Late night session...

Yesterday was the last day of the legislative session and they work up until midnight. Unfortunately, we had to wait up until almost midnight to find out if the midwife amendments bill would pass or not. I was watching a video feed on my computer almost all day long and the bill kept moving up to the top of the list and then the House would move some other bills up ahead of it. This happened numerous times and finally at around 11:30 p.m. they got to the bill. There wasn't really any debate on it, just a couple of representatives got up and stated that this was truly a compromise bill between the UMA and the midwives group and that both groups agreed to not pursue anymore legislation on this issue until the end of the statistics reporting period in 2011. They had to vote on a couple of minor amendments and then the voting was almost unanimous to pass the bill.

Then the bill had to go back to the Senate for them to decide if they would accept the new substitute and changes that were made while it was in the House. Once the Senate received the bill, the whole voting process was over in less than 5 minutes. Senator Dayton just stood up and asked that everyone vote to concur with the House changes and then they voted - she didn't even state what the differences were from when they voted on it originally a couple of weeks ago. The bill passed both houses just barely before the midnight deadline.

I'm not quite sure how I feel about the bill passing. While the midwives won the majority of issues that they were fighting to preserve, there were a couple of issues that were lost which means fewer choices for women in the state. The two big issues that were lost were breech births & twin births. Now while I am not sure if I would want to have my baby/ies at home if I fell into either of these 2 categories, I know many women who would still like to do so. I know several midwives that deliver twins at home and are very competent at what they do. The sad fact is that both of these cases are almost a guaranteed C-section today in the hospital which is why some women would choose homebirth over the hospital. Women that fall into either of these 2 categories can still choose homebirth with an unlicensed midwife, but unlicensed midwives cannot legally carry things like pitocin for hemorrhaging or oxygen for resuscitating. I do like the fact though that the UMA has agreed to leave the issue alone until 2011 (we'll see if they keep their word) and that we did win VBAC homebirths if the woman signs a waiver. Overall I think that it was a great bill and I really can't see the UMA ever agreeing to a bill that allows breech or twin homebirths. I really wish they would allow a waiver though instead of making it a mandatory transfer so the woman still has the ability to choose for herself.

Compromise... finally

Wednesday morning I got up at 6 a.m., showered & got myself ready, ate breakfast, got Blondie & Kitty up and dressed and was out of the door by 7 a.m. We made it to the Capitol & parked around 7:35 and got to the committee meeting room around 7:40. I was surprised when we walked in the room that none of the midwives were there and the bill sponsor was not there either. Usually all of the major players are there in the room before I get there. About 10 minutes to 8:00 some of the House staff came into the room to get set up for the meeting and were surprised to find the room half full already. I heard one of the staff comment that usually there is no one in the room when she arrives and very few people there even when the meeting starts. From what I could tell the majority of people were midwife supporters, but still no midwives. By 8 a.m. most of the committee members were there and the chair spoke and said that he had just been informed that the UMA and LDEMs were in the middle of discussions to come up with a compromise bill to present to the committee. He said that they would wait for about 10-15 minutes for them to show up. So we sat around and waited for about 15 minutes and then the chair decided to bring the committee to order to discuss what to do. Someone got on the phone with someone from the negotiations and was told that it would take about 15-20 minutes to get the new substitute typed & printed up. So the committee decided to "saunter" until about 8:30 at which time there would hopefully be a bill to discuss.

At around 8:25 the midwives walked in and a few minutes later I recognized some of the UMA representatives. They then passed around a new substitute version of the bill and both sides testified to the committee that it was truly a compromise bill that both sides agreed to and that they would not present any more legislation on the issue until the trial period to gather statistics was over in the year 2011.

Overall I think that it is a good bill and definitely the best one that we have seen so far (that the UMA agrees to). The bill does not change anything for unlicensed midwives, but it does limit somewhat the scope of practice for licensed midwives (LDEMs). It looks like expectant moms can see an LDEM if she has had a previous C-section (VBAC) if she signs a waiver. The bill does not allow women to see an LDEM if they are expecting twins or if the baby is in the breech position at birth. That is how I understand the bill. I could tell that there were several doctors in the room who were NOT happy to see the section about VBACs in there. The truth is that there is a less than 1% risk of uterine rupture in a VBAC case and I think that women should have the right to choose their risks - either a VBAC at home or most likely a repeat C-section in the hospital - neither of which is going to be risk-free.

