A Bill To Extend And Enhance The Regulation Of Midwifery In Colorado

I often write about bills in the Colorado legislature that pertain to healthcare, but Senate Bill 088 is one that is particularly important to me on a personal level.  The law in Colorado regarding the regulation of direct-entry midwives is up for review this year.  SB 088 renews the existing regulations, and would also allow direct-entry midwives in Colorado to provide some additional services, such as sutures and the administration of Vitamin K to newborns and RhoGAM to Rh- mothers.

Our son was born at home with the help of two very competent midwives, nearly three years ago.  Our second child is due to arrive in just a few weeks, and we’re planning another home birth, again with the help of excellent midwives.  There is little doubt in my mind that our son would have been delivered via c-section had we been in a hospital, or at the very least I would have been given Pitocin to speed up my labor.  I had a very long labor and what an OB would have considered “failure to progress”.  But while my body did take a good long time to give birth, and didn’t progress in textbook fashion, it did indeed get the job done, and I will be forever grateful for the excellent care – and patience – that our midwives provided.

I’m not going to get into all of the research that has been done regarding the safety of planned home births for low-risk pregnancies.  Studies have been done that support both sides of the debate, and it can be difficult to sort through the conflicts of interest that exist.  The decision about where and how to give birth is ultimately a very personal one, and there is no one-size-fits-all perfect location for birth.  This is why it’s so important to provide safe, regulated options for women who would choose a less-common approach to birth.

SB 088 would extend the current regulations on midwifery practice another five years, until July 2016.  It lays out the specific guidelines for a midwife to be legally registered in the state of Colorado, including examination, education, and experience requirements.  (it’s important to note here that many women who would choose to have a home birth would do so regardless of whether the state regulated midwives or not.  By having these regulations in place, women can be more confident in their selection of a midwife, as the registration process confirms a level of competence and experience that has been evaluated by the state).

Section 9 of SB 088 (see page 11) would expand the scope of direct-entry midwifery to allow midwives to provide better, more comprehensive care for their clients.  It would permit midwives to administer IV fluids, Vitamin K shots to newborns, RhoGAM to Rh- mothers, antihemorrhagic drugs to mothers following birth, and eye prophylaxis for newborns (direct-entry midwives are already authorized to administer the eye drops, the language of the bill would simply allow them to obtain the prophylaxis).  This section of the bill would also allow midwives to provide sutures for perineal tears and administer local anesthetic prior to suturing.  These additions to the regulatory law make sense.  I doubt many women who have just given birth at home are going to be persuaded to get up and go to a hospital in order to receive a couple of stitches.  In a similar fashion, a mother who is hemorrhaging after giving birth will be much better served by a midwife who can administer antihemorrhagic drugs on the spot than one who has to call for an ambulance and wait for EMTs to arrive, or take the mother to a hospital in order to get the medications.

SB 088 also contains language that is similar to that pertaining to the registration or licensure of any profession that is regulated by law, including details regarding suspension of registration, fines for non-compliancy, etc.

Yesterday, the Senate Committee on Appropriations referred SB 088 to the Senate Committee of the Whole.  The bill has generally been well-received in the Senate.  It’s passage will help to maintain and enhance the availability of competent, regulated midwives who can care for women who choose to give birth at home.

 

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

Comments

  1. Regrets My Homebirth Decision says

    I chose a homebirth setting for the birth of my first son. I had begun a childbirth class and learned that the teacher was actually a midwife, and to be honest, she sort of scared me out a hospital birth! She told me that I would be given Pitocin, that the Pitocin would force me into an epidural, and that the epidural would slow labor so much that I would need a c-section. She would also say that in the hospital, they “automatically” circumcise your baby without your permission. Needless to say, as a young and new mother, her scare tactics worked and I was absolutely terrified of birthing in the hospital!
    Everything went wrong at home. I was 2 weeks overdue. She kept saying the baby was LOA (and when I later transferred to the hospital, I found out he was asynclitic posterior!) There was meconium in my water, which was hidden from me. When I was told to start pushing, I pushed hard, with two midwives YELLING at me, telling me I wasn’t pushing hard enough, I wasn’t putting in enough effort to get my baby out- that I didn’t want him bad enough! When I later transferred to the hospital, I was told that I was only 6 cm dilated! After pushing for 3 hours nonstop, I felt like I was going to pass out. My midwife put oxygen on me and left the room. I felt like it wasn’t working. She forgot to turn it on and when I told her- she LAUGHED about it.

    My bladder prolapsed from pushing before I was completely dilated. I was so swollen from pushing for so long, it was almost impossible to get a catheter in. I had an emergency c-section and it saved my life and my son’s (who had to be recuisitated). My bladder is still tilted, however, and I suffer incontinence. Severely. My midwife is under investigation of negligence.

    The people at the hospital were wonderful- even though my midwife treated them horribly! They kept telling me everything was my decision, notified me of everything, asked me what I wanted- didn’t judge me.
    I am honestly very afraid for women who choose homebirth should this bill be passed!

  2. Regrets – I’m so sorry you had such a bad experience. I’m glad the hospital was able to fix the situation and that you and your son are both ok. I strongly believe that nobody should be tricked or frightened into giving birth in a particular way or place. I would be angry if someone tried to scare me into giving birth in a hospital, and I also think it’s wrong for anybody to try to scare someone into giving birth at home if she felt she would be more comfortable in a hospital. The decision about where to give birth is a very personal one, and one that should never be made for us or against our will… which is why it’s so important that the state continue to regulate midwifery.

    From your description of the way your midwives treated you and the hours of pushing when you were 6 cm, I wonder if perhaps your midwives were using the “power birth” technique? This is a controversial tactic used by a few midwives, and I have come across several horror stories about it online. It’s definitely not in line with the thinking of most direct-entry midwives.

    Women will continue to choose home birth regardless of the legal status of midwives. The more regulation we have, the more options a woman has for choosing a midwife who is competent and well-trained. Without careful regulation by the state, more women may find themselves in the hands of unregulated, untrained midwives who may not be providing quality care.

  3. In four years, I’ve never deleted posts that weren’t obvious spam and I’ve never banned anybody. However, Dr. Amy Tuteur and her partner Linda Rosa, RN appear to have a strong reputation for trolling articles on this subject. Their attacks were very condescending and their information was purposely twisted.

    A good discussion of Dr. Amy Tuteur’s reputation can be found in the comments of the Science Based Medicine announcement of her departure:
    http://www.sciencebasedmedicine.org/?p=3969

    If you want to read more of her writing. You can visit Dr. Amy Tuteur’s blog here:
    http://skepticalob.blogspot.com/

  4. Regrets My Homebirth Decision says

    Thanks, Jay. I appreciate the links, because I was curious about Dr. Amy. I actually felt a little attacked after baring such a personal thing…I thought I was protecting the neonate by choosing homebirth. I did so much research. I even kept seeing an OB. I knew that midwives did the same APGAR tests, carried oxygen, Vit K, emergency pitocin, could recusitate a newborn. I had an 8 page birth plan! I wanted immediate skin to skin, the breast crawl, etc, etc. And I felt like my labor was just extremely hard- it was almost 24 hrs before I was transferred to the hospital- and I felt like my midwife wanted homebirth so badly instead of transferring immediately when she saw meconium in my water- (instead of making me push for 3 hours!) Unfortunately, the permananent damage is at a very, very young age, I now permanently see a urologist and surgery will have to be done to right my bladder and I will never. ever. get to know what a natural birth feels like. After the damage done internally, I will not be a VBAC candidate.

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