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Today is my day “off”. I have nothing on my calendar and was looking forward to spending some leisurely time with my family. Unfortunately, the MO legislature has different plans. Be prepared, I am angry. I am angry that I watched families all over the state work FOR YEARS to get midwives decriminalized and instead of being able to enjoy that victory, these families have had to waste their time, energy, and money to fight back bad bills year after year. I am angry that the people who were elected to represent us, who get paid  to represent us, are doing exactly the opposite. The homebirth families aren’t up at the Capitol, asking to be saved. On the contrary, we’re busy having our babies safely at home with lovely midwives and want nothing more than to be left alone. When you throw in the added insults of this bill being sponsored/cosponsored by ONLY women and knowing that there is a perfectly acceptable licensure bill that actually does what the legislators say their ridiculous bill will do (BUT IT DOESN’T), it’s pretty damned hard not to get irate. If you ever wondered why I get angry at our state government, at our legislators, this is it! It’s very simple…do the job you were elected to do, nothing more, nothing less.

Jumping off the soapbox of why I’m angry and onto the soapbox of details, here you go:

Representative Diane Franklin, along with fifteen female cosponsors, filed HB 2189, a bill which is eerily similar to the malpractice bill we saw last year (and the year before?) and vehemently opposed. Why is it back, you ask? One can only speculate…. WHY do legislators insist on wasting time and taxpayer dollars on a bill that does absolutely nothing for the citizens it supposedly protects and is woefully inadequate in terms of “protection”? Yes, “protection”. Apparently, we naive homebirth families need “protection” from these big, bad midwives.

That would be great and noble and stuff if only that were true. Guess what? There IS a bill that DOES the things supporters of HB 2189 say it’s supposed to do. That’s right! A comprehensive bill that was drafted with input from real, actual homebirth families. Can you imagine? Citizens having a say in the law??!! So why isn’t HB 1363 being supported instead? Again, one can only speculate….

One can only speculate that if midwives are licensed, they will be covered by insurance. If they get insurance coverage, more families might choose to have their babies with them. If more families choose to have their babies at home with midwives, hospitals lose money. When midwives were decriminalized, there was a legal pushback. A lawsuit was filed by the Missouri State Medical Association. Do you see where I’m going with this?? I distinctly remember an early trip to the Capitol where a legislator sat behind his desk and said to the two of us homebirth moms, “I’m just worried about how much money this would take away from my doctors.” Now, please understand, I’m not saying doctors themselves are to blame. What I’m saying is follow the money. Birth is a money machine. Unless you’re a midwife! Midwives strive to keep their fees, usually paid out-of-pocket, reasonable for families. Sometimes they even barter for goods/services to help a family out.

My husband says I should stop here before I go on a tirade. I think we need a tirade! My three home-born kids are giggling and calling to me from their hiding spot in the bedroom as I type….I think about each of their births, about the midwives who attended them. I think about the care I received: loving, supportive, empowering, evidence-based AND competent.

One of my favorite photos from my last son's birth.

One of my favorite photos from my last son’s birth.

 

I think about how the midwives I know are some of the most skilled, most compassionate, most hard-working, most trustworthy women I know. I think about how they set up a grievance board and regulatory structure (accountability!) without a law saying they must do so. I think about the peer reviews that are conducted, the educational topics they have at every. single. meeting.

In the end, I guess what I’m trying to say is: let’s call a spade a spade. Legislators, be honest that you’re not at all interested in protecting women and their families. If we, the people, can see HB 2189 is not about protecting us, then surely you can too. IF you care about protecting families, listen to the people. They have spoken, and continue to speak, LOUDLY about what they want. Do the job you were elected to do.

Are you a voting citizen in MO? Are you frustrated by this turn of events and want to do something? See below!

REMEMBER….This is not just about midwifery, it’s about YOUR elected officials representing YOU, something YOU ARE PAYING them to do!

Dear Supporters of Missouri Midwives,

House Bill 2189 was recently filed. It is a one-item bill that requires midwives to furnish proof of one million dollars worth of malpractice insurance. If proof of insurance is not supplied prior to provision of midwifery services, a midwife will be guilty of a class B misdemeanor.

HB 2189 (http://www.house.mo.gov/billsummary.aspx?bill=HB2189&year=2014&code=R)

The Missouri Midwives Association and Friends of Missouri Midwives oppose this bill for the following reasons:

The proposed legislation is not practical and simply will not work.

1. Very few companies provide malpractice insurance to midwives. Insurance coverage is generally not available to those who practice in the home setting. Of those companies that offer malpractice coverage, insurance policies in the amount of “one million dollars” simply do not exist.

It might seem, then, that the solution would be to amend the malpractice insurance requirement to an amount that would be offered to midwives. This still would not address the issues of midwife accountability and safety in home birth as discussed below.

2. No other health care provider in Missouri is required by law to obtain malpractice insurance in the amount of $1,000,000. For example, physicians are required to have malpractice insurance of $500,000 under certain population conditions. (Statute 383.500)

3. Health care professionals who carry malpractice insurance are licensed. They are able to receive insurance payments for their services which creates the ability to afford malpractice insurance required for employment. The first step is to bring midwives to the same legal standing as other health care professionals through licensure and require insurance reimbursement for their services. This will help home birth families afford midwifery services and help midwives afford the professional requirements expected of other health care providers who are licensed.

4. HB 2189 unfairly targets midwives in an attempt to limit access to those health care providers and makes it difficult to continue the legal practice of midwifery. This discriminates against pregnant women and their families who desire these services and have the intrinsic right to the care provider and birth environment of their choosing.