Now the goal is to have it pass out of the House and then back to the Senate for concurrence. Hopefully this is the end of it for at least 3 more years (at which time I will most likely be finished having kids). :0)

Supreme Court Case in Missouri

There was a law passed last year in Missouri to legalize the practice of certified professional midwives (CPMs) attending homebirths in the state. After the law was passed and before it went into effect, the Missouri State Medical Association (MSMA) organized a well-financed challenge to the new law and was granted a temporary restraining order. Now the case is going to be heard on March 5 to decide if they will overturn the restraining order or not. This is a huge case for midwives in Missouri and I would hope that each of you will keep them in your thoughts & prayers. To read more details about the case you can read the following media alert from Missouri:

MEDIA ALERT
Missouri Supreme Court to hear Midwives Law Appeal
Court grants motion by coalition of midwife advocates to file a `friend of the court' brief for Mar. 5 hearing

(Jefferson City, MO) – The Missouri Supreme Court will hear arguments to reconsider the permanent injunction on the state's new midwifery law at 9:30 a.m. on Wednesday, March 5 at the Cole County Courthouse, 301 E High Street. A coalition of state and national midwife supporters, midwives and home birth families, led by Friends of Missouri Midwives (FOMM) and mobilized for the appeals process, has learned that the Court has granted their motion to file an amicus curiae (friend of the court) brief, submitted by:
* Citizens for Midwifery (CfM)
* Midwives Alliance of North America (MANA)
* National Association of Certified Professional Midwives (NACPM)
* Our Bodies Ourselves
* The National Birth Policy Coalition (NBPC)

The amicus brief submitted by the coalition supports the lifting of the midwives law injunction and makes the case that increasing access to trained and qualified Certified Professional Midwives (CPMs) and out-of-hospital birth is beneficial to Missouri citizens. In seeking to provide such access, Missouri is following the wisdom of a growing number of states recognizing the benefit of authorizing CPMs, who provide safe and high quality care, to practice.

"If the Supreme Court lifts the injunction, this law will permit CPMs to provide high quality, cost-effective care that will benefit Missouri's citizens and fill some significant gaps in the state health care system," said Susan Jenkins, legal counsel to the midwives coalition and steering committee member of National Birth Policy Coalition. "Home birth among low-risk women attended by CPMs does not jeopardize the health of mothers or infants, is authorized in 22 states, and is supported by many highly regarded international and professional organizations."

Mary Ueland, Grassroots Coordinator for Friends of Missouri Midwives, says she hopes the Court will rule to decriminalize Certified Professional Midwives and remove the threat of prosecution to professional midwives who assist families who choose out-of-hospital birth. "Missouri shouldn't drag it's feet when it comes to allowing mothers to have safer and healthier
births options."

The new Missouri Midwifery law was supposed to take effect Aug. 28, 2007, but the Missouri State Medical Association (MSMA) organized a well-financed challenge to the new law and was granted a temporary restraining order on July 3. Then on Aug. 8, Circuit Court Judge Patricia Joyce, who serves on the Board of Directors for St. Mary's Health Center in Jefferson City, disallowed the Certified Professional Midwives provision contained within HB818 regarding portability and accessibility of health insurance.

Judge Joyce ruled the provision was unconstitutional and unrelated to health insurance, despite hearing from Assistant Attorney General John K. McManus and Midwifery Coalition attorney Jim Deutsch that decriminalizing midwifery does indeed relate to health insurance as they recalled that the Missouri Supreme Court has already ruled health insurance is interdependent on health services, and the two subjects are related.

During the Circuit Court appeal to Judge Joyce on Aug. 2, Deutsch cited nine other states where Medicaid covers home births attended by Certified Professional Midwives and many others where CPMs receive private insurance reimbursement. Both McManus and Deutsch argued that families obviously cannot get health insurance reimbursement for their midwives if their providers are considered felons by the state. They agreed that legalizing Certified Professional Midwives is a first step to home birth families being able to have their maternity care providers covered by insurance. They also cited the lower cost of midwifery care, which in turn could encourage insurance companies to lower their rates for healthy women.

"We're seeing a strong shift in support of professional midwives as families become more aware of the benefits of CPMs, as well as more alert to skyrocketing c-section rates," Laurel Smith, President of Friends of Missouri Midwives, said. "Beyond the additional risks for mothers and babies that c-sections create, what effect does a c-section rate of more than 30 percent have on our insurance premiums, and how reliant are doctors and hospitals on these increasing revenues?"

Missouri is part of The Big Push for Midwives Campaign, a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

The case defendants and midwifery supporters who are listed on the appeal to the Missouri Supreme Court include:

* Friends of Missouri Midwives (FoMM). A nonprofit organization representing the interests of Missouri families who choose to have safe, alternative, out-of-hospital childbirth options. FoMM was created to support, promote and protect the rights of Missouri families to make choices about how, where, and with whom their babies will be born and to promote access to the midwifery model of care. Contact: Laurel Smith 636-209-1033.

