Why I voted no on the mid-wifery bill: HB-1061

I disagree with your vote and believe we should trust women to act in the best interest of their children, which is why some women choose a home birth instead of an institutional birth (a room of your own in a hospital is still not a home birth, no matter how many friends and family and tchotchkes you bring).

Nonetheless, I am immensely pleased to see you using Facebook and your blog to immediately (or darn close!) update your constituents and all interested parties about your legislative thinking. Your openness is commendable.

I'm sorry for not following this more closely, but am so thankful to read that you voted the way you did. My voice of experience has been against home births since I gave birth to child #4 almost 11 years ago. After 3 previous births that were a piece of cake, I easily would have thought a home birth was for me. Thank God I was not that stupid. My 4th child had an extremely complicated delivery, requiring resuscitation after 9 min. without a heartbeat. A couple of days later, the pediatrician stated, "I'm glad you aren't one of those that wanted a home delivery. Your boy would not be alive, and you maybe wouldn't be either." That 10 y/o boy of ours has brought nothing but joy and blessings to our family, and I can't imagine for a single minute the loss to our family if I had chosen to give birth to him at home. Thanks so much for all of the thought and prayer you put into this vote. We are blessed.

While I respect your opinion Rep Hickey–it is based on a flawed understanding of the FACTS. Facts are funny things. They don't change just because you have an emotional attachment to one view or another. The FACT is that the setting of the birth does NOT change the safety of the birth. An equal amount of babies will die or be injured whether they are born at home or at the hospital.

Hospital births are inherently dangerous because doctors believe that they can improve on the birth process. To find the 2 women out of 100 who actually DOES have a problem serious enough for a surgical delivery they have to expose 30 women and their babies to the risks of surgery.

Midwives, at home, without the flawed model that the doctors believe in, know that they CANNOT improve on the birth process. They find the 2 women who actually need a surgical delivery and bring them to the hospital–without cutting open the other 28. Partially because they expose so many fewer women and babies to the risks of surgery they have equally good outcomes as the hospital. At the same time there are a minuscule number of babies that do not do well because the hospital equipment is not readily available. This is what makes the safety numbers equal.

That doctors are arrogant enough to believe that somehow their interventions make birth safer and better is one of the reasons that they have such terrible outcomes. SD has some of the highest neonatal death numbers in the states. AND WE CRIMINALIZE THOSE WHO PRODUCE THE BEST RESULTS!
We are one of ONLY EIGHT states that is so backward in our in our laws.

A further mention–to your uninformed doctor friend–who thinks he knows–but has likely never even looked at how things are done anywhere but here.

In thirty years of homebirth advocacy I have never needed to ask a doctor to "come and try to resuscitate (a) dead baby at 2 am." What a totally uninformed, hateful, arrogant,and sick comment to make to any pregnant woman. Shame on you!

You cannot give anyone a homebirth in the hospital–and if you have ever offered that to anyone– I want to know if you were willing to lay on the floor to deliver a baby — and if you were willing to hold a woman's head while she threw up while in labor– (I could go on and on) because these ARE the things that caregivers will do at a home delivery–and I have seen only one doctor in my life who was willing to actually "serve" in anyway that he could. You probably only show up in time to catch and leave the family to fend off the many hospital procedures during the entire labor.

There is never a homebirth in a hospital.

I fully agree with you that "Life is too fragile and precious to jeopardize it" which is one of the primary reasons that women chose to NOT use the uninformed doctors and chose to use people who have actually studied natural birth and know how it works!

There are so many examples that I could site–but let's just talk about position. Who is the— up in the air,flat on the back, legs strapped down position for??? Is that for the ease of delivery for the MOTHER?? We know that the pelvis is the largest and most open when a woman is squatting. We know that labor progresses better if Mom is upright. We know that the perineum stretches better , delivers better, and has less tears if Mom is squatting or able or sit and hold her legs however she wants to.

