Illinois' Home Birth Safety Act (SB 3712)
Monday, November 15, 2010 at 7:17PM
By Jill—Unnecesarean
The Home Birth Safety Act is likely to be called to the floor on Wednesday, November 17, 2010, according to Illinois Families for Midwifery.
An article in the New York Times on September 23, 2010, covered Illinois’ struggle to legalize home birth midwives.
The bill’s supporters say it toughens standards and protects pregnant women and fetuses from untrained practitioners, while allowing qualified midwives to practice openly and to transport emergency cases to hospitals without fear of reprisal or arrest. (Women often register home births as “unassisted” to protect their midwives.)
State Representative Robyn Gabel, Democrat of Evanston, is the bill’s chief sponsor. “It’s an uphill battle in the House,” Ms. Gabel said.
That the bill has made it this far is testament to the midwifery community’s newfound political acumen and its first lobbyist, hired by the Coalition for Illinois Midwifery in 2006.
The bill’s opponents, including the American College of Obstetrics and Gynecology, the Illinois State Medical Society and the American Medical Association, argue that home births are inherently more dangerous than births in medically supervised settings. Also resisting the bill, though more quietly, are members of rural midwifery groups that have operated under the radar and off the grid for years, and would prefer to remain that way.
“We just don’t think home is a safe environment for delivery,” said Dr. Jacques Abramowicz, co-director of the Fetal and Neonatal Medicine Center at Rush University Medical Center and a Fellow of the American College of Obstetrics and Gynecology. “Childbirth is very dynamic, and it can be a very dangerous process. In the vast majority of cases, nothing happens. However, if an emergency occurs, it happens very fast — in two, three, four minutes.”
The article also cites wanting to avoid a cesarean as a reason that some women opt for home birth. Rush University Medical Center’s cesarean rate in 2008 was 43.4%.
The senate bill has not gone unnoticed by the Illinois State Medical Society, whose “Grassroots Action Center” posted the following dramatic web alert:
Click to enlarge
Opposition to Licensure of Midwives
DANGEROUS MIDWIVES BILL WILL LIKELY BE CALLED IN NEXT WEEK’S VETO SESSION
A PHONE CALL TO YOUR STATE REPRESENTATIVE TODAY IS CRITICAL TO STOPPING THIS BILL!
House Floor Amendment 1 (HFA1) to Senate Bill 3712 (SB 3712 would license midwives and allow them to provide unsupervised home birthing services.THIS IS AN EXTREMELY DANGEROUS BILL AND MUST BE STOPPED!
HFA1 to SB 3712 is an extremely dangerous bill that would allow the least trained individuals to independently provide one of the most critical services to Illinois women.
These midwives are significantly different from certified nurse midwives. Certified midwives do not consider obstetrical care medical; nor do they consider themselves medical providers. Yet HFA 1 to SB 3712 would allow these midwives to take histories, perform physicals, provide prenatal care, dispense drugs, treat hemorrhages and other emergencies, and treat the infant and woman postpartum. All of these responsibilities are medical in nature and should only be performed by the professionals who are adequately trained to do so.
Under HFA 1 to SB 3712 , midwives would be able to dispense and administer drugs. Yet, the bill only requires midwives to complete minimal training in pharmacology. Their assumption that this prepares them to prescribe dangerous drugs will prove to be life threatening to some mothers and their babies.The majority of a midwife’s training is an apprenticeship program that only requires that a candidate attend a certain number of home births with a preceptor – someone already “recognized” as a midwife. Proposals for licensure require only that individuals receive minimal education in science and first aid, be credentialed as a certified midwife and be in good standing with the North American Registry of Midwives.
PLEASE CLICK ON THE “TAKE ACTION” BUTTON BELOW TO CONTACT YOUR STATE REPRESENTATIVE (LISTED BELOW) IMMEDIATELY AND URGE A “NO!” VOTE ON HFA1 TO SB 3712!
Other critics of the Home Birth Safety Act are concerned that the bill excludes primary VBACs from the home birth midwifery scope of practice and that the bill will change nothing for women who have had a previous cesarean and wish to give birth at home.
Reader Comments (26)
"However, if an emergency occurs, it happens very fast — in two, three, four minutes.”
Ergo, for God's sake, don't let mothers make their own informed decisions about where/how to birth their own babies!
