Let's Protect Our Babies by Licensing Midwives

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Ina May Gaskin

In 1896 Tennessee lawmakers took the wise course of setting into law the principle that midwifery is not the practice of medicine. In 1998 Tennessee lawmakers have a chance to carry on that tradition.

Our legislators currently are considering bills in the House and Senate that will license certified professional midwives. CPMs are skilled professionals who provide what is called the midwifery model of care, the type of maternity care appropriate for most births. CPM certification sets a national standard for out-of-hospital maternity services, and 24 states now use the CPM examination in their licensing or certification procedures.

CPMs have become popular due to a growing demand for out-of-hospital birth services by a diverse group of consumers, from Amish families to obstetrician-gynecologists. They are aware that the midwifery model of care is key to reducing medical intervention in births. Nurse-midwives (CNMs), who already are licensed to practice in Tennessee, have rarely been able to provide out-of-hospital services.

Partly because of the 1896 legislation, which helped make Tennessee a favorable place for midwifery to grow, two Tennessee-educated obstetricians recently were able to have their first baby at the Farm Midwifery Center in Summertown. Along with more than 2,050 other babies, Rudolph Fedrizzi and Heidi Rinehart's daughter was born at our CPM-staffed center, which is world famous for its excellent birth outcomes and low rates of birth interventions.

This physician-couple chose out-of-hospital birth when they were fourth-year obstetric residents at Vanderbilt Medical Center, with all of its state-of-the-art technology. Why? Because they knew that unnecessary cesarean sections and other interventions pose increased risks to mothers and knew that the odds were they would have to face such interventions. They compared Tennessee's cesarean rate of more than 23 percent and Vanderbilt's rate of more than 25 percent with our less than 2 percent rate before making their choice.

When she was a medical student, Dr. Rinehart had the opportunity to spend two weeks at the Farm Midwifery Center. There she witnessed the marked difference in maternal and infant outcome that can be achieved when mothers receive one-on-one, continuous care throughout pregnancy, labor and during the postpartum period. Certified professional midwives provide the care that usually prevents the need for surgery or other interventions in healthy women.

There are many compelling reasons why Tennessee should have a midwifery law licensing CPMs. Tennessee's escalating maternity care crisis, like that of the rest of the country, features ever-higher costs, high neonatal mortality rates, increased use of unnecessary technology, and lower public satisfaction. The midwifery model of care addresses all of these problems. The Midwifery Model of Care also is cost-effective. According to a 1994 study by Public Citizen's Health Research Group, the rate for cesarean sections around the world is 12 percent of all births, which is half of Tennessee's 1992 rate of more than 23 percent. If Tennessee's rate dropped to 12 percent, we would save $45 million a year.

Access to nearby maternity services has long been a problem for many Tennesseans, since only 38 of our state's 95 counties have obstetricians, and a high percentage of Tennessee's obstetricians do not accept TennCare patients. As more and more of Tennessee's smaller hospitals close their maternity wards, this problem only will get worse.

In December 1995, the Cato Institute, the well-known libertarian think tank, published a paper titled, "The Medical Monopoly: Protecting Consumers or Limiting Competition." According to the paper:


Midwives have support from a broad range of organizations, such as Public Citizen and the Cato Institute. The proof is in their record, which goes beyond politics. Tenneseans need to recognize the valuable service midwives provide, and continue our proud tradition of supporting midwifery.

Gaskin, a Certified Professional Midwife, is founder and director of Farm Midwifery Center in Summertown.

Copyright (C) 1998 by the Tennessee Forum.

Quelle:
Tennessee Editorial Forum
http://www.mediaforum.org/states/tn/archive/collection/98gask4.htm

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