Sir, when was the last delivery that you spread a clean/sterile sheet on the floor and let the Mom assume any position that she wanted too. When was the last time that you put yourself in a position of discomfort so that Mom could have the position of comfort?? Oh and did I mention the position where the baby comes through with the most room and there is the least amount of tearing?? When did MOM and BABY come before doctor sitting on his nice little stool with the bright light shining down on "His" "work area" while you inflict injury and sutures just so you are comfortable while you work? Almost every element of birth has been perverted by the men who have learned in medical school and don't know anything else.

If people want a hospital delivery WONDERFUL. You are trained to do them. But why is there so much resistance to allowing those who know more about natural birth than the doctors ever will want to know–allowing them to assist in birth for women who request them. WHY?

It certainly isn't for safety reasons! Because across the United States where CPMs are in use there are NO MORE DEATHS at home than there are in the HOSPITAL. If you can find me ONE, just ONE, study that compares the rates low risk women who plan homebirths with a CPM to low risk women in the hospital–where the hospital comes out ahead–I will cease and desist and never mention it again. I challenge to find me ONE study that supports your "attempting to resuscitate the dead baby at 2am in your living room" comment. FIND ME ONE! I can show you 20–good solid medical studies.

Sir, you would have been one of the physicians that was so sure that Doctor's hands could do no harm that you would have refused to wash your hand when Dr Semmelweis showed you his study. "Oh no, that can't be true" you would have exclaimed.

May I suggest that you inform yourself about how well CPMs are working in other states. Go to these web sites and see all of the options that are available to mothers in a small area of Texas. Pray, ask God if you are arrogant and wrong. Ask him what HE thinks about your uninformed "dead baby" comment to a pregnant woman.
Smehow I can't reconcile that with conversation that is "gentle and seasoned with salt" and a doctor that is "peaceable and easily entreated."

allaboutbabies.netfamilybirthservices.com
gentlebeginningsbc.com

My husband stood in a nursery at the hospital and watched a baby turn purple and almost die, simply because the nursery was overfull and the baby was on it's back and choking on it's own spit-up. We told them that we want to keep the baby with us in the room at all times, they said they needed to do a test on him, we said please bring him back. They were taking a while and we ended up falling asleep and found out in the morning, they kept our baby in the nursery all night and the same thing happened to him while we were sleeping. He almost died from choking on his own spit-up and had to have a tube shoved down his throat to suction up the vomit from his lungs. He is a belly sleeper to this day, but their routines don't allow for variation for healthy babies.

Some people from research or experience believe whole-heartedly that it's safer to give birth at home with all attention on you and your baby rather than in a hospital where you are just another number, where they aren't able to keep up with all that can happen there.

I believe that your heart is good, and that you love women and babies, but it is so scary to put your life in the hands of "professionals" who don't care about a word that you say when you are in the most vulnerable and sacred time in your life. I know you have never been a laboring mom You wouldn't know the feelings of being trapped and taken advantage of while they are doing routines for the sake of keeping themselves from possible lawsuits and making money on each unnecessary test, but disregarding the fact that these are people they are dealing with, people with unique needs.

I had one hospital visit this last time to make sure the baby was in a safe position for birth, and my midwife told me that they are cracking down on them, they can no longer give women options about which tests and routines that they can opt out of. They are pressuring their people to give every woman every test and routine for the hospitals sake not for the woman or child's sake. They are more and more focused on profits and less focused on health.

I know that there are some rare cases where a baby would need medical help or a mom would need some medical intervention, but those few cases should not stop a woman from getting real help during birth from a real professional who does have the baby and her best interest in mind during and after birth in the safety of her own home. Safe because they aren't going to mess with the natural process of giving birth like they do in the hospitals. Every good midwife will bring her oxygen tank and necessary tools for helping in anything that a hospital could help with. There will still be rare cases of neglect, but those same things are in hospitals when their places are too full.

I didn't like the sky-diving analogy anymore than you did. I do believe that placing myself and my baby in the hospital would have been more risky than letting nature take its course at home. A pregnant woman does not have a disease and shouldn't be treated like she does, she shouldn't be the victim of science and profitable tests. A woman in south Dakota shouldn't have to choose between the hospital god who does not respect life and feeds on profits or being alone with no professional.

