HB 1061: Regulation of Midwives

TC had a post on Monday that seemed to really strike a note with a lot of you based on the comments.

This morning HB 1061 appeared on the  LRC site.
I’ll admit this isn’t a topic I know much about, but based on the comments from the previous post I wanted to get the information out to you.

The bill wouldn’t require midwives to be insured, though it does require the midwife to inform the client whether or not they are insured.  It would also require the midwife to have a plan to transport the client to the nearest hospital if needed.

As far as certification goes, as long as the person is at least twenty-one years of age, passes a background check and passes a certified training class (much like an EMT must do), they can be registered as a midwife.
Edit: Thanks to the commenters who have pointed out the certification is much more involved than I originally stated.  I found this information about the certification process for CPMs on the  NARM website.

All candidates must demonstrate successful completion of 1350 contact hours of clinical experience. The clinical component must be at least one year in duration and must include 75 prenatals, 20 intrapartals, 40 postpartals and 20 newborn care by a student midwife acting as a primary midwife under the supervision of one or more perceptions. Ten of the 20 births must occur in out-of-hospital settings, and a minimum of three must be with women for whom the student has provided care during at least four prenatal visits, birth, newborn exam and one postpartum exam.

39 Replies to “HB 1061: Regulation of Midwives”

  1. Name

    This is nothing more than legislators being afraid to stand up to the medical industry in their districts. Woman should be able to give birth at home with the assistance of a midwife. It comes down to $$$ hospitals make money on births in hospitals.

      1. JD

        Unless the person assisting you has no formal education. Come on this is a no brainer. Do you really want someone who watched a few training videos to be trusted with such a huge responsibility? If someone wants to be a midwife they should at least be a registered nurse and know how to handle a situation if there are complications. The issue isn’t about giving birth at home, it’s about protecting the lives of women and the children they give birth to.

        1. I Research Therefore I Am

          “Do you really want someone who watched a few training videos to be trusted with such a huge responsibility?”

          You didn’t read any of the information from the previous post, did you, JD? The fact is, the Certified Professional Midwife credential actually requires MORE CLINICAL BIRTH EXPERIENCE than the CNM does.

          Emergency Medical Technicians, on the other hand, are not required to have any hands-on experience with births–but has the state ever put one of them in jail for assisting a laboring mother?

        2. You Are Blessed Beyond Words

          ” Do you really want someone who watched a few training videos to be trusted with such a huge responsibility?”

          Actually, MIKEH mis-read a key requirement in the bill. The midwife must have earned the national CPM credential through the North American Registry of Midwives, which is overseen and accredited the National Commission of Certifying Agencies (NCCA). The NCCA is the same body that certification body overseeing the Nurse-midwife credential, the CNP (Certified Nurse Practitioner), the OB credential, and so on. The national CPM credential is spelled out here, in policy statement issued by the American Public Health Association. (only about 1/8 of the way down)
          http://www.apha.org/advocacy/policy/policysearch/default.htm?id=242

          You can see that the training is MUCH more rigorous than watching a few childbirth videos.

          One of the purposes of this legislation is to ensure that women seeking a midwife do NOT have to resort to hiring an “underground” midwife (whose training MAY have simply consisted of watching a few training videos). CPMs are certified in anti-hemmorhagic medication administration, oxygen administration, neonatal resuscitation, among other skills deemed by the NCCA as necessary for the legitimacy of the profession. In my personal opinion, this whole regulatory oversight is a bit NANNY-state, but it’s way better than what we have now (which NO practicing CPMs, as they face JAIL-time if caught)…

  2. 73*

    I still hold the opinion that as a woman at the forefront of SD and National politics Kristi Noem has the responsibility to throw her weight in on this topic. She supported it in Pierre as a legislator and she should shed some light and lead an effort to allow women to give birth at home.

    It is hard for me to understand the logic that Hospitals have. It’s ok for a woman to seek an abortion to intentionally kill her unborn child but it is not ok for a woman to give birth at home in an attempt to bring new life into the world within the confines of her home. As I’ve been told oftentimes it is much less stressful on the pregnant woman to give birth at home.

