Roundup: A Win for Missouri Midwives, Will PEPFAR Be Bush’s Legacy?

Missouri Midwives Free to Provide Birthing Care, For Now … Missouri midwives, who for decades risked prison time to deliver
babies in their clients’ homes, can now do their work openly and
without fear of prosecution
. The state Supreme Court on Tuesday
reversed a lower court ruling and upheld a 2007 law allowing midwifery
in the state. Missouri was one of about 10 states that didn’t allow the
practice unless the midwives were certified nurse-midwives — registered
nurses who worked with a doctor. The midwifery provision in the 2007 health insurance bill went basically unnoticed by those opposed to it until after it was signed into law by Gov. Matt Blunt. When doctors became aware of the provision in the bill, they organized and sued saying that doctors could be held legally liable for working with midwives who lack professional licences. The court ruled that the doctor’s groups lacked the legal standing to sue and thus the court could not evaluate the case based on the facts. This leaves the law vulnerable to another trial if doctors can find a way to organize and sue with proper legal standing.

Could PEPFAR Really Be Bush’s Legacy? … The Utne Reader is asking if Geroge W. Bush will be remembered by history as "The AIDS President" because of his role in instating the President’s Emergency Plan For AIDS Relief, or PEPFAR, the multi-billion dollar effort to curb the AIDS pandemic:

We are anxious to confer upon George W. Bush a legacy. It’s no easy
task—world peace is off the table, of course—and the media are still
scrambling to single one out. No one wants to believe that the past
eight years have been entirely destructive, but come on: Are we really
going to let this president, champion of abstinence-only sex education,
claim HIV/AIDS work as his legacy?

The entire article is a great look into why PEPFAR is not, at least in its current incarnation as envisioned mostly by Bush and his Religious Right cohorts, the kind of great policy worthy of being the crown jewel in a president’s legacy. Though, considering the demerits of this president, perhaps any attempt at solving the worst public health crises of this generation, however flawed, would automatically qualify for lack of competition. So, you should read the entire piece, but I’d like to highlight for you this section in which an RH Reality Check article on PEPFAR’s impact in Zambia written by William Smith is cited:

Congress is looking into reauthorizing PEPFAR, which will present an
opportunity to address some of the problems. Currently, one-third of
the funds marked for prevention must go toward promoting abstinence
until marriage; PEPFAR grantees must sign a pledge stating that they
oppose prostitution; and PEPFAR dollars cannot be used to run needle
exchange programs, even in areas where needles are the primary method
of HIV transmission.

These stipulations make evaluating PEPFAR “a moral conundrum,” writes Michelle Goldberg for the American Prospect
online (July 10, 2007). “How do you weigh lives saved by treatment
against lives lost through policies that sabotage prevention?”

And make no mistake, lives will
be lost, considering who is left out of PEPFAR’s prevention equation.
The “prostitution pledge” ensures that some organizations will opt
against working with prostitutes in order to up their chances of
snagging PEPFAR funding. In Zambia, writes William Smith for the RH Reality Check
blog (March 11, 2008), the prostitution pledge is interpreted “as an
explicit direction from the U.S. government that prevention with sex
workers is a risky business if you want grant money.” In the truck-stop
town of Kafue, where impoverished women and girls sell sex to drivers
passing through on one of Zambia’s major highways, there’s only one
group handing out condoms—and it’s not PEPFAR-funded.

Be On the Lookout for the Domestic Gag Rule … The far right is still all about the abstinence despite the hypocrisy and the mountain of evidence standing in strong opposition to the policy.  Women’s eNews reports that  the Bush administration continues to mumble about applying PEPFAR’s Global Gag Rule, which denies funding to any health clinic that talks about or provides contraception and other family planning services, to clinics in the United States.  

Petitioners appear to be taking this step now so Bush can take the political
heat for instating a domestic gag rule, leaving a would-be President John McCain
in the clear on this issue.

Has James Dobson Become a Political Liability? … Frank Schaeffer, author of CRAZY FOR GOD-How I Grew Up As One Of The Elect, Helped Found The Religious Right, And Lived To Take
All (Or Almost All) Of It Back
, argues that James Dobson’s time in the political sun is over and his tired, hateful attacks on Barack Obama will have the unwanted effect of driving more voters to the Illinois Senator.

Nevertheless Dobson has — for eight years — been George
W. Bush
‘s personal shill. In return Dobson has had ego-stoking "access"
to the White House, or rather to the lackeys in the White House laughing at him
but charged with stroking Dobson and the other pompous asses masquerading as
religious leaders.

But the new generation of evangelicals is sick of being labeled as backward
rednecks because of their association with fossils like Dobson. There are many
evangelicals like Cizik too who are not all about homophobia, nationalism,
war-without-end and American
or the Republican Party. Like Cizik they believe that the
America has a responsibility to do something about global warming, poverty,
AIDS, human trafficking and other issues. They see through Dobson and the other
so-called pro-life leaders, who have actually done nothing to reduce abortion.
In fact Dobson has increased abortions because of his "abstinence only" crusade.

It is encouraging to read Schaeffer’s words and dream of a working majority on reproductive health and justice issues that could make huge strides in reducing reasons to choose abortion with solid social support programs that make raising a child easier for a single parent, with comprehensive sex education for our teenagers, and with cheap, high quality, easily-accessed family planning services for all Americans.   There is middle ground on this issue and Schaeffer is at the vanguard of a movement to the middle from the far right, only time will tell how massive that movement is.  

Grand Rapids Considers Rejecting Abstinence-only Funding … The Grand Rapids Press reports that "Grand Rapids educators would be part of a national trend moving away
from ‘abstinence-only’ sex education programs if the school board
adopts a proposal to add high school lessons about contraceptives."



