As Birthing Centers Increase In Popularity, Kansas Midwives Push For Legal Independence
The number of birth center deliveries – while still small compared to hospitals – has jumped more than 50 percent since 2007. And recent research has documented some associated health benefits.
A study soon to be published in the journal Women’s Health Issues says there are fewer pre-term births and low birthweight babies in states where midwives – working in birth centers and hospitals – do more deliveries. There are also fewer cesarean births.
This story was originally published by Heartland Health Monitor, a reporting collaboration focused on health issues and their impact in Missouri and Kansas.
Sarah Lockridge thinks hospitals are where you go when you’re sick, not where mothers-to-be should go to bring their babies into the world.
That’s why she decided to have her first baby at a birth center in Kansas City, Kansas, under the care of a certified midwife.
At first, Lockridge says, her family questioned her decision.
“When you say 'I’m using a midwife, I’m not going to a hospital,' the first thing that comes into their brain is that you’re going to be in a mud hut in the woods somewhere,” she says.
But those concerns melted away after Lockridge led family members on a tour of the birth center where she plans on delivering.
“That whole environment is set up to calm a laboring mom so you can just imagine what it does to just a regular Joe walking off the street,” Lockridge says. “They’re like, ‘Oh, it’s so pretty and the music is so nice and, yes, I’ll have some infused water’ and instantly their fears are gone.”
Sarah is following a national trend, albeit a relatively small one.
“We believe that pregnancy and birth is a natural process,” says Kendra Wyatt, a co-founder with Catherine Gordon, a certified nurse midwife, of New Birth Company. “We don’t believe it’s surgery. We don’t believe it’s an act of medicine. And so, that’s a different perspective.”
Wyatt and Gordon are spearheading an effort to broaden the law that governs the practice of midwifery in Kansas. Backed by the American College of Midwives, they are attempting to do away with a provision that requires midwives – like other advanced practice nurses – to have signed agreements with supervising physicians.
Such agreements are intended to add a layer of protection for patients. But, Wyatt says, they often don’t.
“A certified nurse midwife can have a podiatrist sign their collaborative practice agreement and/or purchase a signature for money,” she says. “Neither of those two things is productive.”
Kansas doctors don’t agree. Jerry Slaughter, executive director of the Kansas Medical Society, says while there may be some exceptions, most collaborative practice agreements serve a very important purpose.
“We encourage physicians when they enter into those agreements that they make them meaningful,” Slaughter says. “Now, are the examples of where that doesn’t happen? Of course there are. But you could say that about any law.”
Slaughter says doctors are willing to agree to changes that give midwives and other nurse practitioners more practice flexibility, particularly in underserved areas. But he said the bill the midwives are pushing – House Bill 2280 – goes too far because it would allow them to essentially practice family medicine.
Wyatt rejects that characterization of the bill.
It’s the kind of turf battle that lawmakers typically don’t like to referee. But the state’s ongoing budget problems might motivate them to deal with this one.
An efficiency report commissioned by the Legislature says about $23 million in Medicaid could be saved over five years by reducing pre-term births and increasing the use of certified midwives.
“There are very clear hard dollar savings that nurse midwifery and birth centers can offer to the state,” Wyatt says. “That’s a game changer.”
She just might be right, says Representative Marvin Kleeb, a Republican who chairs the House tax committee, where the midwife bill has been parked for the time being.
“There’s some people very interested in this bill,” Kleeb says. “I think it has a 50/50 chance of being resurrected and having the discussion continue.”
Jim McLean is executive editor of KHI News Service in Topeka, a partner in the Heartland Health Monitor team.