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June 1, 2008

Midwives seek licensing for home birth; legislature balks

by Craig Idlebrook

A recent bill to license certified professional home birth midwives passed in the Maine House, but was defeated in the Maine Senate. Instead, legislators granted these midwives the right to obtain a limited number of drugs for deliveries.

Many Maine home birth midwives hoped the bill would clarify their legal status. Overall, some two percent of all Maine births take place at home, according to Midwives of Maine, but home birth is considered neither legal nor illegal.

Most home birth midwifery practices are located along the coast and home birth can be an attractive option for some islanders. Some studies of birth outcomes after low-risk pregnancies show no difference between home births with trained attendants and hospital births. But home birth midwives have come under increasing fire in some states, said Steffany Hedenkamp, a campaign coordinator for the National Birth Policy Coalition.

"The climate, the environment, is increasingly hostile," she said.

After several practitioners received cease-and-desist orders in the Midwest, the National Birth Policy Coalition launched a campaign to gain licensure for midwives in all 50 states. The Maine effort began before the national campaign. Currently, 24 states regulate home birth midwives in some fashion, according to the coalition.

Holly Arends, a treasurer for the Maine Association of Certified Professional Midwives, said home birth midwives in the state hoped to gain greater access to medical resources, including the ability to prescribe drugs and order tests. Currently, they must rely on friendly doctors for tests and work around regulations to obtain labor aides like oxygen, she said. The bill's backers also said it would have given families the ability to check on the qualifications and past history of most home birth midwives.

But the bill met stiff opposition from the Maine Medical Association and the American Association of Obstetricians and Gynecologists (ACOG), who argued that licensing home birth midwives legitimizes home birth. 

"Most physicians are uncomfortable with the idea of home birth," said Andrew MacLean, deputy executive vice president for the Maine Medical Association.

The association argued that midwives lacked scientific training and were unequipped to deal with medical emergencies, and a statement from ACOG even went so far as to say women who choose home birth do so "over the goal of having a healthy baby." The bill's backers countered that certified professional midwives undergo rigorous training and testing through midwifery schools and only work with low-risk pregnancy candidates.

According to the compromise bill signed into law by Gov. John Baldacci, a pharmacist, not the state, will determine a home birth midwife's qualifications before dispensing drugs to her. Arends is happy that certified home birth midwives have increased access to medications, but worries that some pharmacists have said they will not participate.

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