Mississippi Advocates Defeat Bill to Criminalize Midwifery


A bill to criminalize Certified Professional Midwifery (CPM) in Mississippi was defeated today, according to reports, thanks to a groundswell of opposition led by the grassroots advocacy organization The Big Push for Midwives.

Had it been passed, HB 695 would have limited the practice of midwifery to Certified Nurse Midwives (CNMs), stating that “any person who is not a certified nurse midwife who engages in the practice of midwifery shall be subject to criminal penalties.” The bill also stipulated that the practice of midwifery would be overseen by the Board of Nursing, something Katie Prown, Campaign Manager of the Big Push for Midwives, saw as an “inherent conflict of interest.”

“This bill would have given the Board of Nursing power over the practice of midwifery when they are two distinct and different professions,” says Prown.

The bill also would have stripped women of an important option when it comes to prenatal, childbirth and postpartum care, leaving pregnant women in the state without the care they needed. 

“If CPMs were to become illegal in Mississippi and [had been forced to] stop practicing, then the families who have become reliant on out-of-hospital care [might] not get the care they need,” Prown noted. By criminalizing midwives who facilitate out-of-hospital and home births, Prown continued, “you’re not going to stamp out home birth. Getting rid of midwives who provide home care is only going to make things worse.”

Prown says that the bill, introduced in the House by Rep. D. Stephen Holland (District 16), was introduced with good intentions. According to Prown, the bill was a response to a 2008 case involving a Louisiana midwife who facilitated a home birth in Mississippi which resulted in the death of the newborn. Mississippi has one of the highest newborn mortality rates in the country, a rate which has risen in recent years.

Licensing and regulation of certified professional midwives is something which The Big Push for Midwives supports and for which it lobbies on the ground, but, says Prown, limiting state licensure to nurse-midwives would do nothing more than severely restrict women’s birth options, especially in a state like Mississippi where no nurse-midwives are providing home birth care.

“Rep. Holland had the right intention but he didn’t have the right information and didn’t understand that this bill criminalizes the midwives who practice out-of-hospital maternity care and outlaws out-of-hospital care entirely because there are currently no nurse-midwives in the state who provide out of hospital care.”

Certified professional midwives must be certified through the North American Registry of Midwives while certified nurse midwives receive an advanced nursing degree in addition to midwifery education and certification. Certified professional midwifery also involves education or apprenticeship. However, certified professional midwives are not universally regulated and licensed throughout the country. In one state, a CPM may be regulated and licensed through a Board of Midwifery, receive reimbursements through Medicaid and offer a range of prenatal, birth and postpartum care. In other states, as is the case in Mississippi, midwives are lawfully able to practice without regulation or licensure.

According to the North American Registry of Midwives (NARM), the organization by which all CPMs are certified, they are aware of only two CPMs in the state though there are likely many more practicing in Mississippi who live in surrounding states.

The Associated Press reports that “home births have been a long-standing tradition in the state, where 18 percent of the population is uninsured:”

Midwife deliveries have been solid options for some, particularly in the Delta, one of the poorest regions in the country. Advocates say a midwife delivery is usually about a third of the cost of one that occurs in a hospital because home births usually don’t involve anesthesia and other medical interventions.

Midwifery advocates were successful at stopping this bill by organizing quickly and efficiently and barraging Rep. Holland’s office with calls and emails.  They also are encouraged by the headway they have made with Rep. Holland and the Mississippi state legislature. Prown says now that the “bad bill” is dead, they will push for an amendment but plan on coming back next year if that effort is unsuccessful. Says Prown, “And they’ve [advocates] definitely made an impression…Rep. Holland, told one of the callers to his office that in all his years at the state house, he had never heard “such a ruckus” over a bill before.”

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  • eternalskeptic

    Do you know if the AMA or ACOG was behind this bill?  Did the state medical association play any role?  When I first heard about it, I wonder if they had dirtied their hands in the matter, or if it was perhaps the first incremental move toward their stated commitment to “develop model legislation” to oppose (and likely ban) home birth. 

  • amie-newman

    the AMA and/or ACOG were not behind the legislation. It was brought to Rep. Holland by the state’s Board of Nursing after a newborn died under the care of a Louisiana midwife who crossed state lines to practice in Mississippi. If I find out otherwise or receive more information, I’ll write a follow up or update this post. I can uderstand the inquiry as AMA is obviously anti-home birth and have put effort into taking this option away for women but I don’t think it pertains to this bill. Thanks for commenting!

  • givesgoodemail

    I find the headline to this story very, very misleading.

    Midwifery would not have been banned in Mississippi if the bill had passed. A regulated, monitored certification program would have been given legal blessing, while an unregulated, unmonitored certification program would have been criminalized. Whether CPMs should be regulated and monitored in the state of Mississippi is a topic for another thread.

    Please refrain from the sensationalistic editorial misdirection that so much of the MSM loves to wallow in.

  • amie-newman

    Thanks for your comment. I’m sorry you feel the headline is sensationalistic. Your analysis of the bill, however, does not seem correct. In fact, certified professional midwifery would have been criminalized had this bill passed. Please read the text of the bill in full but here is just a line from the summary of the bill:

    “TO PROVIDE THAT THE PRACTICE OF MIDWIFERY SHALL ONLY BE CONDUCTED BY CERTIFIED NURSE MIDWIVES;

    “TO PROVIDE THAT ANY PERSON WHO IS NOT A CERTIFIED NURSE MIDWIFE WHO ENGAGES IN THE PRACTICE OF MIDWIFERY SHALL BE SUBJECT TO CRIMINAL PENALTIES AND INJUNCTIVE RELIEF;”

     

    There is this section:

    (2)  The provisions of subsection (1) of this section do not apply to any person who was engaged in the practice of midwifery for a period of not less than five (5) years immediately preceding July 1, 2010, provided that the person submits sufficient proof of that practice to the board not later than July 1, 2011.  The sufficiency of the proof submitted by any such person shall be determined by the board.

    That said, there is absolutely nothing in the bill that would have provided for a monitored, certification program. As well, having a Board of Nursing oversee the practice of midwifery is, as Prown of the Big Push notes, a conflict of interest. They are distinct practices. Yes, there are Nurses who go onto to receive midwifery training and education but of course not all midwives are nurses.