* Kelly & Dallion Rehm, and Eric & Jessica Kerr. Two families that were expecting babies to be born after Aug. 28, 2007, the day the new law was to take effect. They were planning home births with legal, well-trained CPM's. When the new law was struck down, they had to choose between breaking the law, birthing at home without a trained attendant or the expense and interventions of a hospital birth. Contact: Kelly & Dallion Rehm 417-777-8005, Eric & Jessica Kerr 314-962-1143 or 314-248-0952

* Columbia Community Birth Center, Kim James, CPM; Ivy White, CPM; and Dr. Elizabeth Allemann, MD. Columbia Community Birth Center is the only licensed birth center in the state of Missouri. The Center is a place where families give birth in a comfortable home-like setting. James and White received their CPM credentials in 1995. Ivy White says, "As a natural childbirth specialist and professional, to have the freedom and recognition to legally practice in my state is a dream that I share with my midwife colleagues in Missouri. It wrenches my heart that there are families who long for midwifery care, and I cannot give it to them." Contacts: CCBC 573-447-2700; Ivy White 573-356-1059; Kim James 573-424-9115; Elizabeth Allemann 573-268-6946.

* Missouri Midwives Association. An organization dedicated to promotion, protection, support and education for midwives in Missouri. "Generally, parties who want to join a suit want to be on the plaintiff's side. We are an unusual group with an unusual dedication to our cause. We have joined the State of Missouri as co-defendants so we can have a say in what evidence the court will consider, and ensure our victory," says Debbie Smithey, President of the Missouri Midwives Association. Contact: Mary Ueland 417-543-4258.

Media inquiries about the Missouri Supreme Court case should be directed to Mary Ueland at (417) 543-4258. Media inquiries about The Big Push for Midwives Campaign should be directed to Steff Hedenkamp at (816) 506-4630.

Friends of Missouri Midwives
Missouri Midwives Association
Show-Me Freedom in Healthcare
Free the Midwives
The Big Push for Midwives

Another committee meeting

Well, the bill has been put on the agenda for tomorrow's committee meeting (House of Representatives Health & Human Services Committee). It is the only item on the agenda for a 1 hour meeting (and this is the last day of committee meetings). It was originally on the agenda for last Friday but then was removed so we thought that it would just be sent to the House Floor for a floor vote. I think that this is a good thing because I know that several of the committee members are on our side. The meeting is at 8 a.m. (again) so I will be getting up bright & early to go with my 2 little ones. Stay tuned tomorrow for the outcome of the meeting...

Views on Childbirth - part 2

Before I had any kids I had never even thought about or heard about homebirth. When I became pregnant with M&M I heard about a group of certified nurse midwives (CNMs) through some people in my BYU married student ward. They were located in American Fork and reported to be really good. Since I have never been crazy about too many doctors during my short lifetime the idea sounded intriguing to me and they were covered by my insurance plan. So I made an appointment to attend an introductory meeting where they meet with groups of expectant parents and talk about their practice, insurance, hospitals, etc. I think that that was the first place that I heard any mention about homebirth. One of the midwives that was conducting the meeting talked briefly about their beliefs about childbirth - how it was a natural process and that it was even safely done at home. The other thing that happened around this time is that I started immersing myself in childbirth websites on the internet. There were quite a few that I found that had birth stories that people had written and submitted for others to read. I became fascinated with reading other people's experiences. The one thing that struck me the most while reading birth stories was the marked difference between women who gave birth in the hospital with an epidural versus those who had natural, drug-free births. It was amazing to me the difference in attitude of these women. The women who gave birth without drugs had such positive views on their births and felt so empowered by the whole experience. Even more amazing were the experiences of women who gave birth at home, where they were in their own element and in control. I was increasingly saddened though by the numerous stories of women who chose to give birth in the hospital and through the process of hospital "procedures" were subjected to intervention after intervention which ultimately led to a C-section to "save" the baby.

At first I wasn't even interested in the homebirth part until I read more about it and the safety of it (but that came later on). I was also introduced to the idea of waterbirth which some stories also mentioned. More than anything though I quickly knew that I wanted a natural birth. I wanted to be able to have full feeling of my body & what it was trying to tell me during each stage of the birth process. I wanted to be able to walk & move around. I wanted to be fully awake & drug-free when I welcomed my baby into the world - to feel the natural high that comes after childbirth. I also wanted my baby to be drug-free and alert after birth. Another reason drug-free was appealing to me is that I have never been crazy about taking drugs for anything (even over-the-counter medicine) - I have to be pretty miserable before I will even take some Tylenol or ibuprofen. So the idea of being able to go through childbirth drug-free was very appealing to me in that aspect as well.

