Opinion : To the Editor: Licensing of midwives would offer many benefits to women

I am writing to inform citizens on the state of midwifery in Iowa.

At present, Certified Professional Midwives, midwives who attend the majority of out-of-hospital births, are not licensed in Iowa. 28 states in the U.S. offer a license to CPM’s; 3 of those 28 states border Iowa and the other 3 states which border Iowa have introduced legislation that would offer a license for CPM’s. No state that has licensed CPM’s has ever rescinded that license, and in fact, have found licensing midwives to produce reduced healthcare costs.

The lack of licensure in Iowa means that CPM’s can (and have been) be charged with the felony of practicing medicine without a license. The irony is that midwives who have been charged with such a crime are not being charged because of bad outcomes but rather because anonymous reports from those who disagree with the idea of home birth.

One midwife was prosecuted because a family she served wrote a glowing letter to the editor about their home birth. Their attempt to educate the public and share their amazing story is what resulted in that midwife being charged.

One of the concerns that come up when legalizing CPM’s is talked about is safety, of the practitioner and of home birth. Study after study has consistently shown that home birth with a CPM is just as safe as hospital birth and in some cases, safer. The most recent study, released just this year, surveyed almost 17,000 planned out-of-hospital births. Of all the women in this study, just 5.2% ended up with a cesarean, compared to a national average of 32.8%. In other words, women giving birth at home have a 1 in 20 chance of having a cesarean while those entering the hospital to give birth have a 1 in 3 chance of having a cesarean. 1 That is just one example of the many ways that CPM’s working in home birth settings reduces interventions and healthcare costs.

Another concern that is voiced is that of the education CPM’s receive. CPM’s, to receive the CPM credential, must have 1,350 clinical hours of training and must attend at least 55 births before even applying to take the 8 hour written and 4 hour skills exam.2 Compare this to the birth training of Certified Nurse Midwives (currently licensed in Iowa) who can attend as few as 20 births with 700-900 clinical hours and receive their license.3 CPM’s are required to re-certify every 3 years while CNM’s are required to re-certify every 5 years. CPM’s are trained exclusively in out-of-hospital births while only 3% of births attended by CNM’s happen outside of the hospital.

Right now in Iowa there are 3 bills waiting to be moved on in the Iowa House and Senate. Senate bill SF 2152, sponsored by Senators Boettger and Sodders, has been assigned to a State Government Sub-committee where it rests in the hands of Senators Horn, Danielson, and Smith. If those Senators choose not to put this bill through by the first funnel deadline, which is this Friday, February 21st, this bill is dead this session. Representative Mary Mascher has filed a companion bill in the House, and is HF 2178. This bill has ended up in a State Government Sub-committee and is in the hands of Representatives Watt, Grassley, and Mascher. A third bill, HF 2086, sponsored by Representatives Heartsill, Kaufmann, Pettengill, Gassman, and Schultz, is in the hands of Representative Miller.

These legislators need to hear from their constituents today, letting them know that access to safe midwifery care in Iowa is a priority. They need to be reminded that a Scope of Practice Review, ordered by their own legislative body in 1999, came back in 2000 with the following recommendation: “The Review Committee agrees that licensure for Certified Professional Midwives should be done through the legislative body.” 14 years after that committee review was presented, CPM’s are still not offered a license in Iowa.

Thank you for your time and please, contact your legislators and urge them to license Certified Professional Midwives, the only midwives exclusively trained to work in out-of-hospital settings.

Bethany Gates, A.S., CD (CBI)

Vinton, Iowa

1. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

2. North American Registry of Midwives Position Statement, Education Requirements to become a Certified Professional Midwife, updated September 2012. http://pushformidwives.org/wp-content/uploads/2011/09/New-NARM-Requirements_2013.pdf

3. American College of Nurse Midwives, Accreditation Commission for Midwifery Education, Criteria for Programmatic Accreditation of Midwifery Education Programs, Revised June, 2013, Pages 35-36. http://midwife.org/ACNM/files/ccLibraryFiles/Filename/000000003304/Prog%20Criteria%2012%202009%20%28rev%206%202013%29%207%2025.pdf