  3. Janet

    Having someone with a certificate delivering a child in a bathtub is all well and good until there are life-threatening complications and the woman and baby get dropped off at a hospital emergency room for professionals to come in and try to save the day. Who’s getting sued in that situation? Not the lay midwife.

    1. Anon

      It wont be the hospital, either.

      Section 13. No licensed health care provider or hospital or agent thereof is liable for an injury resulting from an act or omission by a registered midwife.

    2. Mamaof2

      The whole point of licensing CPMs is to stop women from having to use “lay” midwives. I want to give birth to my next baby with a qualified attendant in my home (my CPM), not just me and my husband, as it was with my last birth! By licensing CPMs, there won’t be any “dropping off at a hospital emergency room” because it will allow CPMs to work with doctors as backup, and they will be able to collaborate as needed.

      As for the professionals you say are going to swoop in and “save the day”, are you referring to the same professionals who have gotten the maternity wards in hospitals SO out of whack that they slice into ONE out of THREE women in this country to deliver babies – and that number is even more in many SD hospitals! Don’t you dare tell me that any “professional” at the hospital is better than my CPM that I travel across the border to see. I’m glad there are OBs available for high risk pregnancies and emergencies (that number does NOT equal 33%, by the way), but I have *serious* issues with you (or anyone else, for that matter) presuming to tell me what is best for me and my family. I’ll be birthing at home anyway – don’t I deserve the option of a qualified attendant of MY choosing???

    3. Mom2boys

      I personally think pregnancy and childbirth are normal physiologic events. I don’t think that I should labor at the hospital in case something should go wrong anymore than I think I should stay at the hospital and breathe, lest one day I stop breathing. Empirical evidence tells us that no more babies die at home than die in the hospital. The published rate of neonatal death for out-of-hospital birth is consistently ~2/1000 live births. For comparison, in South Dakota in 2007 (the last year for which there was finalized data) the rate was over 4/1000.

    4. Shawna

      I’ve had two babies in a bathtub.

      And both were covered by my insurance provider, Blue Cross Blue Shield.

      A good midwife is one who can assess the risk-factor. Certified Professional Midwives have gone through, at minimum, three years of rigorous training that culminates in an 8 hour written exam and a hands-on skill assessment. It is no paltry “certificate”. In fact, the National Commission of Certifying Agencies, the organization that accredits Certified PROFESSIONAL Midwives (CPM) is the very same institution who accredits Certified NURSE Midwives (CNM).

      There is confusion, yet again, about “lay midwives” vs. CPMs or CNMs. “Lay midwives” are not being promoted in this bill, or ANY bill being presented in the legislature. CPMs are. CNMs have been in years past and are now legal in SD.

      Now, about women being “dropped off at the hospital”. A good midwife — and let’s get this clear, I’m talking about CPMs or CNMs — has enough experience and training to identify potential issues, either through the course of prenatal care or during labor. There is no shame in a hospital transfer for either mama or midwife. That is a sign of a professional who is responsible and committed to the health of mother and child above all. Additionally, midwives transfer WITH their mothers, to provide as much information as possible for the next step. Unless, of course, they are forced underground due to criminalization, like you have in South Dakota.

      I have an acquaintance who was transferred for an emergency c-section when the midwife identified unusual bleeding stemming from an issue with the placenta. This is a GOOD thing. It also does not qualify as an argument for why all women must give birth in a hospital setting. The nationwide c-section rate in hospitals hovers around 34%. CPMs have a less than 4% c-section rate. That is an ENORMOUS difference. For some perspective, the World Health Organization recommends that 10-15% be a reasonable c-section rate. I know which birthing setting I’d rather risk.

      The bottom line is this: all women and their families should have the right to access the care provider of their choice, whether this is at home or hospital.