When I mentioned natural childbirth to DH, he thought that I was absolutely crazy. He felt that we have hospitals & drugs for a reason and didn't think that I could ever manage the pain associated with childbirth. He even said that in the scriptures you read that childbirth is meant to be hard & painful - so why would you not want drugs... Needless to say I was a little disheartened by this but I wasn't ready to give up yet. At one of my appointments one of the CNMs asked me if I was planning on taking a childbirth class. I mentioned that I wasn't too crazy about taking one offered at the hospital and was somewhat interested in natural childbirth. So she gave me the name and phone number of someone she knew who she thought was teaching some independent natural childbirth classes. I called the phone number and the lady who answered said that she wasn't teaching at that time but she knew someone else who was and gave me another name & phone number (it turns out that the first lady I talked to is now my midwife - I made the connection several years later).

So DH & I attended natural childbirth classes with one other couple through an independent instructor. DH & I absolutely loved the class & it was a real eye opener for both of us - but especially for DH. We learned about the whole process of childbirth and what the body goes through at each of the various stages. We also learned what the cause of pain in childbirth is and how to try and cope with it. I learned most of all that childbirth is almost more of a psychological battle than a physical one - so much of what a woman experiences can be changed by how she views the whole process in her mind. The reason we feel pain is because we are afraid and trying to control something that our body can do on its own. The less you fear the process and give in to your body the less pain you will experience (this is definitely hard to do). After attending a few classes, DH was converted to the idea of natural childbirth and we were both determined to have as natural a birth as we possibly could.

DH is in print!

Finally after 3 attempts at sending in a submission to the Reader's Forum of our paper (Deseret Morning News), one of his submissions was printed. DH has been trying over the past week & a half to get the paper to print a submission about the midwife amendments bill that is currently before the Utah legislature. We had pretty much given up that they would print one of his articles when I sat down this morning to eat some breakfast, opened up the paper & there it was! Here is the article that was printed:

UMA a monopoly run amok
Published: Friday, Feb. 22, 2008 12:53 a.m. MST

The Utah Medical Association has shown a disturbing trend to misrepresent, distort and outright lie when it suits its purposes. In the ongoing saga of SB93 (sponsored by Sen. Margaret Dayton) — the midwife bill only but a small number of people care about — the UMA feels it can do whatever it wants. Despite requests from the legislators that the UMA work together with the midwives, it has demanded, made promises and then substituted its own bill ignoring midwives outright. This is a monopoly run amok.

Views on Childbirth - part 1

I want to start out my series on childbirth with a brief overview. This is what I wrote down to say in the Senate committee meeting if I had had the opportunity to speak:

My husband & I have 4 beautiful children & are currently expecting our 5th. I first heard about homebirth when I was pregnant with my first child. When I mentioned the idea to my husband he thought I was absolutely crazy. So we compromised with our first and she was born naturally with a certified nurse-midwife (CNM) in the hospital. When I became pregnant with my second child I mentioned homebirth again to my husband and he agreed.

My husband & I are probably some of the last people you would ever think would choose homebirth. We are both very logical & technical people and we each have college degrees in computer science. We would not have made the decision if we didn't know that it was a safe option for me and I have been blessed with having an experienced & very competent midwife.

Now you will be told numerous horror stories of homebirths gone bad, but I have yet to hear any that involve any of these midwives who are licensed under Utah law. I can also tell you that for every homebirth horror story, I have heard more than 10 times that number of hospital births gone bad that are usually the result of unnecessary procedures and interventions - births that should have been low-risk, uncomplicated deliveries.

While this bill does not have any factors that would "risk" me out, I know that it would severely limit the number of clients that my midwife could take and would force many of these women out of business or force them to give up their license and the ability to carry some important and possibly life-saving drugs with them.

I want you to know that I love my children. I love this baby that I am currently carrying and for the medical community to say or even insinuate that I don't want a safe, positive outcome for myself and my baby is hurtful. We as mothers & fathers & midwives want nothing less than good outcomes and will do all in our power to ensure that - even if it means transferring to a hospital under a physician's care.

I urge you to see this bill for what it really is - the medical community trying to exert power & control over these professionals who they feel are infringing on their territory.

Please vote "no" on this bill. Thank you for your time.

