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Lesson 3: You Know What They Say
You are at a legislative season Cracker Barrel meeting and have stated to your legislator your request for access to a home birth midwife. You identified the ways in which licensing and regulation of midwives would benefit you and the community. You then neatly avoided the "selfish mother" trap by answering the question of why you would choose home birth with reasons that center on safety and the well-being of baby. But then your legislator waves a handful of papers he says are printed out e-mails from the many reputable physicians in his district that are after him to defeat any bill involving home birth and midwifery because it is so dangerous. The physicians’ e-mails cite worrying statistics. NOW WHAT?
Step One
Remain calm.
Expect this kind of opposition. The American Medical Association has pledged to strongly oppose home birth and midwifery and has created the Scope of Practice Partnership (SOPP) to oppose all expansion of practice by non-physicians. On the surface AMA members will claim it is because of concerns for safety, but this year the Supreme Court in Missouri listened to their arguments and told them safety and protection of patients was not their motive, rather it was economics. Protection of their "turf" under the ruse of representing the health and safety of the patients earned them "Lack of Standing" in their case opposing CPM practice. The case was dismissed and CPMs in Missouri are legal to practice.Step Two
Remain confident. -
Lesson 2: Why would anyone want to do that!?
Why would anyone want to do that!?
First Response
Most of the time before legislators (or the press, or the medical community) are able to hear about your need for a qualified attendant for home birth, they simply want to know: "Why would anyone want to have a home birth in this day and age?" How you answer this question is critical, because it could feed the prejudices of those not connected with home birth and shut down their ability to hear about your need for a midwife.The ecstasy of the experience tends to prevail when a woman speaks of her homebirth. Unfortunately, speaking of the serenity, calm, control, peace, beauty, and empowerment of your birth opens you and the case of home birth to the "selfish mother" response. They will (and do) say, "those people care more about their own ‘experience’ and personal comfort than the safety of the baby." Very few become curious about that joy or ever wonder why more women don't have an ecstatic reaction to birth. When speaking about the homebirth option, we must rein in our emotions and present facts.
Selfishness or Sacrifice?
Emphasizing the safety that home birth offers your baby is effective. Compared to the "convenience" of a scheduled, painless birth, with a $20 co-pay to cover all expenses, where someone else has to wash the sheets and cook the meals, home birth is a sacrifice of your comfort and your family's resources. It is a sacrifice, but also an investment in the safety, health, and wellbeing of the entire family unit.The Safest Option
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Lesson 1: Legality of Home Birth in South Dakota
Legality of Home Birth in South Dakota
Advantages of CPM Licensure for the Consumer
Home Birth - Legal or Not in South Dakota?
In South Dakota it is not against the law to have a home birth. You are also not breaking the law to have hired someone to assist you. However the person assisting at a birth risks being prosecuted for practicing medicine or nurse midwifery without a license. The practice of midwifery has never been made illegal in the state of South Dakota. The laws regarding nurse midwifery do not address other types of midwives; they solely state that it is not legal to practice as a nurse midwife without being licensed as a nurse midwife.
Lower courts in South Dakota have not been consistently able to distinguish between midwifery and nurse midwifery (the distinctions will be the subject of a future lesson, as they are important to appreciate), but when the issue reached a state supreme court (in Pennsylvania this past year) that higher court did accurately distinguish between midwifery and nurse midwifery as two separate professions.
If a case could be financed to the Supreme Court level in South Dakota the distinction between the two professions could be recognized and midwifery permitted to resume its historical position of un-regulated, un-licensed and un-restricted. There is no midwifery case suitable for the South Dakota Supreme Court on the horizon.
SDSCO is pursuing instead to have the practice of the Certified Professional Midwife (CPM) recognized and regulated by licensing in South Dakota.
Nationwide more and more midwives in unregulated states are being prosecuted. In many of these states, including Pennsylvania (where CPM, Diane Goslin won her case in the State Supreme Court), midwives and consumers are working together for CPM licensure because of its many benefits. (see page 2)
Advantages of CPM Licensure for Consumers
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CPM 2000 Study
This 2-page handout is a combination of 3 fact sheets put together by Citizens for Midwifery. They explain the advantages of using the CPM credential to license and regulate direct-entry midwives and summarize the largest study of home births attended by CPMs in North America.
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South Dakota Babies
South Dakota Safe Childbirth Options, Inc. SDSafeBirth.org Revised 10/24/08
Why License Certified Professional Midwives in South Dakota?