    1. Alexandra

      EXACTLY! The government thinks I am smart enough to decide wether I want to keep my baby or not, but I’m apparently NOT smart enough to decide where I want to have the baby. I guess I’m also not smart enough to figure out this logic…

      1. Voter

        Those who work for the medical profession (lobby) and who jobs might depend on their vote could use a letter–but it problably won’t change their vote because they know what side their bread is buttered on. Those would include Mark Johnston, Susy Blake, Tim Rave, Jamie Boomgarden, Val Rausch (on the hospital board), Jean Hunhoff,–maybe a few more that I am missing.
        Then there are those who are actually researching, listening, (maybe even praying) and hearing from you might actually make a difference. Hal Wick, Steve Hickey, Todd Schlekeway (he has a baby due really soon!) Shawn Tornow, Bob Deelstra, Pat Kirschman, Frank Kloucek, David Lust,.
        Actuall if you go to legis.state.sd.us Click on “who are my legislators”. Then put in where you live. The list of those who represent YOU will show up along with a link under each of their photos which says contact “Senator_______” Click there and you can type them a (short if you want it read) note to let them know that you feel that this is a choice that families in South Dakota should have the liberty to make without government interference–and they should be able to hire the type of educated caregiver that they want. Hospitals should not be allowed a monoply. Or what ever it is that you feel that they should hear from you.

  4. Name

    As an ob nurse that works on the ne border, I can’t tell you how many disasters I have dealt with from home births. Of course there are no guarantees at a hospital but its pretty telling who is better equipped to deal with emergencies when the home birth people come to us. Certified midwives may have the skills to deliver most healthy pregnancies but too often its the unknowns that can affect both mom and baby (that is time sensitive ) that a midwife is not skilled enough nor has the tools to deal with. I will say though that there is an irrational fear on both sides.

    1. Amy @ Experience Imagination

      “its pretty telling who is better equipped to deal with emergencies when the home birth people come to us”

      Of course people go to the hospital when there is an emergency! That’s the whole reason they are there. But women shouldn’t be forced into a hospital for a normal birth. The research is clear that Certified Professional Midwives have outcomes that are as good or better than the hospital for similarly low-risk births.

      You’ll probably never see a good homebirth at the hospital (at least not a planned one), because those woman stay home with their babies.

    2. Mamaof2

      @Amy @ Experience Imagination, You took the words right out of my mouth. I am SO sick of hearing about the emergencies that end up in the hospital. Well, duh! I didn’t go to the hospital because there was NO emergency! CPMs are trained to recognize situations that may become urgent. The majority of transfers are NOT urgent. They get transferred before the emergency happens….that is, *if* there is a trained attendant there. In my case, it would have been an extreme emergency, because my husband is definitely not trained and probably would not have recognized a potential issue. Let me have a CPM at my next birth, PLEASE!

      By the way, @Name, I’d be very interested to hear more about the “disasters I have dealt with from home births” that you have seen. How many have there been? Were they planned home births? If planned, did they have qualified attendants (i.e. a CPM or CNM)? Were they actual emergencies, or early transfers because of something that could have possibly transpired? If they were actual emergencies, would the outcome have been any different if it had begun in the hospital? How many deaths have you seen? How many births do you see normally? How many c-sections per week/month/year are you witness to in comparison to how many births occur at your hospital? I’m just trying to get a grip on what kind of “disasters” they have been and how many you have seen. Instead of some whimsical anecdote of “I can’t tell you how many disasters….blah, blah, blah”, how about some actual statistics and real life information on what has actually happened in your (I’m assuming since you’re on the border of Nebraska) small town hospital?

    3. live and learn

      Nurse Name….my 1st ob-gyn nurse/lamaze teacher quit her job after my delivery. She was so sick of seeing the people she came in close contact with have horrific, unneccessary things done to them during labor and delivery. She secretly tried to teach us of all of the “disasters” that occur in the hospital and warn us of Dr. with high c-section rates. We also recently have an ob-gyn nurse of 30 years quit after she attended her first homebirth. She said, ” That is the 1st REAL birth she had ever been at.” That says a lot about what happens in hospital. If I were you, I would attend a couple of homebirths and then use that experience to help those who choose hospital birth. Seriously, there is more to labor and delivery than strapping patients to a monitor, starting pitocin and suggesting an epidural.

