Legalizing the Oldest Profession

Now that I have your attention, let me
clarify that I’m referring to midwifery, the
practice of helping women throughout the
childbearing cycle by offering support,
advice, and special birthing techniques.
On June 30th, you can help this age-old
profession win back legal rights to practice
outside of medical institutions in Illinois.
Illinois Families for Midwifery (IFFM) is sponsoring a 9-11
am pancake breakfast at McKinley Foundation to support
efforts to pass Senate Bill 385, the Midwifery Licensure Act.
AREN’T MIDWIVES ALREADY LICENSED IN
ILLINOIS?
For Illinois midwives to legally practice, they must work
under a licensed obstetrician in a hospital setting. These
midwives are Certified Nurse-Midwives (CNMs) who can
be licensed. They are trained in both nursing and midwifery
(advanced practice nurses with at least a bachelor’s
degree from an accredited university).
But Direct Entry Midwives (DEMs), those who enter
directly into the midwifery profession without being nurses
first and maintain autonomous practices outside of institutions,
cannot be licensed in Illinois. Some acquire their
skills through apprenticeships (the “Farm” in Tennessee)
others through formal classes or programs like Seattle Midwifery
School. A college degree is not required. DEMs can
be Certified Professional Midwives (CPMs) in some states
to reflect the extensive clinical training they receive (cfmidwifery.
org). This requires attendance at an accredited midwifery
school where they have met rigorous requirements
and passed written exams and hands-on skills evaluation.
WHY DO WE NEED SO MANY KINDS OF
MIDWIVES TO BE LICENSED?
Every year in Illinois approximately 1,000 women and their
families choose to give birth at home, so being able to find
someone well trained in home birth is critical. OB/GYNs
and CNMs are not trained to do home births, DEMs are. But
at this time anyone can call herself a midwife and lay people
may have difficulty judging whether said midwife is qualified.
For example, people often confuse my work as a doula
with midwifery, but doulas and midwives are not the same.
Although doulas provide support to mothers during pregnancy,
childbirth, and post-partum recovery, they do not
perform medical checks or offer medical advice like many
midwives do because doulas do not have clinical training in
catching or guiding babies at birth. Yet, even though midwives
have clinical training it is important not to confuse
them with obstetricians because midwives are not medical
doctors. Licensure would ensure that a home midwife has
passed certain standards so each mother does not have to
extensively research whether the home midwife is appropriately
qualified and experienced.
Licensure would also facilitate locating a home-birth
midwife. Currently Illinois citizens must go underground to
find a home-birth midwife. According to the IFFM website,
“With the hostile legal climate in Illinois, many midwives
have left or stopped practicing in our state making it harder
and harder for families to find qualified care. People will
keep on having home births for a variety of reasons. Families
find themselves searching for whatever care they can
find, or, worse, doing without maternity and delivery care.”
Licensure would also ensure continuity of care when
complications arise. In the words of a local woman who
needed to go to the hospital after a prolonged labor at
home, “In order to legally protect my midwife I had to go to
the hospital without her. She told me what to tell the doctor
but I can’t say that I got it right. It would have been nice
if she could have communicated with the doctors herself.”
WHY DO PEOPLE CHOOSE A HOME BIRTH?
Some choose a home birth for financial reasons. Uninsured
women must pay hospital costs out of pocket (e.g.,
the Amish). Hiring a midwife is cheaper than a basic hospital
birth ($2000 v. $5000).
Others choose home births due to their personal philosophy:
religion, cultural preference, modesty/privacy,
and a desire to avoid excessive interference to the natural
process of labor and delivery. One local woman believed
that routine hospital procedures caused her to have a
cesarean on her first birth (Google the “cascade effect”) so
she chose the Midwifery Model of Care for her second
birth. “My doctor wasn’t going to let me attempt a v-bac
[vaginal birth after cesarean] so I got my vaginal birth at
home.” Although she could have chosen a hospital CNM,
she knew that even though they are lighter on medical
interventions, they still operate within the Medical Model
of Care due to the fact that they are in a medical institution
that regulates their actions. (See table on next page.)
These differences leave some women feeling that a home
birth is safer. They point to data showing that planned home
births with an experienced midwife have a lower perinatal
death rate than hospital births. To some extent this may
reflect self-selection (women with high risk pregnancies
rarely opt to deliver at home and will not find midwives to
assist them). However, it could reflect the quality of midwifery
care. The US has a higher infant mortality rate than
21 other industrialized countries—countries that primarily
use the midwifery model of care. “In the five nations with
the world’s lowest infant mortality and lowest rates of technological
intervention, midwives attend 70% of all births
without a physician in the birth room” (MANA).
In the US if a woman is in danger then the home-birth
midwife takes her to the hospital. The midwife is trained
to know what’s a problem and how to complete a hospital
transport. Home-birth midwives also screen for potential
problems before birth and if a situation is beyond their
expertise they refer women elsewhere.
In short, it’s not just the hippies and fringe people that are
choosing home births.
WHY HAS IT TAKEN SO LONG TO LICENSE
MIDWIVES IN ILLINOIS?
In the 80s DEMs in Illinois were legal by judicial interpretation.
In 1997, the state investigated five midwives for practicing
medicine without a license and served them cease and
desist orders. Shortly thereafter, DEMs were prohibited from
practicing in Illinois. This change was spearheaded primarily
by medical establishments (Illinois Department of Public
Health, The Illinois State Medical Society and the Illinois
chapter of the American College of Nurse Midwives) and
fueled by public myths regarding midwifery.
