From the April 2009 Idaho Observer:

Warning to other states: Idaho passes bill mandating licensing of midwives

Idaho considered a "model" for other states to follow

By Ingri Cassel

On April Fool’s Day, 2009, Idaho Governor Butch Otter signed into law House Bill 185 that will have the effect of reducing the number of practicing midwives in Idaho by an estimated 30 percent. After the House passed the midwifery licensing bill unanimously on March 3, Idaho’s Campaign for Liberty was alerted of the many changes to the original bill that were proposed and mounted a last minute campaign to stop the Senate from passing it. Despite the Campaign for Liberty’s efforts, only three senators in the state voted against HB 185 on March 25. Due to many of the horrifying provisions in this bill, a phone campaign to the governor’s office was initiated, urging him to veto HB 185. This too failed.

So what was wrong with the 10-page midwifery licensure bill that is now law in Idaho? Revisions made to the original bill in effect "outlaws" the ability of the majority of women in Idaho to be able to have a homebirth.

Unlawful to use a midwife

The following restrictions are at Section 54-5405 – 1(e) (i): "Prohibit a licensed midwife from providing care for a client with a history of disorders, diagnoses, conditions or symptoms that include: 1. Placental abnormality; 2. multiple gestation; 3. Noncephalic presentation at the onset of labor or rupture of membranes, whichever occurs first; 4. Birth under thirty-seven (37) weeks and after forty-two (42) completed weeks’ gestational age; 5. A history of more than one (1) prior caesarian section, a caesarian section within eighteen (18) months of the current delivery or any caesarian section that was surgically closed with a classical or vertical uterine incision; 6. Rh or other blood group or platelet sensitization, hematological or coagulation disorders; 7. A body mass index of forty (40.0) or higher at the time of conception; 8. Prior chemotherapy and/or radiation treatment for a malignancy; 9. Previous pre-eclampsia resulting in premature delivery; 10. Cervical insufficiency; or 11. HIV positive status.

"(ii) Prohibit a licensed midwife from providing care for a client with a history of the following disorders, diagnoses, conditions or symptoms unless such disorders, diagnoses, conditions or symptoms are being treated, monitored or managed by a physician licensed pursuant to chapter 18, title 54, Idaho Code: 1. Diabetes; 2. Thyroid disease; 3. Epilepsy; 4. Hypertension; 5. Cardiac disease; 6. Pulmonary disease; 7. Renal disease; 8. Gastrointestinal disorders; 9. Previous major surgery of the pulmonary system, cardiovascular system, urinary tract or gastrointestinal tract; 10. Abnormal cervical cytology; 11. Sleep apnea; 12. Previous bariatric surgery; 13. Hepatitis; or 14. History of illegal drug use or excessive prescription drug use.

"(iii) Require a licensed midwife to recommend that a client see a physician licensed under chapter 18, title 54, Idaho Code, and to document and maintain a record as required by section 54-5411, Idaho Code, if such client has a history of disorders, diagnoses, conditions or symptoms that include: 1. Previous complicated pregnancy; 2. Previous caesarian section; 3. previous pregnancy loss in second or third trimester; 4. previous spontaneous premature labor; 5. Previous pre-term prerupture of membranes; 6. Previous pre-eclampsia; 7. Previous hypertensive disease of pregnancy; 8. Parvo [parvovirus B19]; 9. Toxo [toxoplasmosis]; 10. CMV [cytomegalovirus]; 11. HSV [herpes simplex virus]; 12. Previous maternal/newborn group b streptococcus infection; 13. A body mass index of at least thirty-five (35.0) but less than forty (40.0) at the time of conception; 14. Underlying family genetic disorders with potential for transmission; or 15. Psychosocial situations that may complicate pregnancy.

"(iv) Require that a licensed midwife shall facilitate the immediate transfer to a hospital for emergency care for disorders, diagnoses, conditions or symptoms that include: 1. maternal fever in labor; 2. Suggestion of fetal jeopardy such as bleeding or meconium or abnormal fetal heart tones; 3. Noncephalic presentation at the onset of labor or rupture of membranes, whichever occurs first; 4. Second stage labor after two (2) hours of initiation of pushing when the mother has had a previous caesarian section; 5. Current spontaneous premature labor; 6. Current preterm premature rupture of membranes; 7. Current pre-eclampsia; 8. Current hypertensive disease of pregnancy; 9. Continuous uncontrolled bleeding; 10. Bleeding which necessitates the administration of more than two (2) doses of oxytocin or other anti-hemorrhagic agent; 11. Delivery injuries to the bladder or bowel; 12. Grand mal seizure; 13. Uncontrolled vomiting; 14. Coughing or vomiting of blood; 15. Severe chest pain; or 16. Sudden onset of shortness of breath and associated labored breathing."