  5. Amy @ Experience Imagination

    I just reread the original post and I see where some of the confusion is coming in. Anybody who has a few classes CANNOT register as a midwife!

    The bill specifies that anyone registering “Has earned and maintains the Certified Professional Midwife credential issued by the North American Registry of Midwives accredited by the National Commission for Certifying Agencies.” (section 5, point 3)

  6. SD-Mama

    The people wanting to refuse Certified Professional Midwives are ignorant of the topic, and the substantial data supporting their practice. Really, people, outside of SD they practice – very successfully – in 27 states. Idaho became the 26th state, and here we wait in SD… How long will be be repressed? I am a Mom of 3, with two amazing home births and one nearly disastrous hospital birth (due to the escalating intervention). I also know over 16 families in western SD who home birth, and their beautiful 40+ home birthed babies who never visited the hospital…This is REAL, this is HERE. Let us have our Certified Professional Midwives.

  7. blackhillsmommy

    For clarification, definitions from MANA:
    Lay Midwife-The term “Lay Midwife” has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.

    CPM-Certified Professional Midwife (CPM)
    A Certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.

    The truth of the matter is that women are and will be having homebirths whether everyone else likes it or not and that will not change, in order to make homebirthing itself illegal every mother who intended to go to the hospital and labored too quickly would have to be charged as well. The only practicing CNM in the state is in the hills which leaves no certified/professional help for the rest of the state. What is wrong with allowing the women who chose to birth at home to have the security in being with someone who knows what they’re doing and signs to watch for in that rare case of emergency?

    Our 4th child was born at home in to her daddy’s hands, as will any future children, in an unassisted childbirth. That means that because at the time no professional help was legal, we didn’t have an option for help but we were determined to be in our environment, but it doesn’t mean that I didn’t want that ‘safety net’ there. Our story is not a lone one, but growingly common. Instead of hoping to change everyone’s minds by belittling and berating us, why don’t you help us to have that knowing person there that knows if a hospital transfer is in order? Homebirths are happening every day, and just as we have the right to chose to do that we should have the right to chose who is/isn’t there for that moment as well.

  8. amy jones

    As a new resident of SD I was dismayed to learn that what I had assumed was a freedom loving state had such restrictions on home birth.

    I would urge my representatives Fargen and Stricherz and my senator Olson to honor families that would like to be able to hire a midwife for an out of hospital birth if they so choose.

    I have very fond memories of the births of all my children, but with the exception of my midwife attended pregnancy I don’t remember much about my pre -natal and post partum visits. The ones with Midwife Mary were a joy.

    Mid wife means with woman, let’s let these dedicated professionals be with women in SD.

    1. You Are Blessed Beyond Words

      Amy jones –

      Please consider e-mailing your district 8 elected officials. You can let them know that this Tuesday, there will be an epidemiologist from Brookings visiting the capital. Dr Natalie Thiex, MPH, PhD, is a post-doc researcher who’s entire professional life is public health. She will be offering a short presentation and fielding questions from legislators in Room 413 of the capitol building, immediately following caucus/session (about 3pm) Tuesday. Definitely, please encourage these folks from your district 8 to attend Dr Natalie’s presentation. She will probably be the only doctor they meet with at the capital who is not financially tied to the hospital-lobby’s “legislative” protection from Healthy Competition.

      Rep.fargen@state.sd.us
      Rep.stricherz@state.sd.us
      Sen.olson@state.sd.us

      Make sure to include that you are a “constituent” in the subject line, and sign with your snail-mail address, so they realize you are counting on them as your district reps/senator. 🙂

  9. Emily

    I just went to the NARM website and it shows that neonatal resuscitation certification is already required to be a Certified Professional Midwife, but the bill has a separate entry requiring neonatal resuscitation. Why is it included in the bill if it’s already required for certification?

