Debate to mandate a license for Oregon midwives reignites after baby's death


Randy Everitt, a top state health regulator, calls it "a hornet's nest."

Val Hoyle, a Eugene lawmaker, calls it "a hot mess."

The death of a Eugene newborn as well as pressure from the state medical establishment has revived the debate over whether midwives should be allowed to deliver babies without a license. Currently, 27 states allow midwives; only in Oregon and Utah is a license for midwives optional.

Half of the estimated 150 midwives in Oregon are licensed, an apprenticeship process that requires attending 45 births while under supervision, completing 40 hours of specialized training and passing a variety of exams. About 1,000 home births per year occur in Oregon.

Pressure to mandate licensing for all midwives has repeatedly collided with the sentiment that birthing is not state business.

The debate, however, is changing.

In July after eight days of labor, Margarita Sheikh of Eugene gave birth to a boy who had no heartbeat ... She blames the two unlicensed midwives ... saying they refused to send her to the hospital when she asked, and didn’t appear to know how to give infant CPR ...

... News of her case has even caused some licensed midwives to publicly call for change.

For years, Melissa Cheyney ... who chairs the state Board of Direct-Entry Midwifery, has not taken a position on mandatory licensing even as she's studied mortality rates and pushed for better reporting of birth outcomes.

Now, however, she thinks it's time to make licensing required. Sheikh's options to hold her midwives accountable are limited because the state can't investigate unlicensed midwives, says Cheyney, and "I can't really accept that anymore."

... "As a feminist it's a really hard choice for me to make, because I don't think the government should have its laws on my body," ... "But I also think any provider ... should be held to a certain clinical standard."

Studies have found low-risk home births to be safe: in fact, some have shown fewer complications than hospital births. Studies that include higher-risk pregnancies, however, have found home births to be less safe than ones attended by a medical doctor. Higher-risk births include breech births as well as when a woman has previously had a Caesarean.

Certified nurse midwives, who typically attend hospital births, are required to be licensed ... It's the direct-entry midwives, who typically attend home births, at the center of the mandatory licensing debate.

Midwives who oppose mandatory licensing say it could drive some midwives underground, hurt access to training and restricting access to home births.

Home birthing has a devoted following based on skepticism of the medical establishment.

Sue Burns ... intentionally chose an unlicensed midwife, one without access to drugs, to ensure the birth of her daughter last year was as natural as possible. Though she ended up going to a hospital for a Caesarean after 80 hours of labor, she said she's glad that option was a distant last resort.

Burns says mandatory licensing would make home birthing "much less accessible. It potentially could lead down the road to home births becoming illegal, or before that home birth becoming too expensive for people who don't have insurance to afford it. Midwives keep each other accountable and I just don't think the state needs to step in at this point."

Another factor in the renewed mandatory licensing debate: A flood of investigations has driven up costs and stress for licensed midwives ...

More than 40 complaints were filed against licensed midwives in the last year, compared to an annual average of six or seven in years prior ...

The complaints required the hiring of three new investigators, he adds. To pay for it, the state is boosting annual midwife licensing fees from $630 to $1,800.

The surge in complaints is partly explained by a 2010 law requiring medical professionals to file complaints if they have concerns over home births transferred to hospitals. But some midwives feel the medical establishment is using the complaint process to eliminate their competition ...

Ironically, the perception that any home birth transferred to a hospital will draw a complaint risks making midwives afraid to seek medical help ...

... In light of the Sheikh case, she thinks mandatory licensing is inevitable. "As a profession, we should be driving this decision, and not the Legislature and not the anti-midwifery proponents."

And Stella Dantas, an OHSU doctor who supports mandatory licensing, thinks the cause will be helped by a study expected to be published later this year showing Oregon has a high rate of infant mortality during labor.

... His Eugene colleague, Hoyle, said she wants to find a compromise, "to ensure that we have a system that allows women to make appropriate choices -- and to understand who's qualified and who's not qualified."

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