Patients' Rights

Here is a great article on patients' rights (focusing primarily on childbirth) that I recently read. This has a lot to do with what the Utah Medical Association is trying to impose on us as citizens of the state with the proposed midwife amendments bill. I have thought a lot about the topic and have been asked recently why I made the decision to give birth at home. Stay tuned for a series of blog entries on how DH & I came to the decision and then the birth stories of our four kids. In the meantime read this article for some food for thought:

Consumer First, Patient Second
Finding the right care provider for your pregnancy and birth
By Sherry L. Payne RN BSN

I had a long conversation with my friend, Pam, the other night. She is in her final month of pregnancy, with her first baby, who is in breech position. Her physician is suggesting a cesarean. If attempts to turn the baby are unsuccessful, she will consider a homebirth in order to avoid the surgery. I urged her to let her doctor know her thinking. Woman are often unwilling to have a frank discussion with their caregivers about their wants and desires. I reminded my friend that she selected this provider (or group of providers) and that she is paying them to be competent partners in this process. During a crisis is not the time to start doing things behind their backs but tell them exactly what you plan to do and why and listen to their feedback (but take it with a grain of salt- they don't have the final say- you do). I think this approach is important because it preserves the integrity of the relationship. Physicians and midwives are not mind readers. They need to know and understand what type of care clients desire, or what they don't want and why. Otherwise they'll just continue to think women are happy with the care they are getting.
Think about this question: What is the role of your pregnancy and birth care provider? Is it to manage your pregnancy, labor and birth for you? Is it to take care of you during pregnancy and birth? Is it to deliver your baby for you? Is it to ensure that you have a healthy baby? May I make the audacious statement that all these things are in your own power to do. When I hear statements like, “my doctor won’t LET me do that” or “my doctor says I can TRY that and see how it goes” it tells me how out of balance the care provider is with the care receiver. It is not the proper role of any physician or midwife to tell you how to have your baby (or where, or when). Receivers of health care must adopt a more pro-active consumer role in their own healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent guide through the process. He or she is not your daddy. They can’t tell you what you will or won’t do throughout your pregnancy, labor, and birth. They can suggest what they think is best, but the final course of action should be up to you.
This does not mean that a caregiver does not have the right to define their parameters for care. If a midwife only wants to take vegetarian mothers as clients, that’s her prerogative. If you happen not to be a vegetarian and really want this midwife to care for you, then you have a choice to make. The same is true for physicians. If their parameters of care include routine epidurals, episiotomies for all their patients, routines IVs, etc. then that is their place of comfort in giving care. If you don’t want any of those things, you’d be much better off finding a different physician than trying to convert this one to your way of thinking, because you’re asking them to take themselves out of their comfort zone to care for you. It’s important that as consumers of healthcare, women understand the pressures that come to bear upon care providers.
Consumers greatly underestimate the role litigious threat has had on healthcare. One of the reasons obstetrics has become so defensive in practice is because the threat of a lawsuit hangs heavily over their heads. Now some medical lawsuits are well deserved, others frivolous, yet taken together their impact has changed healthcare, and not for the better. Obstetricians are more likely than physicians in any other specialty to be sued for malpractice. This alone has changed the way they approach birth- the way they approach you. Midwives don’t get sued nearly as much, but they are still confronted with the ever growing threat. If you think your relationship with your caregiver is built on trust- well, this may be an idea whose time has passed. Trusting patients is a luxury most physicians find they can no longer afford. Many malpractice attorneys and nurse-attorneys make their livings teaching healthcare professionals how not to get sued. It boils down to defensive practice. This translates into taking all precautions, ordering all the tests, acting the moment something appears amiss. If all else fails, there is always the ultimate medical intervention for a birth at risk- perform a cesarean section. This, among other reasons, is why the cesarean rate has risen to 30% and above. Birth has not suddenly become more dangerous, the practice of delivery babies has.
This is why it is so important to know your own philosophy of birth AND your care provider’s philosophy of birth. It will be far more productive to find a caregiver that agrees with your philosophy of care than to try to convert someone because you like them. Don’t just hope you’ll be the exception or that things will go well- you won’t be and they won’t. Liking your caregiver is not sufficient criteria for choosing him or her.
As consumers you’ve got to do your homework. Get referrals from friends and family, asking them WHY they think this person is so great. Listen to their birth stories- do you want yours to mirror theirs? Google them and find out about them, go to those rating sites and see if someone has left comments about your particular caregiver. Ask your caregiver directly for client testimonials or references. Ask directly for their cesarean and induction rates. (If they won’t give them to you, that’s a red flag). Your ultimate goal should be to find the caregiver, be it physician or midwife, OB or family practice, that is right for you.

