Missouri legalized Certified Professional Midwives (CPMs) in 2007, and the law was upheld by the Missouri Supreme Court in 2008. The Supreme Court issued a statement that physicians groups have no standing to challenge the midwife law and that they have no standing to speak on behalf of the families who choose midwives. Now only nine remaining states prohibit midwifery by law.
MMA does not oppose licensing for midwives. We do, however, oppose any legislation that would interfere with the ability of families to freely choose where and with whom they give birth.
The word midwife means “with woman.” Midwifery is an ancient tradition that is present in almost every culture all over the world. 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. 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 Most states repealed the old 1950's laws or enacted new midwifery laws.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.
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.
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 permanent 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 were legally practicing in the state of Missouri. Now, homebirth families easily find a midwife to attend their births at home or several birth centers across the state. When transport to a hosptial is necessary, the transfer goes smoothly, with the midwife able to accompany the mother to the hospital and interact as a professional. Missouri's midwifery law has become an example for the rest of the states and a beacon of safety and freedom for homebirth families and midwives in the state.
Press Release Following Supreme Court Opinion
News from Missouri Midwife Supporters
CONTACT: Mary Ueland (417) 543-4258, firstname.lastname@example.org
FOR IMMEDIATE RELEASE: Tuesday, June 24, 2008
Missouri Women and Families Declare Victory
Independence Day Comes Early for Midwives as State Supreme Court Upholds Right to Practice
JEFFERSON CITY, MO (June 24, 2008) - Today's Missouri Supreme Court decision is a tremendous victory for Missouri families, who have been working for 25 years to gain legal access to professional midwives. The ruling increases access to maternity care in the state and allows women and families more birth options and affirms their ability to exercise their rights to choose how their babies are born.
In a 5 to 2 ruling, the Court upheld a law that legalizes Certified Professional Midwives (CPMs) who practice in the state. The Court determined that the physician groups that brought the suit to overturn the law lacked standing because their only interest in the case was economic.
"The Missouri Supreme Court made the right decision today, and after 25 years of legislative struggles to ensure more birth options for families, we are very excited," said Mary Ueland, Grassroots Coordinator for Friends of Missouri Midwives (FOMM). "Now, we can commence with creating a system in Missouri where CPMs are part of a team of caregivers, where mothers are truly informed and able to determine their own birth preferences, and where midwives can appropriately transport when the need arises, without fear of reprisals, and without intimidation and harassment of the parents."
The decision makes legal Certified Professional Midwives (CPMs) and removes the threat of prosecution to professional midwives who assist families who choose out-of-hospital birth. State and national birth and midwives advocates hailed the ruling as a triumphant and historic moment in Missouri’s history and evidence of a tipping point at hand on the national scale.
"Certified Professional Midwives must pass rigorous exams to obtain the credential, and participate in continuing education and peer review to keep current. They practice according to their Practice Guidelines within national standards for CPMs," said Debbie Smithey, president of the Missouri Midwives Association, "Missouri was one of only nine states to prohibit CPMs from practicing, and now the number drops to eight states remaining."
The Court’s opinion summary is posted online. The ruling makes Missouri the 23rd U.S. state to allow professional midwives.
"Today’s victory over Big Medicine is a real shot in the arm to the growing campaign to legalize midwives across the nation," said Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives. "This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth in Mid-June 2008 - physicians do not have the right to speak for patients when it comes to deciding who delivers their babies. Missouri families now have legal access to CPMs, who provide high-quality, cost-effective care and fill significant gaps in the state health care system."
Across the nation, many have stepped up to help in a case that has been likened to a David-and-Goliath battle, with midwives supporters hosting bake sales and garage sales to stand up to the enormously well-financed Missouri State Medical Association, an affiliate organization of the AMA. In February, an amicus curiae (friend of the court) brief was submitted by:
Citizens for Midwifery (CfM)
Midwives Alliance of North America (MANA)
National Association of Certified Professional Midwives (NACPM)
Our Bodies Ourselves
The National Birth Policy Coalition (NBPC)
The amicus brief submitted by the coalition urged the Court to reverse the injunction against the midwives law and made the case that increasing access to trained and qualified CPMs and out-of-hospital birth is beneficial to Missouri citizens.
The new Missouri Midwifery law was supposed to take effect Aug. 28, 2007, but the Missouri State Medical Association (MSMA) organized a well-financed challenge to the new law and was granted a temporary restraining order on July 3. Then on Aug. 8, Circuit Court Judge Patricia Joyce, who serves on the Board of Directors for St. Mary’s Health Center in Jefferson City, disallowed the Certified Professional Midwives provision contained within HB818 regarding portability and accessibility of health insurance.
Judge Joyce ruled the provision was unconstitutional and unrelated to health insurance, despite hearing from Assistant Attorney General John K. McManus and Midwifery Coalition attorney Jim Deutsch that decriminalizing midwifery does indeed relate to health insurance as they recalled that the Missouri Supreme Court has already ruled health insurance is interdependent on health services, and the two subjects are related.
During the Circuit Court appeal to Judge Joyce on Aug. 2, Deutsch cited nine other states where Medicaid covers home births attended by Certified Professional Midwives and many others where CPMs receive private insurance reimbursement. Both McManus and Deutsch argued that families obviously cannot get health insurance reimbursement for their midwives if their providers are considered felons by the state. They agreed that legalizing Certified Professional Midwives is a first step to home birth families being able to have their maternity care providers covered by insurance. They also cited the lower cost of midwifery care, which in turn could encourage insurance companies to lower their rates for healthy women.
Midwives Supporters Seek Donations to Help Pay Legal Fees
To help pay for the legal fees incurred over the past year, families across Missouri have undertaken fundraising efforts, including bake sales, garage sales, and other community fundraising events. "Through our own efforts, we have steadily chipped away at our legal bills, but we still need help," said Laurel Smith, President of Friends of Missouri Midwives. Smith added that donations to help pay the legal fees of the coalition of midwives and their supporters can be made at www.FreeTheMidwives.org.
Missouri is a priority of The Big Push for Midwives Campaign, a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care. The Big Push for Midwives Campaign is the first initiative of the National Birth Policy Coalition (NBPC). Through our work, we are playing a critical role in the building of a new model of U.S. maternity care delivery at the local and regional levels. At the heart of this new model is the Midwives Model of Care, which is based on the fact that pregnancy and birth are normal life processes.
Media inquiries about the Missouri Supreme Court case should be directed to Mary Ueland at (417) 543-4258, email@example.com. Media inquiries about The Big Push for Midwives Campaign should be directed to Steff Hedenkamp at (816) 506-4630, RedQuill@kc.rr.com.
Friends of Missouri Midwives
Missouri Midwives Association
Show-Me Freedom in Healthcare
Free the Midwives
The Big Push for Midwives
NOTE: The Missouri Supreme Court’s ruling today legalizes Certified Professional Midwives and how they practice within their scope of practice for pregnant women, and has nothing to do with abortion, c-sections, or epidurals.
The Midwifery Amendment
376.1753. 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). **
* Tocology is the science of midwifery or obstetrics. The National Organization for Competency Assurance (NOCA) certifies more than 160 credentials, most of which are in the medical field. The Certified Professional Midwife (CPM) and Certified Nurse Midwife (CNM) are the only tocological certifications under NOCA. CNMs are already allowed to practice under their own statute. There are no ministers certified by NOCA. Therefore, the CPM is the only credential affected by this language.
** This portion of the US Code says "services related to pregnancy (including prenatal, delivery, and post partum services)."