Tuesday, July 15, 2008

A Celebration of Legal Midwives in Missouri!

July 12, 2008 ~ St. James, Missouri

According to the Missouri Supreme Court, Certified Professional Midwives became legal to practice in Missouri on July 4, 2008.

It's a long story, beginning with a little word, "tocology" and ending with a historic Missouri Supreme Court decision that overturned a lower court's ruling. The Missouri Supreme Court stated that the physicians associations who sued the State over the new midwifery law (passed in 2007) had no right to be in court over this in the first place. So, the injunction that they had placed against the midwifery law in August of 2007 was thrown out, and the law stood as passed.

And Certified Professional Midwives became legal to practice in Missouri on the day we celebrate in honor of FREEDOM!

Since most people already had 4th of July plans, we had to postpone our statewide celebration a bit. (Actually, the St. Charles and St. Louis Friends of Missouri Midwives area chapters held celebrations the day the court ruling was handed down - June 24 - and a few days later at their usual monthly meetings.)

Our statewide celebration was planned rather last minute and the Nisbett's graciously offered their spacious home near Rolla.
Here are a few pictures from the Saturday afternoon party (July 12).

The Nisbett's have a dream yard for children...

Their house is really kid-friendly (and fun) as well.
All the kids had a blast!

Jesse and Emily (who take care of all of the accounting and web up-keep for Free the Midwives!) were at the party showing off their new little girl - Ellie.

Senator Mike Gibbons (President Pro Tem of the Missouri Senate)
showed up while we were eating lunch.
Here he is, chatting with folks in the kitchen.

After visiting for awhile and joining us for dessert, Senator Gibbons spoke to our group, congratulating us on the recent court ruling allowing professional midwives to practice freely and reminiscing about several funny incidents that happened at the Capitol, involving "the midwives." He said that every grassroots effort that he has seen in his 16 years as a legislator pales in comparison to the one that the midwives have put on at the Capitol.
Eventually he had to head off and hit the campaign trail again (for his Attorney General race).

Collene agreed to be MC for our afternoon program, which was mostly informal story-telling by those who had been involved in trying to legalize midwives in Missouri over the last thirty-some years.

Dr. David Stewart, Ph.D, and his wife, Lee, joined us for the day and spoke first. They told their story of having their first baby at home in Rolla without a midwife or a doctor in the 1960's, because there was no one to attend a homebirth at the time. They have been working to allow access to Missouri midwives and homebirth since 1967. David Stewart has written many books on the subject and is the founder of NAPSAC International (International Association of Parents and Professional for Safe Alternatives in Childbirth).

Keith and Kim Nisbett came next in the history as they moved to Missouri in the late 1980's and were shocked to find that they couldn't open the Yellow Pages and find a midwife. Keith told the story of writing up the first midwifery bill with their illegal midwife in their bedroom and taking it to the Capitol where he learned the legislative process over the next few years as the bill passed the House of Representatives many times. It was always blocked by a filibuster in the Senate, till families eventually burnt out and went home for a few years.

Margaret spoke next about Friends of Missouri Midwives organizing in the 1990's and deciding that a foundation of public education was necessary before success would ever be secured at the Capitol. (She's speaking way in the back in a white shirt in this picture.)

Then it was Debbie and Mary's turn to tell the story of how tocology really happened behind the scenes the day it was passed in the Senate.
Right in the middle of telling the tocology story, much to our surprise, we looked up and saw Senator Chris Koster (also a candidate for Attorney General, and a friend of ours at the Capitol) walk in! He took a seat and listened intently to all of the details that most of the legislators were never privy to hear about.
(Above, Chris Koster and Jonathan Smith listening.)

Then Collene told a touching story about the 2008 legislative session. She talked about how she was walking around the Capitol on one of the very last days, knowing that Senate Leadership was killing our bill behind the scenes.
She said that in desperation, she finally went into the little coffee room near the chamber and shut the door. She told us all how she had knelt down on the floor by the ice machine and cried out to God, "Why does this have to be so long and so hard and so painful? Why does our bill never pass? I've been coming to this place for 20 years and, God, you know how much I HATE it! I don't ever want to come back! Why can't our bill just pass?!"

She said that she stopped and thought about it before she said it, but then she ended her prayer with, "But I will come back if I must."

Then she recounted the last agonizing day of session and the feelings she had as she left the Capitol, tears stinging her eyes when, once again, our bill hadn't passed... not because it wasn't a good bill, not because it didn't have majority support or any other good reason. But simply because it was all about a few men who wanted to ensure their campaign donations in an election year. She had gone home and cried and wondered why things were so unjust.

And then she nearly brought the whole roomful to tears when she said, "And now I see why God didn't let that bill pass and gave us something better instead. Now I'm so happy that I didn't get what I asked for when I was crying in the little coffee room. Justice was served, and better than I could have imagined or asked for."

Afterwards, Senator Koster (above, speaking) added his own funny stories about "midwives in the Capitol".

... And then we posed for pictures!
Mary, Senator Koster, Debbie

Lastly, we all took a big group picture, and people began to head for home, feeling extremely thankful that midwifery had become legal in Missouri in a way that was far beyond anything we had ever imagined or hoped for. We also went away, realizing the gravity of the situation and the need for us to guard our new-found freedom vigilantly.