Sidebar
Questions to ask your potential care provider
What is your philosophy of birth? (They may have it in written form-even better.)
What are your practice protocols? (What do they do routinely for every patient?)
How many births do you do a month? (Will they be available for you?)
Do you attend your own patients or do I get whoever is on call for your practice group? (This is more the rule now than the exception.)
Will I have an opportunity to meet all the physicians and or midwives in your practice?
Will they abide by any agreements made by you and I?
Which settings do you practice in? (Hospitals, home, birthcenters, etc)
How do you feel about ____________________ (epidurals, episiotomies, routine IVs, or conversely birth balls, squatting, or loud verbalizations – you’d be amazed by how many providers think the birthing woman should be quiet)
What are your parameters for inductions? (What medical or non-medical criteria do they use to decide?)
How available are you (or your staff) for questions between and during appointments?

Bill moves forward, unfortunately...

Unfortunately the midwife amendments bill passed out of the Senate committee and was sent to the Senate floor to be voted on. There was some good that came out of the committee meeting though - in fact it went better than the midwives were expecting. There is an awesome Senator on the committee who asked some great questions about the bill and is completely on our side but his view was unfortunately outvoted 2-3. I was debating on Wednesday night whether or not I would go because I would need to get Blondie & Kitty up early again and I wanted to be out of the door by 6:45 a.m. to be sure that I got there on time and could get a seat. It's also even more work since I'm in my 7th month of pregnancy. Finally right before I went to bed though I made the decision that I needed to make the effort and be there to support my midwife and our cause - plus this doesn't happen every day. I also knew that this bill would be first on the agenda so it would definitely be heard and that I would be able to leave right afterwards and get home earlier than I did on Tuesday.

So I got up Thursday morning at 6 a.m. and while I was getting myself ready DH got up and said that he would stay home and watch the girls for me so that I wouldn't have to haul them along. We had been waffling somewhat on our schedule for Thursday because of the committee meeting at the capitol and then the Family & Church History Department of the church (which DH works for) was having its annual department meeting at 1:30 that afternoon down in Salt Lake that employees & spouses were invited to attend. So since DH works down in Utah county he decided to do some work from home in the morning so that he could watch the girls for me and then we would go together to the department meeting in the afternoon.

Well, I left at 6:45 for the committee meeting and I got there in record time. I was at the Capitol and had found a parking space by 7:20 so I sat in the car for a little while and took some time to write down some thoughts in case I had the opportunity to speak to the committee.

Unfortunately they only let three people speak who opposed the bill and I wasn't one of them. My midwife spoke (who is the head of the LDEM board), our sponsor of the original licensing bill from the House of Representatives, Jackie Biskupski, spoke and then a homebirthing mom spoke. Rep. Biskupski said that she had spoken with the Senate President about this bill and he said that he wanted some results this year so that this issue doesn't keep appearing each year. The legislators are definitely getting sick of seeing our group each year and having to listen to the same issues each year.

The Utah Medical Association (UMA) and LDEMs had a meeting scheduled yesterday afternoon to try and work out their differences and they are in the process of trying to work out a compromise between the two groups. I'm actually somewhat fearful of the concessions that the midwives are going to have to make to appease the UMA.

The committee chair from the meeting said that he would vote to pass the bill out of committee under the assumption that the two groups would meet and hopefully work out any differences and come up with an amendment to the bill that could then be voted on by the Senate.

I'm glad that I went to the committee meeting but I was somewhat frustrated with some of the opinions of the medical community and the committee members (my senator included). There was a rules process set up in statute when the original bill passed 3 years ago and the rules set up have been working. The UMA could have objected to any of the rules that were proposed, but their representative on the rule-making board decided to not show up to any of the meetings.

If anyone wants to listen to the audio file of the committee meeting, click on this link and then pick the date February 7, 2008:
Senate Health & Human Services Committee Meetings

Nothing today

The midwife bill was on the agenda today for a committee meeting and they didn't get to it. I got up super early and left with Blondie & Kitty so that we could be there by 8:00. We ended up being a little late and the room was jam packed so I sat out in the hall until they got further down on the agenda and some space cleared up in the conference room. After the meeting ended the girls & I walked over to the main Capitol building which was recently opened after some extensive renovations. We walked around the building a little and then I went up to the Senate chambers and sent in a message to my senator. I'm still not sure where he stands on the issue. After that we walked back to the car and dropped the family calendar off at my sister's apartment - she was just diagnosed with strep throat so we didn't stay at all. Then we went over to the dealership where we bought our minivan to get the oil changed. On the way home I stopped at the elementary school to vote. All I can say is that it has been a very long day and I am very tired. I crashed on the couch for a little while after we got home.