I think I am at a point where I don't think legislation is going to "fix" anything or make it "safer". Proof of this is the pointed exclusion of lay midwives from the discussion. I don't know that midwives becoming more "political" is really going to help women have more choices. It may create the appearance of choice for some while greatly decreasing the choices for others. An example of this is the exclusion of primary VBACs. So mothers who haven't had a cesarean and want to birth at home think this is the greatest law ever, support it, get it passed. Now moms who want a HBAC are prevented from accessing homebirth care because the registered midwives aren't allowed to attend them. Further, if these moms seeks care from an unregistered midwife or birth unassisted, they are potentially at greater risk for having their child removed from their home because they are now outside a stated law.
My point, is that common sense cannot be regulated. Having a baby at home is common sense.
Can somebody use the same exact wording about midwives hurting women and their babies by giving them drugs and turn it around for OBs? Because god knows it's the truth. I read it that way in my head and it was fantastic!
"Yet HFA 1 to SB 3712 would allow these midwives to take histories, perform physicals, provide prenatal care, dispense drugs, treat hemorrhages and other emergencies, and treat the infant and woman postpartum. All of these responsibilities are medical in nature"
I'm sorry, but how is taking a history "medical in nature"? And the prenatal care that I received at the ob office could have been taught in a weekend to any person with half a brain (weight check, blood pressure, etc.) Talk about control freaks!
Vanessa, I see what you're saying but I think this can be an important step. If I understand correctly, currently ALL homebirth in IL is technically illegal. What is that MLK, jr quote? "It may be true that the law cannot make a man love me, but it can keep him from lynching me, and I think that's pretty important." So, yes, the law won't make these anti-homebirth groups embrace it and use common sense, but it can start the ball rolling and hopefully access will only increase with time. Maybe there are some awesome midwives who would be open to starting a homebirth practice if it became a legal option. Maybe there are mothers who would consider homebirth if it was legal.
Well, good luck to IL. That insulting alarmist language on the 'grassroots' site is really something. Did some PR dude get paid the big bucks to come up with that?
After all, in the end it's all about power and control.
Holy cow, the "dangerous drugs" being considered for use are oxygen, IV fluids (lactated Ringer's = water with electrolytes), and methergen and pitocin for emergency postpartum hemorrhage. No one would blink if a paramedic gave these things to a woman transporting to a hospital. Also vitamin K and Rhogam. Wow.
The bill does exclude first time home VBACs:
[The CPM must consult with a doctor for:]
10 (T) History of any prior uterine incision. A woman
11 who has had a previous low transverse cesarean section
12 (LTCS) with a subsequent vaginal birth may be
13 considered for home birth. A woman with a prior LTCS
14 and no subsequent vaginal birth after cesarean or other
15 uterine surgeries, may be managed antepartally with
16 consultation, but will be transferred to the
17 consultant's care for delivery.
Also must consult with a physician (but not necessarily refer for delivery) with breech babies:
18 (U) Lie other than vertex at term.
And twins:
19 (V) Multiple gestation.
Heather, could you please be more specific? Who is trying to dominate and control whom?
Another Rachel,
You shouldn't say that "all homebirth is technically illegal." For anyone to represent herself as a midwife and assist at a homebirth is illegal. It isn't illegal for a mother to give birth on her own. Not saying this is advisable, but it is what I eventually did.
In general,
As someone whose first baby was delivered by C section, I would have been excluded by this new law. And now there are a lot more women in this situation than ever before. But is that really a good reason to oppose the law? I think getting people used to the idea of non medical midwives and home birth would over time change attitudes enough for further changes to be possible.
And it would still be possible for women who do not want to be limited by this law to operate in the same way they have been doing. At least I think it would. If it wouldn't, someone explain why.
It seems odd to me that a window is left open for home breech delivery, but not for a first VBAC. The skill of the practitioner doesn't make all that much difference to the integrity of the uterine incision, as long as one isn't stressing it with labor augmentation. (Am I wrong about this?) But it makes a great difference with breech birth. In practice thought, the way things are now, the woman with a breech is just going to be told she has to come in and have a section.
I think it would be a good think on the whole if this law passes.