Sunday, July 13, 2008

President's Editorial - Response from MANA President to Res. 205

President’s Editorial
July 11, 2008

Midwives Alliance of North America
611 Pennsylvania Avenue SE # 1700
Washington, DC

Geradine Simkins
888-923-MANA (6262)

Doctors Ignore Evidence,
AMA Seeks to Deny Women Choices in Childbirth

One wonders what process the American Medical Association (AMA) House of Delegates used to determine that “Resolution 205 on Home Deliveries” was a prudent and reasonable proposal to adopt. AMA Resolution 205 attempts to outlaw a woman’s choice to birth at home or in a freestanding birth center by calling for legislation to establish hospitals and hospital-based birth centers as the safest place for labor, delivery and postpartum recovery. Further, Resolution 205 seeks to establish that hospital-based midwives who work under the control of physicians are the only safe midwifery practitioners.

The Midwives Alliance of North America, which has represented the profession of midwifery since 1982 and whose members are specialists in homebirth, finds AMA’s Resolution 205 to be arrogant, patronizing and self-serving. We have three major objections to Resolution 2005. First, Resolution 205 patently ignores the vast body of scientific evidence that has documented homebirth to be a safe, cost-effective and satisfying option for women who prefer this alternative to hospital birth. Second, AMA Resolution 205 is seriously out-of-step with the ethical concept of patient autonomy in health care (encompassing both informed consent and informed refusal), which has gained widespread acceptance in the medical community. And third, Resolution 205 distracts from other critical issues in maternity care to which healthcare professionals should be giving substantial attention, including increasing access to care, improving perinatal outcomes, reducing health disparities and fostering client satisfaction. AMA Resolution 205 is anti-homebirth, anti-midwife, anti-choice and is unsupported by scientific evidence.

Why is the American Medical Association not asking the real questions instead of trying to debunk existing research evidence on the safety and efficacy of homebirth and attempting to corner the market on maternity care? For example, why are midwife-attended births far more likely to have fewer interventions, fewer postpartum infections, more successful breastfeeding rates, healthy infant weight gain and result in more satisfied, empowered mothers ready to embrace their newborns and parenting experiences? Why are so many women across the nation left emotionally traumatized by their childbirth experiences in hospitals and consequently why do rates of postpartum depression, anxiety and post-traumatic stress continue to escalate?

It is ironic that the AMA should have a quarrel with a known safe birth option such as homebirth at the same time when the epidemic rise in coerced or elective cesarean sections puts healthy mothers and infants at greater risk than normal vaginal birth and causes excess strain on the limited resources of our healthcare system. The rate of cesarean sections in the United States is unacceptable—one in three pregnancies end in major abdominal surgery—and the decline in availability of vaginal birth after cesarean (VBAC) is deplorable. It is unethical to expect that women and infants should continue to bear the brunt of increasing medical malpractice risks by over-treating them with obstetric technologies such as c-sections while denying them safe evidence-based options such as VBAC. It is past time that the AMA in collusion against homebirth with the American College of Obstetricians and Gynecologists (ACOG) realizes that women and their partners are choosing to labor and deliver at home and in freestanding birth centers to avoid ethically unsupported obstetric interventions.

Modern medical ethics have evolved to embrace autonomy—patient choices and patient rights—over medical recommendations based on paternalism or physician preference. In almost all areas of modern medicine, except obstetrics, the locus of control rests firmly with the client or patient and not with the medical provider. It is a commonly held principle that it is not appropriate to force medical treatment upon clients or patients against their will, including medications, blood transfusions, chemotherapy or even life-saving surgeries. Informed consent has appropriately become the gold standard in healthcare decision-making. Why then do the AMA and ACOG believe that they can promote legislative efforts to deny women choices in maternity care providers and childbirth settings? In the 21st century this concept is outdated and absurd.

The AMA and its members might consider using their considerable energy, intelligence and resources to focus on promoting the health and well-being of mothers and babies and devote less time to limiting women’s access to midwifery services. All maternity care providers should band together to reduce the unacceptably high rates of maternal and infant mortality and morbidity in the United States, increase access to maternity care for all women, reduce unnecessary cesarean sections, encourage vaginal birth and VBACs for healthy women, reduce health disparities of women and infants in minority populations, and promote increased breastfeeding. These challenging but attainable goals would improve the health of mothers and babies far more impressively than reducing the rates of homebirth.

The Midwives Alliance joins the other individuals and organizations, including individual AMA and ACOG members, who have grave concerns about the AMA taking the stand articulated in Resolution 205, and calls for the AMA to abandon this resolution. Midwives everywhere honor and respect the numerous friendly physicians with whom we already partner and look to the day when midwives and obstetricians will consistently work collaboratively to support women’s choices in childbirth and provide the best possible and most appropriate range of services for every situation.


1. K.C. Johnson, B.A. Daviss, Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America, British Medical Journal 2005; 330: 1416 (18 June).
2. Royal College of Obstetricians and Gynaecologists and Royal College of Midwives Joint Statement No. 2, April 2007. See
3. Wiegers TA, Keirse MJ, Van der Zee J, Berghs GA. Outcome of planned home birth and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ 1996; 313:1309–13.
4. Olsen O. Meta-analysis of the safety of the home birth. Birth 1997; 24:4–13.
5. Ogden J, Shaw A, Zander L. Deciding on a home birth: help and hindrances. Br J Midwifery 1997;5:212–15.
6. Canadian Institute for Health Research Giving Birth in Canada:
Regional Trends From 2001-2002 to 2005-2006.
7. CMAJ Maternal mortality and severe morbidity associated with low-risk
planned Cesarean delivery versus planned vaginal delivery at term
8. Listening to Mothers II Report (2006.) Childbirth Connections,