The midwife bill is first on the agenda for Thursday morning at 8 a.m...

Bill sent to committee

The midwife amendments bill that has been proposed in the Utah senate has now been sent to the Senate Health and Human Services Committee and is on the agenda for tomorrow morning. Blondie has a ballet class, but I think we will skip it this once and attend the committee meeting. I think the more people we get to show up the better it looks for us - so the legislators sees that this bill will affect many average people who really care. I am composing a letter to my senator right now - who just happens to be the committee chair of this committee. I am told that of the 5 members on the committee, two are definitely in favor of it, two are pretty sure against it and the 5th one we are unsure of (my senator). He told the midwife group 3 years ago that he would vote in favor of the original bill if they needed his vote and then voted against it because we didn't need his vote (it was very close though). I'll let you know how things go tomorrow...

At it again...

Well, the Utah state legislature is at it again trying to modify the existing direct-entry midwife law. It looks like I will be spending some more time up at Capitol Hill again this year. Senator Margaret Dayton has introduced a bill once again that would strictly limit the practice of direct-entry (homebirth) midwives in the state. We worked really hard at getting the current law passed three years ago and statistics are great so I really don't see any need for this bill other than the Utah Medical Association trying to assert more control over the practice of these midwives... Stay tuned for more developments.

You can view the proposed bill here:
Utah Senate Bill 93

Sunset

Here is a picture of the sunset tonight. By the time I got to my camera and was able to take a picture, it was almost gone (in just a matter of a minute or two)...
On another note, the hostile midwife amendments bill that was proposed in the Utah legislature this year has reached it's sunset as well. On Friday, the sponsor of the bill chose to remove it from the senate reading calendar and send it to an interim committee to study the issue during the off-season of the legislature. Another win for the midwives!! Yea!! Now hopefully the committee that is chosen to study the issue will realize that it is not needed or will actually have an open dialog with the midwives to see which limitations are reasonable and which ones are not.

My prediction...

My prediction regarding the midwife bill is that it will not make it out of the Utah Senate - either because it won't get enough votes or because they will run out of time. At the end of yesterday's Senate session they sent all of the senate bills that were on the 2nd reading calendar back to the senate rules committee to prioritize them. The legislative session ends 2 weeks from today and they are needing to cut back on the bills they consider and deal with those that are before them now (especially those that have been passed and sent over from the house of representatives).

On a similar note, there was an excellent editorial in the Salt Lake Tribune this morning that was written by their editorial board. It basically said that they think Sen. Dayton is trying to solve a problem that doesn't exist by proposing this bill.

Here's a link to the editorial if you would like to read it:
The midwife way: Current home-birth regulations are sufficient

Also, there was an article in the paper the other day where Sen. Dayton said that she specifically requested that the midwife bill be assigned to her committee instead of the Health & Human Services committee so that it could progress more quickly...

Making headway?

After the committee hearing in the Utah senate last Thursday, I was a little disturbed by some of the misinformation that was being shared regarding this bill. So, I decided to go out on a limb and write an email to the senator that was chairing the committee to address some of that misinformation. The committee chair that day is one of the senators that is a definite 'yes' vote already so I figured that I couldn't do much damage by trying to contact him. My email basically said that contrary to what was said at the committee meeting, this bill will affect ALL homebirth midwives, not just the ones that are licensed by the state. He specifically asked the bill sponsor at the committee meeting if this bill will affect the "lay" midwives in the state to which she answered that it will not - it will only affect those that are licensed. If you read the actual law that is in place already and how this bill will change that law, it is clear that the bill that is proposed is changing the definition of the practice of direct-entry midwifery which will affect ALL midwives. I even sited to him where in the law that is stated.

Well, I was actually surprised when I got a response from this senator on Sunday evening. (I haven't even gotten an answer from my own senator whom I emailed on Wednesday...) I could tell by this senator's response to me that he hadn't even read my email, or if he did that he just skimmed through it. So, I decided to email him back and state very clearly that a "lay" midwife IS a direct-entry midwife and that this bill will affect all of the direct-entry midwives in the state, not just the licensed ones. I wrote a very nice letter to him and said that I felt that it was important that he understand this point, regardless of whether or not it changes his vote. I also thanked him for his time in reading my email.

Not 15 minutes after I sent off that email, he emailed me back and said that he would check into it and "Thanks for the heads-up."

