Last updated on 2011.02.10
The South Dakota State House continues not to trust women. Yesterday the House failed to pass HB 1061, which would finally allow midwives to operate as licensed, regulated professionals in South Dakota. Representative Roger Hunt's bill got 36 Yeas versus 31 Nays, but this bill needs a two-thirds vote to pass, so yesterday, it was eleven votes short.
My Rep. Patricia Stricherz could be one of those missing votes; she was "excused" during yesterday's midwifery vote. Patty! Call the office! You can't miss votes on important women's issues like this!
Now really, Pierre, why is midwifery so hard to accept? Women want to have some control over the setting and style and cost of delivering their babies. There are midwives who can provide the alternative, healthy service that some women want. Of all the medical procedures they might undergo, women are probably least likely to take risks with the delivery of their own babies. Does maternal instinct not operate in South Dakota? Why does Pierre continue to insist on making women's health care decisions for them?
Update 09:17 CST: Rep. Steve Hickey (R-9/Sioux Falls) uses the Web the way all legislators should, to update us all directly and immediately on why he voted no on the midwifery bill. His big sticking points: liability and risk to the child. But I would still contest his analogy to his beliefs on protecting the unborn from abortion. A hoe birth with a midwife is not an effort to harm the child. Mothers choose home delivery with a midwife specifically because they think it is better for the child.
Now maybe, just maybe, there are legislators who want to license midwives but feel HB 1061 makes too many hoops for midwives to jump through. There were some Dems voting no (Hunhoff, Fargen, Wismer, Blake), so I'm hoping that was their reasoning. Rep. Hunt intends to move to reconsider, so let's hope we can bring HB 1061 back to the table and make it work.
Update 2011.02.10: The House reconsidered HB 1061 yesterday and passed it 37--32. Reps. Stricherz and Schrempp joined the yeas, while Rep. Turbiville flipped from yea to nay. Apparently the Speaker ruled that the two-thirds vote requirement was erroneous and that a simple majority was sufficient. Now on to the Senate!
Ahhhh, the irony. Representative Hunt defending a woman's right to choose.
to quote Montana Cowgirl: "protect the unborn. after you're born, f**k off.
Nick, indeed, I am curious about how Hunt squares those positions, especially given the rationale offered by Rep. Hickey for voting no. And Larry, I thought you said Montana was better than South Dakota. :-)
I can't speak for Representative Hunt, but I imagine it's not too difficult to square positions. Why not advocate personal / familial choice in where and how a child is brought into the world, so long as risk to mother and child is mitigated? At the end of the day, the child is still being born, so midwifery isn't out of sync with pro-life values... or am I missing something?
I think it'd be wise not to over-simplify the complex nature of the ethical dilemma abortion poses to our society, and the many conflicting values at stake.
I was there yesterday and listened to this debate. It was very interesting. One legislator stated that these home births are going to occur anyway as it is a choice these couples make, and it would be much better to have a certified midwife present than not. I agree. I too noticed Rep Stricherz was absent. I was very surprised that this did not pass; it is simple common sense. Malpractice insurance is addressed in the bill if I understood it correctly. Many proponents said this is not a choice they would make, but it is a choice that parents make after careful deliberation and they should not be denied the best care they can get in that situation. I too hope that Rep Hunt brings this bill back.
In this case, I think Roger Hunt is simply more educated about the issue than Hickey is. The number one reason women choose homebirth is because of safety -- the safety of their child and themselves. Between unnecessary, dangerous interventions, iatrogenic injuries, and hospital born infections, a good case can be made that there is just as much risk in a hospital birth (if not more). I'm working on post right now about the liability issue, but it basically comes down to the fact that very few people in our legislature actually know how the law works in South Dakota and can't be bothered to do a cursory search of the SDCL to find out.
Kelsey - that's pretty par for the course. I've worked with City Councils that don't bother to read their own ordinances... Rather scary, actually.
This bill creates more issues than problems solved.
This is a Registration bill and not a licensure bill: "Registration" of a health care worker is reserved for those who have the lowest level of responsibility or decision making health care. Like nurses aids(CNA's) and dental hygienists. This is not something you would expect from a provider who faces life and death decisions of not just one but two lives at a time.
There is no legal recourse for malpractice: Because there is no license, there is no way to insure that unlike the certified nurse midwife, lay midwives (CPM) who are sued for malpractice are placed on the National Practitioner Malpractice Database. This database allows the public access to the legal history of providers so they can make informed choices about who is providing their care. These midwives are also not required to carry malpractice liability insurance.
Because there is no license, these CPMs are not required to report license suspension, disciplinary action or revocation of licenses held in other states. This opens the door for midwives who have been previously disciplined to come to South Dakota. We will be welcoming midwives with less than honorable pasts….
