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The Lang family stands next to the newborn and her mother, Caroline, after a successful birth in a natural birthing center.

Increased danger with new safety protocols

Historically, midwives have had an important role. Indigenous midwives were part of communities long before the practice of midwifery.  The American College of Nurse Midwives, ACNM, currently has 6,300 members, approximately 5,000 of which are in clinical practice. However, because of the existence of less educated and uncertified midwives, there is animosity toward midwifery.

A bill relating to the minimum standards for birthing centers and certain health professionals was filed in February 2013. It has been pending with the House Public Health Committee since the 25 of February.

The biggest concern expressed by midwives is that Texas House Bill 1507 would place new regulations on the transfer of laboring women from birthing centers, or the care of a midwife, to hospitals.

It would require a formal agreement with a hospital, instead of a consulting physician, to accept patients in emergency situations and complicate the procedures involved in the transfer.

All certified nurse-midwives, CNMs, are trained and licensed in nursing and midwifery. They possess at least a bachelor’s degree from an accredited university and are certified by the American College of Nurse Midwives.

CNMs currently have contracts with at least one consulting physician in case of emergencies. They also have a set of written protocols and sufficient training for emergencies during and immediately after the birthing process. However, the new bill would require that a CNM consult with the contracted physician in an emergency situation.

Patricia Perkins, a CNM out of Spring, Texas, believes that the bill “creates dangerous barriers during an emergency.” She explains that having to stop during an emergency and contact the physician takes away from the time that could be spent treating the patient.

The midwives would also be required to fill out paperwork and get written consent from the patient, or a person acting on the patient’s behalf, during the emergency before a transfer can be completed. The birthing center would be required to have a contract with the hospital allowing transfer of emergency patients.

Perkins says this bill contradicts the law that prohibits hospitals from turning away laboring patients. Jean Smith, a CNM at Inanna Birth and Women’s Care in Denton, concurs and adds that, although true emergencies requiring transfers are incredibly rare, putting all of these regulations in place does more harm.

“By trying to do all these things for ‘what-if or just in case something happens’, it’s actually increasing a woman’s risk,” Smith says.

Betty Hoffman, a fellow CNM alongside Smith, says she doesn’t believe that the new bill, if it passes, will drastically affect the Inanna Birth and Women’s Care. She sees the bill as an attempt to regulate midwives who are not required to have contracts with physicians, namely Lay Midwives and Direct-Entry Midwives.

Smith, however, sees possible consequences in the future. Hospitals provide constant fetal monitoring whereas birthing centers monitor the fetus periodically.

Constant monitoring requires the expectant mother to stay in bed, which decreases mobility. This hampers the normal fetal rotation and often causes more pain, which, in turn, usually results in the desire for an epidural.

Epidurals have a tendency to cause complications in the vaginal birthing process. Smith fears that if the new bill calls for more hospital-like procedures, like constant fetal monitoring, the likelihood of urgent situations will increase dramatically. If that happens, the more complicated emergency transfer system will have a negative effect on the mothers, and possibly the babies.

Many women express hesitancy about the natural birthing process for fear of danger arising during labor. Dr. Smith puts these fears to rest. She says, in an emergency, the time it takes to transfer a woman to the hospital from a natural birth setting is no longer than the time it would take the on-call doctor to arrive at the hospital if the woman was giving birth there.

However, if the bill passes and the transfer process becomes lengthier and more complex, it is possible that the trend in natural birthing with midwives will begin to decrease for fear of complications.

Jackie Griggs, a CNM and President of the Texas Coalition of Birth Centers, is urging midwives and those opposed to the bill to speak directly to their legislator. She says not to send a generic letter because they are often not taken seriously.

She recommends a brief letter of concern because the “legislators need to hear about the personal impact this legislation will have” on expectant mothers and midwives.

Smith hopes that by educating others on the protocols currently in place to protect patients and educating them on the benefits of a natural birth, the animosity toward midwives will decrease and the trust in a woman’s natural ability will increase.

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