So, even if it doesn't end up changing his vote, I hope that he does look into it and will pass the word along. Maybe then more of the legislators will understand the concerns that the midwives and homebirthers have.

Didn't make it...

Blondie developed a stomach ache and fever last night so I decided not to try going to the capitol this morning. I was able to listen on my computer at home and it was very frustrating listening to those that spoke (both for and against the bill). Those that spoke for the bill were all doctors (of course) and they like to tell horror stories and scare the legislators into believing that everyone who chooses to give birth at home will die (or their baby will). Unfortunately, they are much more organized though than the opposition to the bill. There was very limited time for comments on the bill before the vote was taken and the 3 who spoke for the opposition I thought were not very good people to have speak. One was a man whose wife gave birth at home 8 weeks ago, one didn't state who she was representing (I actually think she is the president of the Utah Friends of Midwives grassroots group) and the third person was a practicing midwife who didn't say if she is licensed with the state or not. I didn't think that any of the 3 gave very persuasive arguments for our side.

Anyways, the bill was voted on and passed out of committee 4 votes to 2. Right now I think it has been sent to the Division of Professional Licensing for fiscal input. Then it will go to the bottom of the list for the Senate Floor to vote on.

Midwife Bill Update

Well, the Utah Senate assigned the midwife amendments bill to the Senate Natural Resources, Agriculture, and Environment Standing Committee of all places. The last time I checked, midwives & homebirth have nothing to do with natural resource, agriculture or the environment. We all thought that it would go to the committee related to the issue which is the Health & Human Resources committee. The unfortunate thing about this assignment is that Sen. Dayton (the author of the bill) is on this committee along with another staunch opponent. My midwife believes that it will make it out of committee and to the Senate floor easily. It's on the committee agenda for Thursday morning at 8 a.m. So, I guess Blondie & Kitty & I will be making an early morning trip up to the capitol tomorrow. Unfortunately neither of them are morning people so I have a feeling they are not going to be too happy while we are there. (Hopefully they will sleep in the car. :) It's very interesting and frustrating at times getting involved in the political process. I have definitely learned a lot about how the legislative process works over the past couple of years.

I'll post what happens tomorrow...

Midwives in Utah

Well, the Utah Legislature is at it again. Two years ago the Direct-entry Midwives finally succeeded in getting a bill passed in the Utah legislature to officially legalize homebirth with a direct-entry midwife and allow a form of licensure for those homebirth midwives that want to be able to carry and administer certain drugs that they are not allowed to otherwise. The battle to get this law passed actually started at least 5 years ago and I was involved with the lobbying the year that it passed and the year prior to the passing. I have sent emails to my legislators and met with a few of them in person. I have spent hours at the Utah Capitol building attending committee meetings and trying to meet with legislators. Just when we thought that things were in the clear, a senator from Utah County has introduced an amendment to the bill last Friday that would just about make it impossible for the overwhelming majority of women to qualify for a homebirth with a licensed direct-entry midwife (LDEM).

The senator's name is Margaret Dayton and she was an OB nurse and her husband is an OB/GYN. The LDEMs that are currently licensed with the state looked over their clients/births from the previous year and determined that 96% of those births would not have qualified for a homebirth under the current amendment changes.

Everyone is hoping that this bill will be killed quickly because it is so unreasonable. There have been a couple of studies recently published that should also help our cause. In addition to these studies (one of which is by the Utah State Health Department), the report to the Utah Division of Professional Licensing (DOPL) was nothing but positive. The law that was passed 2 years ago required the LDEM board to compile statistics each year of mother/baby outcomes and to determine if any negligence is occurring in any of the LDEM practices.

All of the midwives have fought so long and hard for the law that we currently have that it would be so sad to see that ruined by this senator who is trying to instill unfounded fear in her fellow legislators. The truly amazing part of the law that was passed is that in addition to allowing midwives to become licensed, it still allows midwives who choose not to license to practice without fear of prosecution. I believe Utah was the first state to pass such a law.

The biggest thing that we all wanted to accomplish with this bill was to allow women to CHOOSE where they give birth and to allow them to CHOOSE a care provider that they feel the most comfortable and confident with. There are no guarantees with birth, but some women feel that more complications are introduced when giving birth in a hospital. Midwives are there with a woman the whole labor and are trained in "normal" birth and how to detect when something is not right before it has escalated to an "emergency".

Here are some links to some studies for those of you interested in reading them or wonder about the safety of homebirth:

DOPL Outcome Report for LDEM homebirths from January 2006-August 2006
British Medical Journal Study on planned homebirths in North America for the year 2000
Utah Health Department Study Home Birth Trends in Utah, 1992-2005