By: Meiying Wu, Jiayi Wang, Rachel Thomas, Humera Lodhi
You don’t want an unqualified mechanic fixing your car or an unlicensed lawyer defending you in court. So why do some mothers choose unlicensed midwives to deliver their babies? KBIA’s Humera Lodhi explains how Missouri’s lack of midwifery regulations can leave some expectant mothers in a risky position.
Missouri midwifery law may put mothers at risk
In 2009, lay midwife Elaine Diamond oversaw the home birth of a Springfield mother. Diamond allowed the mother to labor for over 48 hours and refused her requests to go to the hospital.
The mother was eventually taken to Mercy Hospital Springfield, and the baby was delivered in the parking lot. The baby suffered severe brain damage and died less than a week later.
The doctors at Mercy Hospital Springfield said that, in the right setting, the baby could have been safely delivered, according to a story published in the Springfield News-Leader.
Seven years later, Diamond pleaded guilty to endangering the welfare of a child and unauthorized practice of medicine, according to a news release from the office of the Greene County Prosecuting Attorney.
Dee Wampler, Diamond’s attorney, said the problem was that Diamond did not complete any medical or midwifery training.
“My lady didn't want to take any training,” Wampler said. “She just believes that God told her that this was what she was supposed to do.”
Until midwifery was legalized in Missouri in 2007, it was a felony for lay midwives to practice midwifery in the state. A lay midwife is a midwife who does not have a license to practice medicine.
In 2005, former state Rep. Cynthia Davis, R-O’Fallon, proposed a bill specifying that nothing may prohibit a woman from giving birth with the caregiver of her choice. Potential caregivers included lay midwives who provided services other than the practice of medicine, nursing and nurse-midwifery.
“The women who did want it were people who believe that women are smart enough to know what’s in their best interest,” Davis said of her proposed bill. “We don’t have to have laws to protect the little ladies from making terrible mistakes.”
The bill was passed by the Missouri House of Representatives but failed in the Missouri Senate. But it set the stage for legalization of midwifery the next year.
In 2007, midwifery was legalized in Missouri after former Sen. John Loudon, R-St. Louis, surreptitiously slipped a sentence into a 123-page health insurance bill. The sentence stated that “any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance may provide services.”
“Tocological” is an ancient Greek word and a synonym for “obstetrics,” the branch of medicine concerned with childbirth. The sentence allowed lay midwives to legally deliver babies in Missouri.
No one realized what Loudon had done. That is, until former state Rep. Sam Page, D-Creve Coeur, noticed the added sentence and told his colleagues about it. But it was too late to debate -- the Senate had already made its final vote.
The bill's lead sponsor, former state Rep. Doug Ervin, R-Holt, said that Loudon had deceived him, according to an article published by the Southeast Missourian.
Loudon was removed as chairman of the Missouri Senate Small Business, Insurance and Industrial Relations Committee by President Pro Tem Michael Gibbons.
"It was a very aggressive move," said Loudon, "I would do it again in a heartbeat."
The Missouri State Medical Association and three other organizations filed suit to invalidate the section that would allow legal midwifery practice. The Missouri Supreme Court, however, ruled in a 5-2 decision to uphold the law. The ruling indicated that MSMA had no standing to challenge the constitutionality of the law.
A year later, things became more controversial when the National Organization for Competency Assurance changed its name to the Institute for Credentialing Excellence.
“That organization is now gone. It's been renamed,”said Tom Holloway, executive vice president of MSMA. “There is a real legal question to answer whether there’s any protections anymore.”
Holloway is concerned about the lack of protection for mothers who choose to have home births.
Dr. Ravi Johar, an OB-GYN at Mercy Clinic Women’s Health in St. Louis, said doctors have been dealing with the disasters that come in from attempted home births when unfortunate situations happen.
“There are no regulations at all on midwifery in Missouri,” Johar said. “They can do whatever they want, whenever they want with no ramifications because there is no oversight of any kind.”
Thirty states in the U.S. currently have regulations over licensure of Certified Professional Midwives, and Missouri is not one of them. Missouri is one of 10 states in which midwifery is legalized but not licensed, which means that anyone could potentially call themselves a midwife. Currently, no one in the state governmental body is proposing any regulations over CPMs.