1. Home birth is legal in South Dakota and many families are giving birth out of hospital for philosophical, practical, religious or financial reasons.
2. When SD licenses and regulates midwives who meet standardized national criteria, the safety of home birth babies and mothers will improve.
3. When South Dakota doctors are able to legally confer with professional midwives, faster, more thorough transfers of care will be possible reducing complications and increasing good outcomes for mothers, babies, and hospital staff.
4. Certified Professional Midwives are specialists in low tech, out of hospital care and could play a major role in safeguarding South Dakota’s most vulnerable citizens during a natural disaster, pandemic, or terrorist event.
5. Requiring South Dakota midwives to carry malpractice insurance will not improve outcomes for babies and mothers and because this insurance is not available, will prevent licensed midwives from assisting at home births.
6. Licensing professional midwives has proven to be a low cost, effective way to improve outcomes for babies and mothers and no state that has implemented a licensure program has revoked it.
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SD Needs More Midwives
The CPM Credential was established in 1991 with the first certificate issued in 1994.
Today over 1400 CPMs assist birthing families across the United States.
CPMs are legal by statute in 24 states including Missouri & Maine who passed laws in 2008.
South Dakota families hope we will be next.
No state has ever reversed its decision to license CPMs
No state has reported an excess of damaged babies due to CPMs or home births.
All states reporting results have described favorable outcomes for mother AND baby, and reduction in expense to the state for initial and follow-up care.
SD Needs More Midwives
Certified Professional midwives Can Fill in our maternity care Gaps
SDSafeBirth.org» -
Prevent Waste
PREVENT WASTE OF STATE RESOURCES
Developing state specific testing and credentialing is: costly, time-consuming, and lacks scientific validity. The nationally accredited CPM credential uses validated, psychometrically sound testing based on third-party job analysis, making the CPM credential the best option for establishing state licensing requirements for homebirth midwives.
CPMs are the only nationally credentialed birth attendants specifically trained in homebirths. Setting Up a program to license and regulate Certified Professional Midwives (CPMs) would:
• Prevent the huge expense of regulation by prosecution,
• Prevent birth injuries and deaths as homebirth families gain access to skilled midwives, and
• Prevent the legislature from having to deal with this issue again next year.Save Lives and Money!
License CPMs to assist homebirth families.
An economic analysis of the cost benefits of a licensed midwife program indicate that “The cost savings to the health care system (public and private) is estimated to be ten times the cost of the program.” 1
Midwifery Licensure and Discipline Program in Washington State: Economic Costs and Benefits, (A report to the Washington Department of Health), Health Management Associates, October, 2007.
SDSafeBirth.org» -
Malpractice Insurance
High-Cost Malpractice Insurance Causes Serious Access-to-Care Issues for Women
"Physicians are quitting the baby-delivery business or leaving states where juries award lawsuit 'lottery prizes' to parents with impaired newborns, says Thomas Purdon, president of the American College of Obstetricians and Gynecologists (ACOG). 'Liability insurance has become unaffordable or even unavailable,' he says." (USA TODAY, May 6, 2002)
"Over the last four years, malpractice insurance rates for ob/gyns have jumped as much as 150 percent, prompting record numbers of obstetricians - about 1 in 11 nationwide - to scale back their services to gynecology only." (Self, Magazine, April 2002)
Licensing professional midwives to practice in the home will:
• Restore access to some of the maternity care that has been dwindling because of malpractice concerns; and
• Improve outcomes for families having homebirths, decreasing the cost to the state for educating children with special needs caused by birth injuries.But this solution will not be effective if malpractice insurance is required. Women are paying the consequences of rising malpractice insurance premiums through rising health care costs and less access to quality care.
South Dakota law does not require doctors, nurses, or nurse midwives to carry malpractice insurance and it shouldn’t require it for homebirth midwives.Provide SD Moms with Access to Quality Care License Certified Professional Midwives
SDSafeBirth.org» -
Licensing Trends
2006 NARM Year End Report
Twenty states, including South Dakota, are
currently working towards CPM licensure legislation.
Over 1400 CPMs in 2008No state has ever attempted to reverse its decision to license Certified Professional Midwives
No state has reported an excess of damaged babies costing the state funds for lifelong care
All states reporting results have described favorable outcomes for mother
AND baby, and reduction in expense to the state for initial and follow-up care.
SD Families want access to these skilled midwives!
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