Now, to work.

Last Tuesday, I was part of a group that met in Jackson to begin work on crafting our own legislation to introduce next year that will make CPMs recognized and licensed, and will create a review board to oversee them. I’m not totally sure how that will work, because I’ve just never dealt with that aspect of things before. However, there were some TN CPMs at the meeting that talked about how it worked in their state. You can join the Yahoo group MSFriendsofMidwives to see the latest version of the bill and to stay informed on the process.

Currently in Mississippi, there is only one CPM, although there are several out-of-state CPMs who serve various parts of MS, and many other midwives who could become credentialed and licensed. With licensure and certification not having been required to practice in MS, it could easily be seen by midwives as being an unnecessary use of time and money to get that piece of paper, when there was no risk to not having it and very little if any benefit to getting it. I suppose that saying that you’re a CPM might get you a few extra clients, but it wouldn’t alter your legal status, and you probably couldn’t file for insurance repayment either (I suppose it might be possible, but I highly doubt that without the legal recognition that insurance companies would recognize you either). Under the legislation that will be proposed next year, CPMs would be legally recognized, and current non-certified midwives who can demonstrate that they meet the NARM criteria would be grandmothered in.

So, benefits of the legislation would be that midwives who are currently operating legally and safely in the state will continue to be legal birth attendants, and will also be recognized by the state. I asked about legislation that would make Medicaid be able to pay for such midwives, and was told that the legislation doesn’t specify that, but once CPMs are recognized, that such a step may come in the future — I don’t know if it would need to be a law, passed through the state legislature, or if it’s just one of those things that once they’re legal, they can get set up to file claims, or petition Medicaid to recognize CPMs. Another benefit would be that with credentialing perhaps comes a higher degree of respectability and also recognition. There is a certain something that comes with proof that others recognize the work you’ve done, whether that’s proving you can survive med school and get M.D. after your name, or that you’re a certified piano technician, and become a member of the PTG.

One downside of this particular legislation is that it would make non-certified and non-licensed midwives illegal. Those working on the legislation believe that any measure that allows non-CPMs to practice would be defeated. I can see that, based on the bill that was just defeated, that would have made all midwives (except CNMs) illegal. Yet, midwifery has been unregulated for so long in our state, that I can also see that enough legislators might support the bill, even if it did not criminalize non-licensed midwives. But, it seems prudent to take the safe track. I do wish that legislation such as what is in Oregon could pass, with licensure being optional but having benefits; however, those with much more experience and knowledge about midwifery and legislation are making the suggestions, so I’m going along.

“Why would anyone not want certification??” I can think of a few reasons. Some just don’t like government interfering in your business — it’s simply a libertarian issue. “Government is there to keep the peace, and that’s about it — everything else should be left free and open,” some might say. With certification comes regulation — in some states, non-nurse midwives have become legal, only to be basically legislated out of existence by the laws that made it practically impossible to operate. It’s sort of like the hospitals that have labor tubs, but women can’t use them if their water is broken based on a theoretical but totally unproven risk of infection; and they can’t use them if their water hasn’t broken, lest their water break in the tub, and nobody know it. As long as rules and regulations are sound, then there is minimal problem with them; but when they get to be stupid and over-reaching, they can cause more problems than they solve. In Arizona, the law says that home-birth midwives cannot attend VBACs. If you agree that VBACs should not take place at home, then you’d probably agree that this is good legislation. However, if you think that the risk of adverse events is so small that HBAC is a reasonable choice for women to make, then you’ll probably disagree with the legislation.

John Stossel is in a series of articles discussing the downside of certification (not mentioning midwives at all, and only briefly mentioning doctors). Here are two articles, “The Right to Work,” and “Licensing Madness,” as examples. He makes a pretty good case that certification serves to protect established industries at the expense of those who are equally competent to provide certain services (braiding hair, yoga instructor, writing wills), but don’t have the money (or don’t want to spend thousands of dollars) to certify just for the right to do what they already can do, especially if they’re doing it on the side, or are starting to build up a business. He points out that market forces will serve to weed out incompetent florists at least as well as (if not better than) the lengthy and expensive certification process. When it comes to businesses such as these, I’d have a hard time coming up with a counter argument — the “risk” of a bad florist is that you waste $30 on an ugly flower arrangement, in which case, you’d go tell all your friends and family and neighbors and co-workers to avoid that flower shop, and the florist would soon go out of business. But an incompetent midwife may lead to dead or injured mothers and/or babies, so it’s easier to say that doctors and midwives and such should be regulated and certified.