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  • invalid-0

    Missouri direct entry midwives may be celebrating their victory on a technicality, but Missouri babies have suffered a defeat. That’s because homebirth increases the risk of neonatal death and homebirth midwives are grossly unqualified to provide care to anyone for anything.

    All the existing scientific evidence shows that homebirth increases the risk of neonatal death. There are papers that CLAIM to show homebirth is as safe as hospital birth (many written by people with financial ties to the homebirth industry), but they do that by comparing low risk homebirth with high risk hospital birth, or with hospital birth from 20, 30 or even 40 years in the past.

    The Midwives Alliance of North America (MANA), the trade organization for direct entry midwives, has been collecting detailed safety statistics since 2001. They have publicly offered the statistics to those who can prove they will use them for the “advancement of midwifery”, but even those people must sign a legal non-disclosure agreement to prevent anyone else from learning about the data. MANA’s own safety data almost certainly shows that homebirth with a direct entry midwife increases the neonatal death rate, and therefore, MANA is deliberately hiding this data from the public.

    It is also important that people understand that American direct entry midwives have less education and training than ANY midwives anywhere else in the industrialized world. American direct entry midwives would not be eligible for licensing in any other first world country. Homebirth advocates like to point to midwifery in the UK and the Netherlands, but fail to mention that American homebirth midwives would not be allowed to practice in those countries.

  • invalid-0

    at how you use information, Dr. Tuteur. Your site,, is filled with your frustration over the availability of home birth as an option for women. You quote statistics that don’t tell the whole picture, you talk above about the comparison of low-risk home birth with high-risk hospital birth as flawed.

    However, in my experience, the certified midwifery practices and independent practitioners that I know are very clear about home birth as an option for healthy laboring women – comparing low risk births at home is entirely appropriate as that is the norm for lay midwives – low risk births. And, in fact, for the most part midwives are more than happy to work with ob/gyns (and ob/gyns have been amenable to working with midwives) caring for women who are not candidates for home birth because of a medical condition. I was just at the hospital this weekend with a friend with very high blood pressure who labored for over 24 hours. A particular complication arose, the doctors wanted to do an invasive procedure, the lay midwife who was acting as my friend’s doula at the hospital suggested my friend change her position, and the problem disappeared. The ob was thrilled at not having to do an invasive procedure – as was my friend. For you, Dr. Tuteur, to presume to know what you simply don’t simply doesn’t help anyone. 

    While you may not be able to see home birth with a certified midwife as a safe, legal option for healthy, laboring women who chose it, there are many doctors who do. Here in Seattle, for example, the University of Washington Medical Center – one of the nation’s most respected hospitals – takes all transfers from midwives in the area. Likewise does Group Health, another facility held in high regard for childbirth.  Swedish Hospital, on the other hand, a facility with one of the highest c-section rates in the country, and which does not take midwifery transfers has a medical director who has actually said that he doesn’t know why all women wouldn’t chose cesarean section because of its convenience. 

    While I won’t comment on what the mainstream midwifery organizations do or don’t do – or how they use their data – I will say that I am consistently amazed, after having been present at home births and hospital births, at how different a birth experience can be (not always is) for a healthy woman who has had quality pre-natal care throughout her pregnancy, at home, compared to a birth at a hospital with medical professionals. At hospitals the medical professionals opt right off the bat for interventions where as I have seen and heard over and over again how wonderfully  women can manage birth at home without any of those interventions. While home birth is not for every woman, it has been proven to be a safe option for some.

    Amie Newman

    Managing Editor, RH Reality Check

  • invalid-0

    Ms. Newman,

    In order for women to make healthcare decision, they must have access to factual information. Unfortunately, homebirth advocacy is made up of mistruths, half truths and outright deceptions.

    For example, how many people realize that direct entry midwives have less education and less training than any midwives anywhere else in the world? Shouldn’t American direct entry midwives be required to meet the standards of European midwives, Canadian midwives, and Australian midwives?

    How many people know that the BMJ 2005 article actually shows that homebirth has a neonatal death rate almost triple that of hospital birth in the same year? How many people know that Ken Johnson is the former director of MANA (Midwives Alliance of North America)? How many people are aware that Bettye Ann Daviss is a homebirth midwife? How many people know that the study was funded by a homebirth advocacy foundation.

    This is not an issue of “choice”, it is an issue of safety. Homebirth advocates want to avoid discussing the safety issues and the qualifications of direct entry midwives. They have very deliberately attempted to trade on the widespread support for abortion rights and reproductive freedom, when many homebirth advocates support neither.

    As Katherine Beckett and Bruce Hoffman have written in “Challenging Medicine: Law, Resistance, and the Cultural Politics of Childbirth”:

    “Midwives and their supporters consistently frame this debate as one centrally about individual choice, arguing vigorously that women have the right to choose where and with whom they will give birth. As the legislative sponsor in California stated, “At the core of this issue are two simple beliefs: first, that childbirth is a natural process of the human body and not a disease. And second, that a parent has the responsibility and the right to give birth where and with whom the parent chooses …”

    … Notably, birth activists avoided linking this choice to the right to choose abortion by avoiding more general terms such as reproductive choice or the right to choose.”

    Women are not receiving accurate information about homebirth and about direct entry midwifery. Don’t they need that information to make an informed choice?

  • invalid-0

    The reason why “women are not receiving accurate information about homebirth and direct entry midwifery” is because “Amy” likes to misrepresent the facts and then blog trolls them all over the net.

    The Missouri State Supreme Court upheld the law regarding Certified Professional Midwives. Not direct entry or lay midwives.

    hmmmmm I think women deserve to know the truth about “Amy”.