As you can see, while some medical conditions may warrant physician involvement, many women who plan a homebirth have resolved past health issues naturally after allopathic intervention failed to resolve them. Furthermore, midwifery was legal in Idaho prior to the passage of HB 185 with thousands of healthy babies delivered successfully in the comfort of their homes by lay midwives. But now it would be a felony act to perform midwifery services in Idaho without paying a licensure fee that "may not exceed $1,000."

However, there is an exemption: "A person, in good faith, engaged in the practice of the religious tenets of any church or religious act where no fee is contemplated, charged or received..."

James Stivers, chairman of the Idaho Liberty Caucus, said, "Defenders will say there is a religious exemption in the bill...but only if the midwife does it for free! Can you imagine your local clergyman preaching the Gospel ‘for free?’ This is a naked grab by establishment midwives for monopoly control of home birthing in Idaho."

The amount of paperwork and record keeping required by the new Idaho state board of Midwifery for licensed Certified Professional Midwives (CPMs) is horrendous, further discouraging potential new midwives and older experienced midwives from practicing in this state.

Mirelle Stevens of Pocatello, Idaho, who traveled to Boise on March 16 to testify to the Senate in opposition of HB185, called about half of the midwives in Idaho to find out how mandatory licensing of CPMs would affect future homebirth availability. She noted that 10 midwives would be forced to quit while others would not qualify for grandfathering due to performing a couple births annually (75 primary births in the past 10 years required with a minimum of 10 births in the last two years prior to licensing.) She memorialized the lay midwives main concerns as follows:

• "overly restrictive"

• Midwives must "’facilitate mandatory and immediate transfer of care to a hospital for...the suggestion of fetal jeopardy such as ...meconium or abnormal fetal heart tones, which are not evidence-based and will result in unnecessary transports OR midwives or parents choosing not to transport, thereby opening themselves up to serious legal ramifications."

• "I fear that midwives will be forced into illegal practices for common circumstances of labor" such as one episode of deceleration.

• "I fear that these restrictions [non-cephalic presentations, multiple births, VBACS after more than one c-section and births of women with a BMI over 40] may drive some women to have unattended home births as a direct result of being unable to find a midwife to attend them." These are the very ones who need their births attended.

• Midwives claim that some of the restricted medical conditions listed in this bill can be fixed by a change of diet or lifestyle.

The few midwives who have been representing the midwives of the Idaho Midwifery Council (IMC) are not representing them adequately. Furthermore, the IMC does not represent all practicing midwives in the state Idaho.

I have spoken with a midwife who practices in Delaware. Under their oppressive laws, only one CPM has a permit to practice legally. The midwife said that the rest of the midwives practice "under the radar."

Who is leading the campaign for licensing of midwives in all 50 states? "The Big Push for Midwives" is a nationally coordinated campaign advocating for the regulation and licensing of Certified Professional Midwives. Certified Nurse-Midwives (CNMs), who practice primarily in hospital settings, are legally authorized in all 50 states, while CPMs, who specialize in out-of-hospital birth, are legally authorized to practice in just about half of the 50 states. Representatives from The Big Push for Midwives Campaign noted that Idaho typifies recent legislative trends across the country, as a growing number of states come closer to passing CPM legislation. In fact, their recent press release boasts this legislation as a model for other states to follow... [See ]

Why is homebirthing being threatened now?

The Newborn Screening Saves Lives Act of 2007 was signed by President Bush on April 24, 2008 and is now Public Law No: 110-204. This act allows the federal government to screen the DNA of all newborn babies in the U.S. and has since been implemented in all hospitals throughout the country. By restricting legal homebirth options, more women will be forced to deliver in a hospital setting where their baby’s genetic code will be captured by the Dept. of Homeland Security (DHS).

Today, the DNA taken at birth from every citizen is owned by the government and every citizen becomes a potential subject of government-sponsored genetic research. All 50 states are now routinely providing results of genetic screenings to the DHS. Congressman Ron Paul stated that passage of this Act was the first step towards the establishment of a national DNA database.

HR 20, the Melanie Blocker Stokes Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act, better known as the Mother’s Act, passed the House of Representatives on March 30. The Mother’s Act, if passed, will mandate that all new mothers be screened by means of a list of subjective questions that will determine if each mother is mentally fit to take their newborn home from the hospital. Just imagine that after your child is born, you are told you can’t take him home since a multiple-choice questionnaire wasn’t answered correctly. Just imagine being told that the only way you can take your child home is if you or your spouse goes into treatment or takes dangerous anti-depressants?

There should be no doubt that the ultimate goal of state regulation and licensing of midwives is to reduce the possibility of sovereigns being born in the U.S., ensuring the ownership of all newborns by the state.