These CPMS are asking for use of the Guidelines for Practice that were written for and by Certified Nurse Midwives who are registered nurses with masters degree education in midwifery. The CPM has no formal educational pathway. These guidelines written by the nurse midwives include use of physical assessment skills in determining risks for delivery. CPMs do not have the extensive training in physical assessment to incorporate these guidelines into their own use. (Apples and Oranges)
CPMS are not trained in suturing perineums and this bill will allow CPMs to do so after they take a weekend course in suturing chicken breast. CNMs have months, and sometimes years of experience with suturing, observation of suturing, postpartum care of those who have been repaired. Would you want your wife or yourself to be sutured by an unskilled CPM? Most CNMs have years of experience in labor and delivery where deliveries are seen and carried on, on a daily and/or hourly basis.
This bill gives CPMs the authority to administer drugs that is not congruent with DEA regulations: They can administer drugs but not prescribe? This is an enigma. How would you know what drug to administer if you do not prescribe the drug. Since they are not working with any other health care provider, how will they know what to administer if it is not prescribed? Therefore they are prescribing. CNMs spend years training on diagnosis and treatment.
Example: What if they have a client who has group B strep requiring antibiotic therapy and that client is allergic to the most common antibiotic given for group B. The midwife then has to determine what antibiotic can be used and be ready to treat any adverse reaction to that antibiotic. What do they do in the case of anaphylaxsis. If this is not prescribing, I don’t know what is. They do not have the year long pharmacology education that CNMs have that is necessary to make these determinations. A Saturday course is not sufficient to address this.
This bill requires no standardized formal education. In spite of what some legislators have espoused, the only educational path for CPMs that guarantees that the core curriculum of basic midwifery is taught are those CPM programs that are accredited by the Midwifery Education Accreditation Council (MEAC). The authors of this bill, South Dakota Safe Childbirth Options, are asking legislators to invite the lowest educational model possible into our state to provide care in rural South Dakota.
Because of the way the bill was written, it implies that any RN or nurse practitioner can practice as a midwife even though neither have the training necessary to provide out of hospital birth care. There is no definition of the practice of a registered midwife, therefore in the absence of such a description, you cannot be charged with practice if you so choose not to register.
Section 3 states: The following persons are exempt from the registration requirements of this Act:
Any certified nurse midwife, registered nurse, or licensed nurse practitioner
And finally, it appears that there is a loophole for any precepting (one who is managing an apprentice) midwife. This appears that this bill would allow the senior midwife to come into the state and practice without registering. She is exempt from the registration. There is also no requirement for her students in South Dakota to register. They are also exempt. Therefore, you will have many “unregistered†untraceable midwives coming and going in this state and there will be zero over site.
I believe Hunt, Brunner and many of the other legislators have finally broke to 10 years of active lobbying by a handful of South Dakota women who what a short cut, to good legislation and care.
That's just for starters, there is more: Like who's going to pay for this new "Registry" like the Dept. of Health testified, this will come at a cost and they may have to cut vaccinations to get this funded?
Don't get me started, we need a CPM Law, but this is not it!
Year after year, advocates of homebirth and midwives try to bring a bill to legalize CPM practice. They try to work with everyone, they try to address all the issues, but those in the medical community who are against midwives will always be against midwives. When they suggested licensure, they were told that was too expensive and no one would be willing to oversee it. So they bring registration and they get accused of trying avoid licensure.
The whole debate seems to come down to, "There isn't enough oversight!" "Okay, here's a bill with more oversight." "You expect us to regulate you?? No way!" Of course the opponents' solution is simply to continue to keep homebirth rouge and underground. I'm sure they believe that's where it belongs. But the majority of states in the U.S. (not to mention pretty much all of Europe) has managed to figure it out. I think SD can do the same.
Also, I got really excited about this National Database idea -- I was all prepared to check out doctors in my area so I could make an informed decision. So I register with the site, go to the datebase, and find this:
"The National Practitioner Data Bank Public Use Files contains information about doctors and other health care practitioners who have had medical malpractice suits filed or adverse action taken against them. The information has been redacted or altered to remove details that could identify a particular practitioner.
...
Although names are not included in the public version, some news organizations have been able to use this database with other public data, including court records, to determine the identity of individual practitioners in the past. Since that time, however, the public use file has been changed to obscure potentially identifying details."
I'm not sure how that's going to help me be a more informed consumer.
Corey,
I just want to say that I find it appalling that Kristi Noem (a supporter of midwifery when she was in Pierre) is no where to be seen now. She as a conservative woman and supporter should be working her behind off to get this done.
I know a lot of women who support this who are conservative and liberal. It seems to me those who don't support it are political and afraid to stand up to the Hospitals.
Kristi Noem - where are you??? We need you!!!!!!!!!!!!!!
All midwife supporters should call Noem's office and ask why she can't be bothered to comment on this.