Susan Peterson
@ Chris [The Man-Nurse Diaries]
Susan Peterson is correct. At the present time, any midwife who practice in Illinois is breaking the law and is subject to arrest, prosecution, civil proceedings to force her to cease practice. Many midwives have been forced out of practice in the state. Parents in Illinois and other states who utilized the services of an illegal midwife have found themselves embroiled in legal battles over the custody of their babies with state child welfare/protective services agencies. So this bill presents a BETTER situation for most families -- a pregnant woman will not have to worry about their midwife getting a cease and desist letter two months before the due date, nor will she be faced with the police demanding that she identify her home birth midwife, nor will she have to worry that her baby will be taken away because using an unlicensed illegal midwife is deemed negligent or child endangerment. Right now, ALL families who want a home birth are in this position, including all women and families who want a VBAC. If the law passes, the VBAC families will be no worse off than they are now. Those midwives who oppose licensure can simply remain unlicensed and will be at no greater risk than they are at present. Those families that oppose licensure can continue to use unlicensed midwives and will be at no greater risk than they are at present.
Susan - the drugs and dosage guidelines/restrictions are explicltly written into the Bill. I wrote about this more in my blog, or you can look at the bill (pages 8-12). So I envision that midwives are being enabled to use "dangerous drugs" in the same way paramedics are enabled to use other drugs in emergency situations. I suppose it is without a specific "physician order" though as you point out, the protocols used by paramedics (or, say, under the advanced life support guidelines that nurses use) are approved by hospital boards. They're not really written physician orders.
So the difference is that the State is approving these protocols? That is an interesting distinction I hadn't thought of, and thanks for pointing that out.
As an Illinois resident, the birth options are stressful. In this state we have documents I Child protection services taking newborns away feom moms who chose a Home Birth. So, the fact that we have an opportunity to make more providers available legally would mean more safety an more choice for women.
Having had my cesarean in 2007 at the lowest c-sec rate hospital in my area (still over 20%!) I was in search for different care for my VBAC. There is only ONE (mayb now two) midwives who would do a primary VBAC at home. While the law doesn't change this, it is a step to doing so. Some OB's don't even offer primary VBACs! How are we to find support if our state doesn't "allow it". This left me with the option to birth w an "illegal" attendant or unassisted. I believe the home both act needs to pass, I don't want another mom going through the stress of finding out she has to birth rogue so she can birth naturally. Call your reps an tell them how you feel, they truly want to know. Some haven't even looked or considered HB Act.
It is *the same* way in the state I live. Midwives still manage to practice and babies aren't being taken away from their moms. I don't welcome panels, licensing boards, review committees or consultants into my birth choices. Laws like this go down that path. If a mom wants an HBAC, she cannot go to a licensed midwife (which is supposed to be better because they're certified, right?). Currently, she has the same chance of being harassed and having her baby removed as anyone birthing at home. However, once the law states that VBACs are excluded from "safe homebirth", CPS and the like have much more ammunition to use against her. It feels like a real Pandora's Box to me and not evidence-based. It is much harder to repeal things once they are law.
Homebirth is not illegal in Illinois. The only providers allowed to currently legally attend homebirths are physicians (and there are a few, surprisingly) and certified nurse midwives who practice with a collaborative agreement with a physician. Certified professional midwives cannot legally practice. Also, CNMs can only practice with a collaborative agreement and a supervising physician, making it very difficult for CNMs to legally practice since so few physicians will agree to collaborate. Last I knew, there were 4 legal CNMs practicing in Illinois - but this may have changed. I know the one in my area is still practicing.
While there are underground midwives practicing, there are definitely cases of midwives receiving cease and desist orders, or even being arrested, and families harrassed for their choice of provider. I lean toward thinking this bill would help expand legal homebirth services in IL - but as a physician, maybe I'm more a fan of licensing than some others would be!
(I'm a small town family practice doc, myself, in rural Illinois.)
A midwife other than a CNM who attends a home VBAC today in Illinois is at risk for arrest and cease and desist orders. It is presently illegal for midwives to provide VBAC services. That has to be changed. But until it is changed, why deprive all women who want a home birth from being able to utilize the services of a licensed midwife? Why should all midwives be subject to arrest, cease and desist orders, and practicing as outlaws? Why should all families be subjected to the difficulties Sarah points out in trying to access an outlaw midwife? Those who oppose this bill -- or are on the fence -- because they are concerned that primary vbacs are excluded should consider the following points:
1. Those who oppose this bill because it isn't perfect are playing into the hands of the AMA and IL State Med Soc (ISMS), which opposes ALL home birth and wants to make home birth itself illegal. In June 2008, the AMA, with the full support of ACOG and ISMS, passed Res. 205 at the AMA House of Delegates meeting. That resolution calls for legislation that would make home birth itself illegal, not just home birth midwives, which are dealt with in Resolution 204. All of this is public record -- google AMA and Resolution 205.