Still, there are probably some very good healers that could not be certified because they are alternative practitioners. For example, Chris Gardner, who wrote the book The Pursuit of Happyness, which was also a movie by the same name with Will Smith playing him, has an interesting history. If you remember the movie, he became a stockbroker while being homeless much of the time, with his son in tow. That’s only part of the story. When he was in the Navy and for several years afterward, he worked for and with a doctor. While my memory of what all he did is a little fuzzy, he had “great hands,” meaning, he was proficient in the medical work he did. He never went to one class of med school, but he had what it took to do what he did, including operate on people, teach med students how to do the right things — he even had work published in medical journals! But, because he wasn’t a doctor and hadn’t gone to med school, what would have been a promising medical career was necessarily stopped. He didn’t have enough money to become a doctor, and the doctor who employed him couldn’t afford to pay him more. “So, big deal — that’s just what you’ve got to do to become a doctor! We can’t have just anybody calling himself a doctor!” Well, true, but this also kept him from applying his skills and healing a lot of people. Sure, it kept some quacks out of the business of medicine, but it probably keeps some who would be very good doctors from doctoring.

There are definite upsides and downsides to this. Regulation helps to keep bad practitioners from starting a business, although it does not entirely eliminate bad practitioners. However, nothing can. While capitalism is a strong influence in keeping bad practitioners out of business (because people will not willingly spend their money on bad goods or services), they can for a time prosper. And if they’re schmaltzy enough, may be able to keep people blind to their incompetence or poor products or services to stay in business for a while — Bernie Madoff was a master at this (of course, he also blinded them with greed, which is another tangent and topic entirely). We’ve all known people who were certified, licensed, bonded, insured, and/or regulated who were really bad practitioners of their craft or trade. It happens. There are bad apples in every barrel. Regulation can make it so that people don’t have to do their own work to make sure people are really competent, which can be a good thing, or a bad thing if they are lulled to sleep and think that everyone who produces a piece of paper is competent.

As you can see, I’m conflicted about this — mostly because if you’ve got a bad midwife, we’re not talking about losing a little bit of money by not being more conscientious, but perhaps losing your baby’s life. Given enough time, the truly bad will probably be eliminated simply by market forces, but what may happen during that time? How many babies may die? Not something to be talked about lightly. However, we cannot protect people from themselves. Some people are going to choose things that others may think are “woo” (acupuncture, acupressure, magnets, copper, feng shui, craniosacral therapy, chiropractic care, herbs, vitamins, supplements, etc.) — we can’t stop them from doing that. And if a woman thoughtfully considers the matter, and chooses a non-certified midwife, or even just has a few friends over to attend her birth, can we really stop her? Should we? At what point does “society” get to dictate who attends her birth? Recently, there has been a national conference on VBAC (which since you’re birth junkies, you’ve probably heard about, unless you’ve been living under a rock). A similar argument has emerged from the pro-VBAC community, namely, that women have the right to choose how to give birth, and should not be forced into a C-section, even if there is a risk of uterine rupture and perinatal mortality. Does someone else get to choose how women give birth, or is that something that each woman should be able to choose for herself?

I think highly enough of women and our intellect to say that if a woman understands that she is hiring as a midwife someone who has only attended ten births, hasn’t really read too much about birth complications, and has never handled a postpartum hemorrhage or a “slow to start” baby, or any other complication, that she should still be allowed to hire that midwife, knowing the risks. I would want someone more qualified than that, but some women are comfortable with that level of skill and knowledge. Unless the midwife misrepresents herself or her skills, then I just don’t see that “we” should try to save the woman from herself. Others may disagree — it comes down to where on the “libertarian” continuum you find yourself.

Illinois CPM Legislation!

Forwarded from an email list I’m on — please email, forward, blog, etc. — however you can get the word out…

Greetings home birth supporters.

We have an extremely urgent message. PLEASE DROP ALL YOUR PLANS AND HEAD TO

@ We cannot overstate how important this is.  @

The Home Birth Safety Act (HB 226), which will license Certified
Professional Midwives (CPMs) for home birth, is going to be heard in the
Health Care Availability Access Committee next Tuesday, March, 3, 2009, at
4pm. This will either be the beginning of a great era or the final chapter
in our decades long efforts to pass a CPM licensure law. The next time after
this year to introduce a viable bill will be years from now, so we must make
our best efforts now.

We have gone down every possible avenue over the past few years, to get as
much support as possible, and even reached agreement with our state’s
nursing groups. We have built a strong coalition with many state groups
including Illinois Public Health Association, Illinois Maternal Child Health
Coalition, Health and Medicine Policy Research Group, and Health and
Disability Advocates, among others. We’ve even managed to get our bill
placed in a better committee. So it all comes down to this: will we make it
out the House Health Care Availability Access Committee, or will our bill

We have just received word from our people on the ground in Springfield that
individual doctors have been traveling to Springfield to lobby against our
bill. A lot of them. And they are making an impression. This is
unprecedented in Illinois and even across the whole country that large
numbers of individual doctors are actually going to the state capitol to
lobby against a CPM licensure bill. So please PLEASE if you value home birth
and want the option available for your future pregnancies or for your
daughters in the years to come, then make it your number one priority to
come to Springfield, Illinois next Tuesday, March 3, 2009!

We need EVERYONE to take a vacation day or call in sick, pull your kids out
of school, and bring your sister, your best friend and your mother to
Springfield that day to pack the hallways and the hearing room! We have to
show Illinois legislators that the people of Illinois need access to
licensed midwives!

Please forward this message to everyone you know and ask them to do the

See you there!