What opponents of untrained midwives are up against

The Oregon Midwifery Council (OMC) is the most important midwife organization in the state. It pays for our lobbyist who fights to maintain midwifery the way we hope it will be. This includes things like ensuring we are autonomous practitioners, maintaining our right to attend VBAC, twins, breeches, post-dates and so many other types of births. The OMC is glad to receive donations to help pay for the lobbyist and further the cause of midwifery in this state. — Alma Midwifery, Portland Oregon

The righteous anger in the wake of the most recent senseless, totally preventable homebirth death in Oregon seems like the only fitting response to the tragedy. That a couple of “birth junkies” exercised their legal right to call themselves “midwives” in the absence of even the most basic education and training and let a baby die is a scandal.

But don’t make the mistake of thinking that because Oregon’s homebirth [direct entry] midwives are so grossly unqualified, uneducated and unprofessional, they are equally ignorant of politics. Nothing could be further from the truth. And those who ache to protect innocent babies from the lethal incompetence of these women need to become equally politically astute.

Consider what you are up against in Oregon. The current situation is a result of a concerted, ongoing effort by state and national homebirth midwifery organizations to allow any “birth junkie” to call herself a midwife, to make consumer protection laws toothless, and to allow “midwives” to collect insurance reimbursement. Although their informal motto is to enable choice for “women,” their real aim is to enable enrichment of uneducated, untrained women who wouldn’t qualify for midwifery licensure in ANY other country in the industrialized world.

I recently reviewed the Oregon statutes governing direct entry midwifery. The Oregon Board of Direct Entry Midwifery, charged with licensing and regulating midwives doesn’t even require a midwife to be licensed. The statutes governing the regulation of homebirth midwifery are designed to protect midwives from consumers. The qualifications for licensing are minimal, the disciplinary penalties for licensed midwives are vague and limited and there are no provisions for regulating unlicensed midwives.

How did this happen? Part of the problem is that homebirth midwifery is a fringe practice and doesn’t draw much attention from lawmakers. To the extent that the Oregon legislature is subject to pressure from consumers on this issue, it is only proponents who call, write letters and attend public hearings. From the point of view of the average Oregon lawmaker, promoting the goals of homebirth advocates is all upside. Homebirth advocates will be happy, and no one else will care.

But the real reason is hidden. State and national homebirth midwifery organizations hire professional lobbyists and, since lobbyists don’t come cheap, they raise money to do so.

A Facebook group supporting the Oregon Midwifery Council makes this clear:

Contribute to the OMC. We desperately need money to pay our lobbyist and to cover other expenses. Join OMC, and donate an extra amount. You can mail a check directly … Or use Paypal from our website …

The Oregon Midwifery Council is not alone, many state and national homebirth organizations have professional lobbyists. Take, for example, the MAMA Campaign, a collaborative effort by the National Association of Certified Professional Midwives (NACPM), Midwives Alliance of North America (MANA), Citizens for Midwifery (CfM), International Center for Traditional Childbearing (ICTC), North American Registry of Midwives (NARM), and the Midwifery Education Accreditation Council (MEAC). They employ Billy Wynne, former Health Policy Counsel of the Senate Finance Committee. His other clients include major corporations like Abbott Labs.

The services of such a lobbyist do not come cheap, costing tens of thousands or even hundreds of thousands of dollars. What has their money bought?

According to the MANA website:

On Friday, November 13th, MAMA representatives met with a top health aide to Senator Maria Cantwell from Washington State. In direct response to MAMA advocacy, Senator Cantwell has included a provision in the Senate Finance Committee bill that will require Medicaid to reimburse licensed birth attendants (which would include state-licensed CPMs) who provide services in licensed birth centers. We were told that the Senator feels strongly about including CPMs in the health care bill … The Senator has heard the call from MAMA loud and clear and committed to finding a way to move the ball forward for CPMs…

As a key member of the Senate Finance Committee, Senator Cantwell has a limited number of initiatives that she can champion herself, but she has offered to fully support any other Senator who will file MAMA’s original provision on the floor of the Senate to require that Medicaid reimburse all CPMs in all settings.

The take home message is that toothless homebirth statutes and virtually non-existent consumer protections do not happen magically. They required a coordinated campaign involving letter writing, attendance at public hearings, and, above all, professional lobbyists.

The single most effective thing that those mourning the unnecessary homebirth deaths in Oregon could do is to raise money and hire a lobbyist to take the stories of these innocent, unprotected, and ultimately dead babies directly to the only people who could put an end to these tragedies, the legislature of Oregon. In the meantime, write to your legislators, attend public hearings, contact local media and encourage your friends to do the same.

Don’t let these deaths go unnoticed, unchallenged and unpunished.

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