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News: Legalizing Birth

Ohio criminalizes midwives wanting to help women deliver at home

By Renea Frey · February 13th, 2008 · News
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Jerren Helwig of Fairfield Township in Butler County is a certified professional midwife (CPM) with 10 years experience attending more than 200 births. In October 2007 her life and profession were abruptly disrupted.

"On Oct. 6 police came with an enforcement officer from the (Ohio) Board of Medicine with a search warrant," she says. "They took my computer, my husband's computer, all my supplies and equipment -- even the drawers from my file cabinet. They took everything but the birth stool, only because they didn't know what it was."

The "raid" resulted from a complaint filed in May 2007 by a doctor to whom Helwig had transferred a laboring mother for medical care, she says. The complaint led to an investigation and subsequent warrant.

"Ohio doesn't have a revised code that includes midwifery. There is no licensure available in Ohio," she says. "There is no autonomy for us."

Jerren Helwig of Fairfield Township in Butler County is a certified professional midwife (CPM) with 10 years experience attending more than 200 births. In October 2007 her life and profession were abruptly disrupted.

"On Oct. 6 police came with an enforcement officer from the (Ohio) Board of Medicine with a search warrant," she says. "They took my computer, my husband's computer, all my supplies and equipment -- even the drawers from my file cabinet. They took everything but the birth stool, only because they didn't know what it was."

The "raid" resulted from a complaint filed in May 2007 by a doctor to whom Helwig had transferred a laboring mother for medical care, she says. The complaint led to an investigation and subsequent warrant.

"Ohio doesn't have a revised code that includes midwifery. ... There is no licensure available in Ohio," she says. "There is no autonomy for us."

Ohio law only recognizes nurse midwives, who are registered nurses with a master's degree in midwifery, according to Stephanie Beck Borden, chair of Ohio Families for Safe Birth.

"In Ohio, nurse midwives are not independent practitioners" but rather have a "written collaborative agreement with an obstetrician to practice," she says.

But CPMs or direct-entry midwives like Helwig, who care for women giving birth in their homes, lack official approval.

"Direct-entry midwives are at risk of legal prosecution for practicing medicine," Beck Borden says. "In Ohio there is no protection, no regulatory body for direct-entry midwives. (They can be) prosecuted for practicing advanced-practice nursing without a license or practicing medicine without a license, which is a felony."

Months have passed since the search, but that doesn't mean Helwig's problems are over.

"No official charges have been filed," she says. "They can file charges for up to seven years. I've asked for my husband's computer back because it's holding up his work. We've lost our family pictures. I can't file my taxes -- my tax records are on there."

What has this meant to Helwig's life and practice?

"It's insanity," she says. "I've been serving the community for 10 years, on call night and day, and my life has completely stopped. Now I'm sitting and waiting for the state to decide if they're going to punish me or give me back my stuff and send me on my way."

Beck Borden recently gave birth to her second child at home.

"Direct-entry midwives' training is specific to birthing at home," she says. "It is an amazing resource. The care I received while pregnant was far superior in terms of time, care and resources. (Midwives are) trained in a different type of birth setting than obstetricians."

A large-scale study published in the British Medical Journal in 2005 examined the outcomes of 5,418 home births planned in North America, 98 percent of them in the United States, in the year 2000.

"Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States," the study found.

The study noted, however, "Despite a wealth of evidence supporting planned home birth as a safe option for women with low risk pregnancies, the setting remains controversial in most high-resource countries."

If out-of-hospital births with a certified professional midwife have been shown to be as safe as hospital birth -- and with a lower rate of medical intervention -- then why does the practice "remain controversial"?

One reason might be the differing models of the birthing process in midwifery, as opposed to obstetrics. The "Midwives Model of Care" says it's based on "the fact that pregnancy and birth are normal life events (and includes) minimizing technological interventions and identifying and referring women who require obstetrical attention. ... The application of this model has been proven to reduce the incidence of birth injury, trauma and cesarean section."

"An obstetrician is not appropriate for (maternal) care," Helwig says. "Their concern is with complications. ... Midwifery care is necessary for every woman."

Despite the proven safety of out-of-hospital births, Beck Borden contends that "not everyone would make this choice (but) what's not right is taking that choice away."

"Direct-entry midwifery is recognized in 22 other states," she says.

Ohio Families for Safe Birth (OFSB) hopes to soon have Ohio included among those states.

Tracey Johnstone, a local midwife and legislative coordinator for OFSB, says the time has come to legalize direct-entry midwifery.

"This has got to change," she says. "Nothing is going to change if we don't make change happen from the top down."

How are these changes happening?

The organization's Web site (www.safebirthohio.org) says, "OFSB is a consumer-driven effort to create a statewide coalition of families and professionals promoting legislation and policies grounded in the Midwives Model of Care, which support families' access to safe, appropriate, evidence-based care during pregnancy, labor, delivery and postpartum."

A new organization, the National Birth Policy Coalition, includes representative organizations from more than 10 states, several national midwifery counsels and notables such as Rikki Lake and Carrie-Anne Moss.

The group's Big Push For Midwives Campaign is "the cornerstone of health-care reform," according to Steff Hedenkamp, one of the coalition's organizers. Its goal is licensure of CPMs across the country. �

 
 
 
 

 

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