Throughout history there have been midwives and there have been physicians. Midwifery is and always has been separate and distinct from the practice of medicine. It should not be included in the definition of the practice of medicine in Missouri law.
The word midwife means “with woman.” Midwifery is an ancient tradition that is present in almost every culture all over the world. The earliest recorded history bears witness to the fact that midwives have played a significant role worldwide. Egyptian hieroglyphics, early Chinese and Hindu writings, and the Bible all refer to midwives.
As civilization evolved, midwifery became an honored and respected profession. Hippocrates wrote that male physicians were called upon to assist with difficult births, but the management of normal labor was the realm of midwives. Socrates’ mother was a midwife. Aristotle speaks of the wisdom and intelligence of the midwives of Greece.
In the United States, in the late 1950's there was a nationwide effort to eradicate midwives. Most states, including Missouri, put new laws on the books strictly regulating or eliminating the practice of midwifery. Fewer and fewer midwives could practice. Then, in the 1970’s there was a revival of midwifery. Most states repealed the old 1950's laws or enacted new midwifery laws. Missouri was one of only nine remaining states in which direct entry midwifery was illegal.
During the 1980’s and 1990’s MMA presented bill after bill to the Missouri Legislature, usually passing through the Missouri House of Representatives only to die in the Senate under the threat of filibuster. Then, in 1997, MMA brainstormed on both the positive and negative aspects of being illegal and of becoming legal. As a result, MMA decided to hold out for a good law that will serve the families of Missouri well.
After 1997, the energy fueling MMA died out and we did not present any bills to the Legislature. Other homebirth and midwifery groups took a turn presenting bills, but without success.
Then, in 2002, a Legislator in the Missouri House of Representatives, Cynthia Davis from O'Fallon, happened to be on a long flight from Paris, and was seated beside none other than Ina May Gaskin and Robbie Davis-Floyd. They talked all the way home, and Cynthia put legalizing midwifery in Missouri on her list of things to do. In 2004, she re-vamped an old bill from years gone by and asked MMA what we thought of it. It was wrong for what MMA wanted for our state. So MMA gave her feedback and she re-wrote the bill. Despite a huge showing of supporters who came to speak in favor of the bill, the bill died in committee.
Representative Cynthia Davis
Again, in 2005, Representative Davis has filed a midwifery bill. The bill would remove all reference to midwives from Missouri law, making Missouri a “gray state.” Then, to add to the strength of mothers, the following phrase was included, to be added to the Missouri Statutes, “Nothing in Missouri law shall encroach on a mother's right to give birth in the setting and with the caregiver or caregivers of her choice.” The outpouring of support from Missouri families and midwives was overwhelming. "Yes," they said, "That is exactly what we want!" Members of Missouri Midwives Association and Friends of Missouri Midwives (FoMM) joined forces and educated legislators for the entire 2005 legislative session.
The bill passed the House of Representatives Children and Families Committee by a UNANIMOUS YES VOTE, passed the House of Representatives during a vote in the wee hours of the morning, went to the Senate and sadly expired in the Senate General Laws Committee when the 2005 session came to a close.
But Missouri homebirth families and midwifery supporters did not give up. The 2006 bill was very similar to the bill filed in 2005. The main focus of the bill was the informed disclosure document that the midwife must give to the client, describing her education and training. But in this bill, the midwife must be a Certified Professional Midwife. That is a big change from 2005. The decision to add the CPM requirement came after many, many hours of debate among MMA Members at our regular and special meetings. The 2006 bill also had a Grandmother clause for experienced midwives, and a religious exemption. Months of negotiation and compromise ended with a disappointing filibuster by Senator Chuck Graham from Columbia.
But the momentum driving the midwifery bills would not stop. As Senator Cauthorn was term-limited out, Senator John Loudon from Chesterfield took up the midwifery bill. He filed the same bill that had passed out of Senate Committee the year before. Despite Senator Loudon's best attempts, the bill was filibustered on the senate floor, again by Senator Chuck Graham from Columbia.
The legislative session closed in May 2007 with the passage of a provision to legalize Certified Professional Midwives (CPMs) in Missouri. It was not our full licensure bill, but it did get around the filibuster and legalize the CPMs in Missouri.
The provision was signed into law by Governor Matt Blunt. It reads "Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 r-6(b)(4)(E)(ii)(I)." What this means is that Certified Professional Midwives may provide services related to pregnancy (including prenatal, delivery, and post partum services).
The Missouri State Medical Association and other opponents of midwifery in Missouri promptly persuaded a judge to place an injunction against the provision. The judge made the injunction permanant in August of 2007.
Several groups and individuals, including the Missouri Midwives Association, appealed to the Missouri Supreme Court. The Opinion issued by the Supreme Court in the summer of 2008 clearly states "certified midwives are exempted out of the unlawful practice of medicine under section 334.010."
MMA strongly opposes all legislation that would repeal the Tocology provision. It is unfair to ask the legislature (the majority of whom support midwifery licensure) to make the midwives felons again.
For the first time in almost 50 years, midwives may legally practice in the state of Missouri. Homebirth families can find a midwife to attend their births at home.