  10. Student Midwife

    I see in this thread that there are several mentions of the CPM being certified through NCCA and that this agency also credentials CNMs and OBs etc. Thought that is true, it would be incorrect to imply that just because the same credentialing agency is used that parallels should be drawn between the training, clinical hours and experience of these separate professions.

    To illustrate:
    Most CNMs must complete their masters in nursing, (6 years minimum of medical training) The total is 470 clinical visits with a minimum of 600 hour that are sub-divided into various aspects of care, including antepartum, intrapartum, and postpartum in addition to a minimum of 40 births. Not to mention extensive newborn and well woman care.

    The CPM 6 months of classes, 75 prenatals, 20 intrapartals, 40 postpartals and 20 newborns

    This is to illustrate that though the same credentialing agency may be used, the training for these midwives is VERY different. To correlate the same training just because the same agency was used for credentialing would be incorrect.

    Also, CNMs in the state of South Dakota are required to report their statistics to the SD Board of Nursing and the SD Board of Medicine. No where in House Bill 1061 is there mention of who CPMs will report their statistics for South Dakota families to have public knowledge of their CPM’s safety record. As a parent, I would want access to that information. As a safe birth advocate I see it as imperative. Obviously it is an important issue as “mama of 2” mentioned statistical information above.

    The next area I have concern over is this bills mention of “registration” not licensure. When a midwife holds state licensure, if their license is revoked due to unsafe or negligent practice, they must report this to any other state in which they apply for a license. In other words it ensure that the women being served are receiving quality care.

    For well trained CPMs who are serving mothers, babies and families well, statistics and licensure are not an issue. It should be a great concern that these issues are not mentioned in this bill. Our primary goal should be quality out of hospital care.

    1. Amy

      Licensure would be great, and is the ultimate goal of most of us supporting this bill, but where is the money to set up the oversight board and all the regulations going to come from when Gov. Daugaard just cut everyone’s budget by 10% or more? Registration allows SD mothers immediate access to Certified Professional Midwives rather than delaying everything another year (5 years? 10 years?) until funding is available.

      1. Student Midwife

        Typically a board is composed of volunteers and the funds needed are from the licensure fees. So, it should be in place shortly after legislation is passed. As I am sure you know our neighbor to the west recently allows CPMs and it took NO time for a board in WY to be in place.
        As for immediate access – absolutely, it is needed more midwives within South Dakota! However, if a CPM has their license revoked from another state, do we want them to “register” here and take care of our moms and babies? Or, do we as consumers insist that legislation have quality control checks in place? I would not be willing to compromise on ensuring the quality and experience of those catching our future.

        1. Debbie Pease

          Most states who have passed a CPM licensure law, take about a year to set up a board, develop rules and then get those rules approved by the state legislature before they are able to license a midwife. WY passed a licensure during last year’s legislative session. They are in the process of getting their rules approved right now. I’m not sure how much longer it will be, before they are able to start licensing Certified Professional Midwives in their state.

          If HB1061 is passed, Certified Professional Midwives will be able to begin registering with the Department of Health on July 1st.

    2. Quincy

      Doctors get way more training than Nurse Midwives. Does that mean nurse midwives shouldn’t be able to do the job they were trained to do? You can argue all you want about education and requirements, but the facts are clear. The training of Certified Professional Midwives is working well. They are having excellent outcomes in the states where they are regulated. Although nurse midwives and physicians can legally assist families at out of hospital births in South Dakota, they are not meeting the needs of the families who are asking for this option.

      Those who are truly concerned about the safety of mothers and their babies will work to pass HB1061 and allow SD families access to the midwives who specialize in out of hospital birth – Certified Professional Midwives.

  11. Moe

    Can someone just explain this to me? Is it currently illegal to give birth at home with a midwife? I realize that a person can choose to have a child at home without a midwife but are there any approved attendants under the current law?

  12. Elais

    Arrowhead

    Why would Ben Nesselhuf object to this bill? Giving women choices is staple of liberalism.

    I had automatically assumed all republicans would be against this because republicans are always against a women’s right to choose.