I see your concern and respect for life, but I don't think you know the nature of hospitals, and why they do what they do. I know there are good doctors and good nurses but they are all being trained the same things, people are customers and they are in business to make money. The hospital is no place for healthy people and especially no place for a healthy natural birth. My healthy baby almost died from neglect in a hospital because they not only neglected my wishes but were to full to care for all the babies and too set in their routines to give individualized care for a baby who should have never been put on his back to sleep. Life is risky, but giving birth at home is the safest option, in most cases

So what you're saying is you didn't bother to read ANY of the research presented to you, with real statistics and studies, and instead chose to listen to a "doctor friend". Glad to have you in politics, you fit right in.

CPM - I read ALL of it, several things several times, went to hear Dr. T and rented the movie on Netflix. And yet I remained unconvinced this doesn't risk lives unnecessarily. The stories like that of "Friend" here in the comment string weighed heavy on me. Also I will say I know that the rudeness of those like yourself cost you some votes. And in addition, yes I did consult several doctors who deliver babies every week - amazing that Tammy can refer to them as arrogant and uninformed. Whatever.

Exactly. You consulted DOCTORS. Who view birth as a medical issue and often make it more of an emergency situation than it needs to be. How many midwives did you speak with? How many World Health Organization studies did you read? The fact that you voted based on the "rudeness" of "people like me" is disgusting.

I didn't say my vote was based on your rudeness. My point is attitudes like yours are pushing people away from your cause.

Ironically, I do not typically react this way. Forgive me if I'm a little tired of seeing repeated ignorance on the matter, usually willful. Riddle me this, Steve…The US has one of the highest number of hospital births in the world, yet we are 40th in the WORLD for birth safety. Countries such as Norway, which currently holds the #1 slot in the world for birth safety, deliver the majority of their babies at home.

I am an RN and I have worked in hospitals where I would be put in delivery for the sift….not that I worked there often..it was just my turn. I knew a little about many things in nursing, but not a whole lot about one area. Granted things are different in bigger hospitals today, but workers can still fall between the cracks.
With my first child I was not a nurse yet and she was presenting in a "face up" postition. Have you ever tried to put T-shirt on a toddler while he is looking at you? He knows automatically to tuck his chin so the small part of the head (the place our Jewish friends place their
skullcaps) because it goes on easier that way. This is the way babies come through the birthing canal. Not my Michelle, she was coming face first. The back pain was unbearable…ANY midwife would have had me on all 4's to disengage her so she could come normally. But not at the hospital..they kept me stsarpped down even when I begged to get up (I wanted to bend over…I wanted to move…I wanted to lift my belly up because somehow I knew I needed to. Even if my wants were listened to - I may not have had the classic gash that I had with a c-section that followed. Michelle was born with apgars of 3 and 5…the lowest I have ever seen on a "normal" kid. God only preserved her. But I have had problems since that horrible surgery and was limited to 3 children…i always wanted 6. The hospital pretended to be my saviours - when really they were the blunderers….

Rep. Hickey, I appreciated your vote today and your stand. I believe and really hope the Senators and our Governor take a real hard look at this Bill and try to get a good understanding of what is in it. I want you to know that I'm in complete favor of CPM's practicing in this state, however this bill doesn't go far enough in protecting the women and children in their registry/licensing. They must adhere to higher education standards as was recently required by Wyoming for CPMs.

I believe a 10 year old SD militant milkmaids group is pushing this CPM bill through our capital. Thier testamony in the committee was inaccurate and based on false information.

I believe you shouldn't rely on just testamony from Doctors nor the medical profession to make this determination. I believe that one very good person to rely on would be however the practicing and license CNM that is the only midwife currently doing Home Births in South Dakota.

Once again, this Bill needs to be sent to the trash and have the milkmaids return to their parlors for a rewrite that fits the Department of Health Standards of practice for a CPM.

Mr. Mom

It's interesting how the midwife supporters vilify doctors, insisting that doctors are not nearly as qualified as they are to deliver babies, yet the doctors are the people midwives expect to handle situations that they (midwives) are not able to handle. Makes no sense.