2. Opposition from organized medicine is what frequently forces supporters of midwifery legislation to have to compromise on scope of practice issues like VBAC. Supporters of midwifery legislation to propose these types of limits. They are sometimes forced to compromise by opponents and the legislators who are backed by organized medicine. By helping the AMA and ISMS defeat bills like the IL bill, VBAC- supporters are actually making organized medicine more powerful. You are actually REWARDING them for having exercised the pressure on groups like Illinois Families and the Coalition to force them to accept compromises in the first place.
3. This bill doesn't MAKE home VBAC illegal. Right NOW in Illinois, home birth VBAC is ALREADY illegal. Any midwife who is caught providing home birth services for a VBACing woman, particularly if transport results, is pretty much guaranteed to get prosecuted for something, and the family should expect having to deal with interference or worse from child welfare authorities. In fact, ALL midwife-assisted home birth in Illinois is effectively illegal (except for maybe 2 to 4 CNMs). Penalties for the unauthorized practice of medicine (which is what unlicensed midwifery is under Illinois law) are actually ENFORCED in Illinois. Numerous midwives have been threatened with prosecution and had to give in to cease and desist orders or have left the state. Does ANYONE really think that the supporters of this bill are just supporting it because they want to limit access to HBAC? Hardly. They are working for this bill because, without it, NO CPM can practice legally.
4. If this bill gets passed, home VBAC families and those midwives who choose to continue to provide home birth VBAC will be no worse off than they are now. In fact, they likely will be better off because the midwifery regulatory mechanism will not provide the kind of incentive to "hunt down" home VBAC midwives. The IL medical board is behind the enforcement of the present "unauthorized practice" laws which outlaw midwifery practice whether or not an HBAC is involved.
5. The Illinois State Medical Society is a charter member of SOPP, the AMA's Scope of Practice Partnership, which seeks to limit consumer access to ANY health professionals other than physicians. Google SOPP and AMA -- you will be horrified to learn that they oppose independent practice by advanced practice nurses like CNMs and nurse practitioners, chiropractors, psychologists, naturopaths, optometrists, podiatrists, physical therapists, and certified professional midwives. SOPP's is to make sure that physicians maintain a monopoly over all health care practice by forcing all other health professionals to be "supervised" or under the control of a physician. SOPP opposes convenient consumer access to an nurse practitioner at the local CVS or Target store, wants to deny access to hospital practice for CNMs, wants you to have to see an opththamologist every time you change your eyeglass prescription, require back surgery instead of chiropractice care, etc. Opposition to this bill is part of the SOPP agenda.
6. Are the anti-licensure families willing to take their babies to unlicensed pediatricians, or get dental services from unlicensed dentists, or go to unlicensed chiropractors? If someone is a total libertarian on the issue of licensure, that is one thing -- at least they are consistent. But why should midwives be the only profession that shouldn't be licensed? Eating is a natural function, but nutritionists and dieticians who help people eat healthier diets are licensed. Massage therapists, barbers and beauticians, manicurists, plumbers, electricians, real estate agents, lawyers -- in the U.S., professions and careers that have an impact on human life, health, or safety are almost always subject to licensure. You may be opposed to the system, but then just identify yourself as a libertarian, don't take it out on midwives and the consumers who want legal access to midwives.
Susan
Susan,
Where can I learn more about SOPP? Your info is great and I'd like to do some digging.
I wonder where they came up with the rationale that first time VBAC is too risky for home birth? The risk is negligibly different than the risk of any vaginal delivery.
I apologize if this is inappropriate for the forum - feel free to delete if so - but doctorjen, by any chance are you near Shelbyville? I know it's a big state, but I have a friend there who is expecting her first and hoping for a low-intervention/hands-off kind of birth (not necessarily at home - she's exploring her options). Do you (or anyone else in that part of Illinois) have any recommendations for docs or midwives? Are you available, perchance?