5. Missouri has actually been limiting malpractice insurance payouts in the last two years. (HJR 45 proposes to amend the constitution to cap noneconomic damages in medical malpractice cases.) (See also: http://www.stltoday.com/news/local/govt-and-politics/political-fix/caps-on-medical-malpractice-lawsuits-win-ok-from-missouri-house/article_6b5fcfd2-50ab-5e04-aff9-791797f61707.html)
This is from a concern that rising medical malpractice insurance premiums will drive doctors out of practice or encourage them to leave the state.

Clearly, there isn’t the same concern for midwives who may not be able to afford large insurance premiums since the pool of practitioners would be so small. Midwives might need to pass the cost of malpractice insurance on to home birth families making the already out-of-pocket expense of home birth completely unaffordable.

6. There is no practical enforcement plan in place for HB 2189.

7. Only one state in the U.S. requires malpractice insurance and that is Florida. Midwives are licensed in Florida, and the cost of insurance is subsidized by the state due to the small risk pool. Amount of insurance required is in amounts up to $300,000.

Other reasons HB 2189 is a bad bill:

HB 2189 does not provide a mechanism by which midwives can become registered, licensed, or otherwise known to the state of Missouri. It does not provide a means to confirm the fulfillment of educational and training requirements for midwives.

HB 2189 does not regulate the practice of midwives in any way. It does not address issues of accountability or responsible practice. It does not provide a board to direct scope of practice or designate rules and regulations to govern the practice of midwifery in Missouri.

HB 2189 does not provide a grievance process or case review mechanism.

HB 2189 does not address the issues of safety in home birth practice. There is nothing in the bill that will make the practice of midwifery in the home setting safer.

Malpractice insurance companies do not regulate midwives. They do not remove from practice midwives who act with negligence. There is no process outlined in this bill to determine if a midwife has been negligent.

Fortunately, midwives in Missouri do offer a grievance process and adhere to the practice standards set by the certifying agency NARM (North American Registry of Midwives). While there is already a high degree of professional accountability practiced in Missouri, this is because the state professional organization (Missouri Midwives Association) believes it is important and necessary for the professional practice of midwifery and not because the state has directed midwives to do so.

The state of Missouri has continued to be uninterested in working with midwives and home birth families to improve and safeguard the practice of midwifery.

Is there a better option? YES! HB 1363

Instead of HB 2189, we would like to suggest directing legislators to support HB 1363. This is a comprehensive midwifery licensing bill which does provide a mechanism for oversight and responsible, regulated practice. It also addresses the issue of malpractice insurance by requiring midwives to have coverage under the same conditions as physicians. It would also require Medicaid reimbursement for families desiring the care of Certified Professional Midwives and home birth.

HB 1363:

http://www.house.mo.gov/billsummary.aspx?bill=HB1363&year=2014&code=R

How Can I Help?

The bill has been assigned to the Health Care Policy Committee. Please check to see if you live in the district of one these legislators on this committee. If so, please contact him or her soon!

Also listed are the legislators who have signed onto HB 2189 as co-sponsors. If you are a constituent of one of these representative, please contact her.

If not, you are still free to write or call any of these representatives, but being a constituent will have more impact. Clicking on a name will take you to her page on the legislative website.

Contact your own representative and let them know what’s going on and your position on these matters. It is essential that legislators across the state hear from home birth families.

Please feel free to use any of the points mentioned above as ideas and starting points for your own conversations.

What’s next?

If you would like to come to the capitol to meet with your state representative and do some lobbying, but don’t know quite where to go or what to do, please contact Dawn Finney at dawnmfinney@gmail.com . The MMA maintains a weekly presence at the capitol and either Sarah Davis or Dawn Finney, the co-legislative chairs for the MMA, can arrange to meet you at the capitol and help you get around and visit your representatives and senators. The capitol is a beautiful building with interesting museum displays, and it really makes a great family day trip to see the capitol and legislative system in operation.

Health Care Policy Committee Members:

Last Name First District Party Phone Room

Chair:

Frederick Keith 121  Republican 573-751-3834 403B

Vice chair:

Franklin Diane 123 Republican 573-751-1119 206B

Members:

Cross Gary L. 035 Republican 573-751-1459 112
Hodges Steve 149 Democrat 573-751-4085 101C
Kelly Chris 045 Democrat 573-751-4189 106B
Kirkton Jeanne 091 Democrat 573-751-1285 135BC
Morris Lynn 140 Republican 573-751-2565 200BC
Neely Jim 008 Republican 573-751-0246 115C
Neth Myron 017 Republican 573-751-1218 408B
Pace Sharon 074 Democrat 573-751-4726 105G
White Bill 161 Republican 573-751-3791 407A
Wood David 058 Republican 573-751-2077 115A
HB 2189:

Last Name First District Party Phone Room

Sponsor:
Franklin Diane 123 Republican 573-751-1119 206B

Co-Sponsors:

Crawford Sandy 129 Republican 573-751-1167 302-1
Solon Sheila 031 Republican 573-751-8636 305B
Lichtenegger Donna 146 Republican 573-751-6662 314
Entlicher Sue 128 Republican 573-751-1347 207A
Lauer Jeanie 032 Republican 573-751-1487 412C
Haefner Marsha 095 Republican 573-751-3762 305A
Swan Kathryn 147 Republican 573-751-1443 115I
Mims Bonnaye 027 Democrat 573-751-7639 116-3
Nichols Mary 072 Democrat 573-751-1832 105H
Zerr Anne 065 Republican 573-751-3717 315
Black Linda 117 Democrat 573-751-2317 105F
Englund Vicki 094 Democrat 573-751-3719 135BB
Newman Stacey 087 Democrat 573-751-0100 101K
Brown Wanda 057 Republican 573-751-3971 412B

 

 

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