We don't disagree that doctors are prepared to manage surgical deliveries–or deliveries that need medication–to reduce B/P - or for pain etc. We don't disagree that if a woman is dehydrating and needs IV fluids that a doctor does that well. Our disagreement is that doctors have never even seen–much less managed a normal, full tern, low risk, labor and delivery with no interventions. They have NOT read the studies, they are totally uninformed–so they think that they are doing things right–and they are not.

Dear Lora,

Your story is frieghtening and unimaginable to any man. (period) But staying to the point here of why Rep. Hickey, didn't vote for this bill, I just wonder what a blunder this would have been in the care of an under educated "Registered" midwife. Believe me, I know a couple CPM's who I would trust with a situation like yours, but they are "Old School" CPM and have now 20+ years of experience. This Bill just does not offer the other things needed to support a CPM in todays world.

Many families don't realize that babies are different than they where just a few years ago. We have smaller more petite women having larger babies from BIG country men. We use to marry and have babies from in our own demographics. Now its common to see a smaller asian woman for example wed to a large frame European man. Those parents have now had children and they are now having children and whats in the oven sort of speak isn't what you though was in the recipe. This situation makes for some very complicated births at home and in the hospital and this bill 1061 does not address this with the same type of "Registration" that we offer to nurse assistants.

Dear CPM supporter,

I think you should "Support Mothers & Babies", cause your basis for support was based on facts for CNM not CPM's, I believe. Hospitals are a place for the sick, I agree. My point is how is a CPM suppose to diagnose a medical problem or determine if her mother patient is high risk if she doesn't know how to diagnose medical conditions???

Another point, when our cattle where having calves, we called a Vet. Everyone knows most vets, have more education than most doctors. Oh, sure most cattlemen don't call a vet when they are calving. But then again, most cattlemen aren't breeding Grand Champion calves like I did. We mixed large breeds with small cows.. and we had major problems! (See story above.) Ever notice how we as society place a higher importance of care to our livestock and pets then we do our own families? Yet, you will fight for the right for a "Registered Midwife" to have the right to administer drugs, but you have no idea, where she can get them LAW? Good Job! Girls,,,, Senate Send this to the Trash!

By the way, my children where born at home, with a CNM.

Mr. Mom

Tammy,
All of the stats you throw out don't really ring true to me. As long as doctors and hospitals are delivering the complicated cases that midwives aren't trained to handle, the stats are going to be skewed against them because those are the cases most likely to have bad outcomes.

It's like comparing test scores from students at the Challenge Center to students at the school with the most children living in poverty or from recent immigrant families. Does it mean the teachers at the Challenge Center are superior because those test scores are higher? Do we then assume the teachers at the other school are "totally uninformed, hateful, arrogant,and sick" because their test scores are not as good as those of the Challenge Center teachers? After all, the kids are all taking the same tests. You are not comparing apples to apples. I believe if doctors were attending ONLY the births that the midwives were, their stats would be equally as good, if not better.

Friend,
The studies that I have sited placed any hospital transfer–and any subsequent intervention–including c-section-as a stat on the homebirth side. That is how they are able to compare outcomes.
Certified Professional Midwives transferred 2% of their laboring pts who needed who subsequently needed c-sections.

Physicians deliver 30% of women by c-section.

Out of 100 women- CP midwives have 2 that need to be surgically delivered.

Out of 100 women - doctors deliver 30 surgically.That is one of every three. No matter how you slice it–that is too many–especially when in other parts of the world–like the Netherlands–they deliver 40% of their babies at home and have much better numbers then we do as far as babies and mothers that die and are injured.

Never the less–my biggest concern is that WOMEN–should be able to decide for themselves what is the best course of action for themselves and their families. If they chose to hire someone to help them with a homebirth it should be their choice. There are only eight states who make it illegal for you to hire a Certified Professional Midwife to help you deliver your baby at home. South Dakota shouldn't be counted among those who have antique laws and act as a police or Nanny state for women.