In the back of many people’s minds, midwifery is synonymous
with “witch work.” When Druidism evolved in
Europe, one group of Druids, the Ovates, were known to
be healers, herbalists and midwives, the type of person
many would call a Witch. Christianity forced Druidism
underground in the 6th century but Druidism resurfaced
in the 17th century as the Cunning Folk, witches in modern
perception (druidry.org). Many people wrongly
assume that these “healers and midwives” were persecuted
during the Puritan Era. But the records reveal few trials
persecuting midwives who were deemed respectable and
trustworthy by the locals (Harley, 1990). Midwives were
actually the least likely women to be targeted as witches.
In the few cases where midwives were accused of witchcraft,
the accusations stemmed from theologians (the educated
working in institutions) who mistrusted midwives’
access to potions and knowledge of the birth cycle, including
birth control (afwh.org).
The educated working in institutions continued to
diminish the status of midwives with the rise of Modern
Medicine and the attitude of superiority that came with
this model of care. For example, at the inception of modern
obstetrics in the late 1800’s, there was an increase in
“childbed fever,” an illness that usually resulted in maternal
death. The illness was nearly absent in clinics run by
midwives. Basically, the medical students were not “washing
up” before leaving their cadavers to deliver babies. The
midwives had no cadavers so they were not spreading the
infection. Did this strengthen the respect for midwives by
the medical community? No. In fact, the doctor who discovered
the problem was fired from the clinic.
Was firing the doctor who made the discovery easier
than asking doctors to admit to having caused “countless
unnecessary deaths”? To what extent was this attitude of
superiority in the medical community protecting economic
profit? During the Industrial Revolution factory owners
had to “care” about the health of skilled workers. Did
modern medicine spread as an almost “necessary step in
the development of capitalist economies”?
One look at the billboards around town and Carle’s new
wing for birthing women will tell you that childbirth is big
business. While CNMs help bring in clientele for a hospital,
DEMs are in direct competition with the medical establishment’s
ability to make money. Is that why medical
practitioners are one of DEMs’ key persecutors today? Or
is it because medical practitioners have reason to believe
their way is the better way and get to use a tradition of
paternalism to legislate their beliefs?
Laws regulating maternity care can be connected to profit.
For example, the Chicago Maternity Center (est. 1895)
was delivering about 2000 babies a year at home by 1929.
During the Great Depression the primary hospital supporter
closed the center down for economic reasons. The originator
began running the center through separate funds. “As
more and more babies were being delivered by doctors, in
or out of hospitals, states around the country were passing
laws about midwifery. In some states it became illegal for a
midwife to practice.” (cwluherstory.com).
This history has biased our reactions to stories we hear
about home births. Rather than reinforcing the stories of
positive home birth outcomes and chastising the problematic
hospital births we do otherwise. We blame the
“botched homebirth” on the midwife or mother and praise
the doctors for having “done all they could” or “being
there to save a terrible situation” even if their own actions
might have contributed to the process (and as a doula I’ve
seen this happen several times).
Rather than think about the modern-day midwives that
carry oxygen and dopplers, etc., and how they are trained
to watch for danger signs, sending women to hospitals
when something goes awry, we merely focus on their use
of natural medicines. And rather than focusing on the statistics
showing fewer problems in midwife-attended home
births than hospital births we focus on the few complicated
home birth cases and ignore the complications and
deaths caused by doctors in hospital settings.
The purpose of IFFM is to increase public awareness of
the safety, availability, and benefits of the Midwifery Model
of Care and lobbying for a Certified Professional Midwife Licensing Law in the State of Illinois. IFFM states, “Illinois
women deserve to have access to all the nationally certified
maternity care providers that women in 22 other states,
including nearby Wisconsin and Minnesota, can choose
from.” Contact Pat Cole, the President of IFFM at 309-722-
3345 or ilfamiliesformidwifery@gmail.com for more information.
HOW WILL SB 385 MAKE A DIFFERENCE?
Republican Senator William R. Haine filed SB 385 on
Februrary 7, 2007. The bill has 24 Democrat and Republican
co-sponsors, including three locals: Dan Rutherford,
William B. Black, and Shane Cultra. This bill would allow
for the licensure of DEMs in our state so they can practice
independent of a medical establishment and give women
the right to give birth in their own way, in their own time,
and in their own space.
Unlike many bills, SB 385 is bringing people together.
According to Sarah Stalzer, fundraiser for IFFM, “It’s one of
the few bills with bi-partisan support… On the lobby bus
to Springfield there was an Amish woman, a lesbian couple,
a mother who was Jehovah Witness, a hippy, and a liberal
elite. How often do you see liberals and conservatives
working together? It’s bringing all these diverse groups
together. When a line of Amish women walk into the State
Capitol, it catches your attention.”
SB 385 recently passed in the Illinois Senate with a 51-
7 vote. Instead of voting and it not passing in the Illinois
House, it is currently tabled in the Registration and Regulation
Committee until it gets more support (bills can only
come up every two years, so if it doesn’t pass they will
have to wait 2 more years before re-introducing the bill).
Sarah Stalzer added, “The big chance is for it to pass in the
fall. Funds are needed to pay lobbyist fees to keep this bill
alive and help the bill get further than ever before.”
Even if you personally would not consider a homebirth
please consider helping to keep that option safe and available
to those Illinois families who do choose to birth their
babies at home.