April 20, 2019
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Bill to regulate, license midwives wending through Augusta

BELFAST, Maine — Maine midwives are moving closer to being licensed and regulated by the state. Many of the state’s midwives say the proposed law will lead to professional recognition that has been a long time coming.

If LD 690, An Act to Ensure the Safety of Home Birth, becomes state law, it will establish criteria for licensure and oversight, a regulatory body and allow for easier consultation and collaboration with other health care providers.

For moms such as Elly Burnett of Belfast, the proposed law is personal. With Burnett’s first pregnancy, instead of the natural birth she had wanted, she felt forced by her medical practitioner to induce labor at the hospital when she was two weeks past her due date. The labor was long, painful and involved drugs and extraction devices, she told lawmakers earlier this month at a public hearing on the bill.

“I think that nine or ten years ago, if there had been a regulatory and licensing system in place where I could look up providers and know credentials, I think that would have made a difference for me,” said Burnett, a lawyer and mother of three. “It certainly would have given me choices. I think there are plenty of people like me who want a natural childbirth. If homebirth midwifery was brought out from the shadows, more people would realize it’s not a scary choice, or a choice only for a few natural types, but that it’s a good and healthy option for a lot of women.”

Ellie Daniels, a longtime Belfast midwife who also is the president of the National Association of Certified Professional Midwives, said that a growing number of Maine families are interested in midwives and homebirths. Midwives attend just under 2 percent of the births in Maine, an increase of more than 60 percent since 2007. In Maine, there are about 25 certified professional midwives who attend homebirth and about 90 certified nurse midwives who practice in and out of hospitals.

In some parts of state, interest in and access to non-medical births is much higher than the state average, Daniels said, citing a recent statistic that shows about 8 percent of Waldo County babies now are born at home.

The proposed law would be a way for midwifery to integrate further into Maine’s maternity care system, Daniels said, adding that while a similar bill did not pass in 2007, the current bill has had support from such entities as the Maine Medical Association and the American Congress of Obstetricians and Gynecologists.

The next step for LD 690 will be a legislative work session that has not yet been scheduled, according to the Maine Legislative Information Office.

“I think that we’ve really built broad-based support,” Daniels said. “We’ve had a lot of support from the national organizations. It’s really a wonderful thing.”

At the public hearing, Robin Doolittle Illian of the Maine Association of Certified Professional Midwives said that a state license will provide consumers with assurance that their midwife has met state and national standards.

“Licensure will also provide a disciplinary mechanism with which to respond to cases of negligence or misconduct on the part of the midwife,” she said.

Daniels said it would set necessary standards for midwifery in Maine.

“There will be some expectations for practice. You can’t just do whatever you want,” she told the BDN. “You have to practice within some guidelines for safety. It will also improve our ability to collaborate. When a woman appropriately needs some medical support, that will be easier to access. It also will be a place at the table, to contribute towards what birth looks like in the state of Maine.”

Unlike the 2007 effort to license midwives, the only person who spoke in opposition to the bill at this month’s public hearing on it was Anne L. Head, the commissioner of the Maine Department of Professional and Financial Regulation. She told lawmakers that LD 690 would trigger a state “sunrise review” law.

The Sunrise Review Process was adopted by the Maine Legislature in 1995 to provide a mechanism for gathering and analyzing pertinent information needed to make an informed decision about whether to regulate a particular group of individuals or entities, Head wrote last year in a memo about the process. Sunrise reviews are meant to make sure the state imposes only the minimum level of regulation necessary for public health and safety, and does not create unnecessary economic barriers of entry to a profession.

“I certainly understand and appreciate the proponents’ interest in licensure, but this committee must consider the underlying central question — is there a demonstrated threat to public health in the absence of a licensure program that would justify new regulation?” she said.

About half of the states in the country have laws around licensing home birth midwives, including Vermont, which has required midwives to be licensed by the state for 15 years. In Nebraska and Alabama, laws prohibit home births attended by certified nurse midwives.

For Maine parents, such as Elly Burnett, the idea of licensing midwives is appealing because it will make it easier to find a good midwife.

“Safety was incredibly important to me. Part of why this licensing bill is important is that there’s going to be mandatory reporting and disciplinary action,” she said. “Attorneys are licensed. We’re regulated. You wouldn’t come and hire me if I weren’t. It’s an important part of hiring a professional.”

In Burnett’s third pregnancy, she had a very different — and much more positive — experience, she told lawmakers in her testimony. Her family had moved to the midcoast, and she has asked her new neighbors about their birth experiences. She found out about local obstetricians and midwives. She learned that lots of people felt that home births were “not just for hippies and homesteaders,” but for different kinds of people — including her, she decided.

“This time, I was informed, and I was making informed decisions about my care,” she testified. “When my due date grew close, I wasn’t scared.”

As before, her baby arrived two weeks after the due date. This time, Burnett labored with the help of her midwives and in the comfort of her home. She went for a walk in the woods as the sun rose and by the time she came home, she was in hard labor and eased into the birthing tub.

“I gave birth to Flora at around 9 o’clock on a beautiful, breezy, sunny June morning filled with birdsong,” Burnett told lawmakers. “I had a phenomenal birth experience at home. I sincerely regret that it took me two hospital births to realize there were other options that were safe and normal.”


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