@ Mr Mom–Are you married to a CNM?

http://maternidadsinriesgos.org.mx/documentos/parteria/Midwifery outcomes and education, Direct Entry and CNM pathways.pdf

This article was published in the Journal of Midwifery & Women's Health, which is the official journal of the ACNM. The author states in her conclusion, "Core competencies, clinical requirements, and national certification examinations are nearly identical for CPMs and CNMs/CMs. No evidence exists that apprenticeship-trained midwives are less competent than midwives who completed accredited education programs."

She also quotes The Evolution of Surgical Training: Perspectives on Educational Models from the Past to the Future which was published in Otolaryngologic Clinics of North America in 2007. I can't access the full article, but the abstract says this, "Surgical education and training have progressed through the centuries, with the most commonly used model being the apprentice model. With advances in medical knowledge and practice, the apprentice model has evolved and competing models have arisen. However, the apprentice model remains the gold standard today"

I totally agree with you and your vote AGAINST this ridiculous bill. I can not believe that our Legislators voted in favor of this. YES…their is a HUGE liability issue here. What these Legislators do not know is: NO OBSTETRICIAN is obligated to "treat these trainwrecks" when they show up at the ER door. My husband happens to be an Obstetrician, and he and his partners have already agreed to the fact that NONE OF THEM intends to be available to treat these trainwrecks. Just because they have "hospital privileges"…they are NOT employees of the Hospital…yes, they are "on-call"…but ONLY for THEIR patients! Sure, the Midwife can transfer the patient to the hospital ER…but she is going to be "cared for" by the ER staff…who aren't going to want to touch her with a ten-foot pole! In many hospitals, the ER staff consists of an RN and a Physician/or an MD…NOT an Obstetrician…an MD who is either an "Internal Medicine" or "Family Practice" doctor…they DO NOT deliver "emergency babies" and they certainly DO NOT do C Sections…only an Obstetrician or Surgeon performs surgeries…and they WILL NOT be available…as they ARE NOT obligated to be available. The ER doctor will probably try to "consult" them…but from all of the Obstetricians that I've talked to so far (and I know SEVERAL of them)…they ALL plan to REFUSE…they are not about to risk their medical license because of an ignorant patient and her incompetent Midwife. Medical doctors don't pay $50,000 a year in Malpractice insurance for nothing! I think that it is VERY crucial that the Midwives be REQUIRED to carry Malpractice Insurance…the same amount as the Medical Doctors are required to carry.
There is also the issue of the lack of education/experience with Midwives…are they going to be bringing their CONTINUOUS Fetal Monitor Machines along with them? I have been a Labor & Delivery RN for 25 years now…statistics prove that FORTY PERCENT OF ALL LOW RISK PREGNANCIES/LABORS BECOME HIGH RISK DURING THE LABOR PROCESS.
These Midwives seem to think that "all we have to do is transfer the trainwreck to the hospital…then they'll be liable for everything, because how are they going to PROVE that the complications resulted while I was watching the patient?" Sorry idiots…but I guarantee you…you will NOT be getting the support of the Obstetricians in South Dakota. You want to play with fire…you're on your own! This idea is about as smart as letting Stewardesses fly Commercial airplanes!

Isn't it amazing that all of these "pro midwives" are trying to throw in their facts, but they can't provide the proof…let me see your proof…post your articles…and I'm not buying ANY articles that were written by Midwives…I want articles from the AMA or some other Medical Association…not from some phony "Midwife" division. I know for a FACT that the medical and birth complications of home births are a LOT HIGHER THAN THE BIRTHS IN THE HOSPITAL. And I CAN PROVIDE MY PROOF!!!

I can only hope the rest of the reps where CPM's are illegal/alegal see things how you do. I had a child who did die due to a negligent homebirth midwife (who I later learned had made a few trips in front of grand juries in other infant deaths around here but walked).

First, there is a difference between CNM and CPM. EVERYONE should know this. Thus I propose an education bill. but alas, that would cost too much to get everyone to a 12th grade level, especially the delivery RN who thinks that 40% of all low-risk pregnancies become high risk during the labor process–she must have raided the medicine chest at the hospital!