Advocates urge state to license midwives

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BY HEATHER AUGUSTYN AND PATRICK GUINANE
The Times | Saturday, January 26, 2008 | (14 comment(s))

INDIANAPOLIS | In Indiana, a midwife who helps another woman with a birth at home better keep quiet, unless a big push to bring licensing to the profession succeeds.

Several local women are joining a national campaign to advocate for regulation and licensing of certified professional midwives in all 50 states and the District of Columbia.

Indiana is one of 28 states that currently does not license midwives to practice home births, unless they are a nurse midwife assisted by a doctor.

About 200 people rallied at the Statehouse on Thursday, working to introduce legislation in Indiana next year.

"We've been working on getting licensing in Indiana for about 14 years," said Cindy Lybolt, of Crown Point, an advocate for home births. "It is legal in Indiana to have a home birth but not legal to have a certified professional midwife attend you."

Pregnancy and childbirth have "become this big medical intervention thing with drugs and procedures," said Robin Joyce, of Hebron. "With home birth, it's just more of a natural experience."

Lybolt said a planned home birth with a midwife means the team has done prenatal care and thoroughly discussed the birth procedure, nutrition and exercise to ensure a safe birth.

"We don't advocate for high-risk women to have a home birth, but 95 percent of women are healthy and don't need specialists," Lybolt said. "Midwives are great at prenatal care, and there's a huge need in Indiana for qualified midwives."

Dr. Alfred Kobak, of The Kobak Women's Health Center in Valparaiso, said that licensing is a way to make sure people in any discipline are knowledgeable and capable according to the required standards.

"The principle of licensing is to ensure competence," Kobak said from his Valparaiso office. "The most important issue here is the safety of the patient. That's always paramount. Licensing would prove they're competent to do what they say they're going to do."

Licensing also would help midwives come out of the shadows, he said.

"They won't have to worry about the police coming to arrest them for practicing medicine without a license," Lybolt said.

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OrganicMama wrote on Jun 11, 2009 5:31 PM:

" Midwifery is not a criminal profession!! Indiana is so far behind in the times!! Home births are safe and low risk for those women who are low risk and healthy!! Anyone who reads this email our IN Senator and Congressman urging for this to be legal and require insurance companies to pay for this!! It's BS that they don't! This is a violation of a women's reproductive rights!! Push for Certified Professional Midwifery, you won't be sorry! Best care I've ever received!! "

Melissa Huffman wrote on Jan 28, 2008 11:34 AM:

" The previous comment posted that Indiana does have licensed nurse midwives was addressed in the article, wasn't it? The difference here between midwives trained to assist in homebirths and those working in hospitals or birth centers are crucial. I have not found a CNM that can take me as a homebirthing patient in the last 5 years because I am a VBAC. I was told by CNM's they can't because of hospital privelage restrictions, doctor back-up requirements and insurance policies concerning malpractice that they can no longer allow VBAC birth to occur at home in their practice. I have now had 5 successful births at home in spite of those fears the CNM must adhere to but thankfully a homebirth practicing CPM can see past to assist me. "

Cindy wrote on Jan 27, 2008 10:17 AM:

" Thank you for the great article. All of us know that our health care system is broken. One of the evidences of that is our abysmal birth outcomes. The rate of maternal death in the United States is rising. Our infant mortality rates are the worse in industrialized nations. Midwifery care offers evidence based, personalized safe care for moms and babies with excellent outcomes. We do have a small number of CNM's in Indiana offering homebirth. They are wonderfully skilled care givers. The ones I know though are experiencing challenges and obstacles in their practices and they are definitely the minority. Most CNM's practice in a hospital setting. Licensure of CPM's will increase the availability of midwifery care in our state, while insuring consumers of accountability and competency. Licensure will facilitate interaction and collaboration between midwives and obstetricians. It will help to ensure continuity of care and safety in the event of a transfer. We need the support of consumers in Indiana, who believe that women should have options in childbirth. "

Nurse Midwife wrote on Jan 26, 2008 11:41 PM:

" Midwifery is legal in Indiana. Nurse Midwives are licensed by the State Board of Nursing as independent practitioners. Physicians do not "assist" midwives, nor do they "back-up" midwives. Rather, midwives collaborate with physicians when the care of a woman falls outside of her own expertise.

Hospitals may restrict the practice of midwifery with supervision and so forth, but this is not required for practice within the state. It is most often an attempt to restric the trade of midwifery.

Legislature does however require written collaboration for prescription privileges, which not only restricts the trade, but creates less than optimal care for mothers and babies. In spite of this challenge, the state has a handful of Certified Nurse Midwives offering homebirth services - independently, interdependently and legally. Each can be found at the ACNM web site. "

Kat wrote on Jan 26, 2008 1:19 PM:

" Thank you for the supportive article!

I don't want to need to move away from Indiana to find the opportunity to birth naturally at home with support.

If Indiana doesn't want the younger generations to move away, we need to have the opportunity here to make our own informed decisions about our prenatal and medical care. "

someoneinindy wrote on Jan 26, 2008 10:38 AM:

" was a wonderful event.. the speakers were great! I had two in the hospital, one with a CNM and my next one in june will be with a CPM at home. I would love for them to be able to work legally and will do my best to support that bill! "

Margie wrote on Jan 26, 2008 10:36 AM:

" As a grateful consumer of midwifery services, I salute those midwives who have been so diligent to lovingly help moms all these years when so much was at stake for them personally. I couldn't be at the rally myself and there are thousands of others like me. We would all like to see our midwives able to come out of the shadows at last. And some of us would like to say to our own children, "Maybe you should be a midwife when you grow up." "

Melissa Huffman wrote on Jan 26, 2008 10:04 AM:

" Your article considering the licensing of midwives in Indiana is correct. Licensing gives consumers the knowledge that the state has set a standard that is nationally recognized and this profession is available to serve those interested in a healthy pregnancy, comfortable labor and safe delivery at home. I have chosen homebirth 5 times and though I have a midwife the state doesn't believe is competent I know how her training, care, and education make her the best provider I have ever had. I previously had 4 hospital births, including an emergency c-section after following all the OB suggestions that led to hemorrghing. Supporting licensure of CPM will just offer a legal avenue for women like myself to have assistance through pregnancy and birth who would otherwise risk going it alone at home, which is legal. "

Shay wrote on Jan 26, 2008 8:51 AM:

" The choice to birth at home ~ with a qualified, legal midwife ~ should be an option in Indiana! Homebirth is PROVEN to be safe for healthy, low risk women. It is a shame that our Indiana homebirth midwives could be faced with charges for practicing without a license. Come on Indiana, join the other states who have laws recognizing Certified Professional Midwives, this is 2008! "

TD wrote on Jan 26, 2008 8:21 AM:

" Support your Certified Professional Midwives! They are trained care providers, not criminals. "The most important issue here is the safety of the patient."?????? Hmmm, is that why hospital birth is so "safe" and the USA's c-section rate is 31.1%? Think not. But, home birth is a SAFE option for healthy, low-risk women with the care of a midwife. "

Julie wrote on Jan 26, 2008 7:53 AM:

" Childbirth is a natural normal event in most women's lives. As an educated mother of three children, I sought out to research our birth culture before the birth of my last child.I had previously known that unmedicated birth was very important to the mother and baby, but had never given homebirth a thought. I had heard from others how dangerous and how selfish people are when they do that. Why put your baby at risk? What if you bleed? There were so many questions and negatives about homebirth UNTIL I reasearched it myself. I looked at the newest studies. I evaluated the rising number of c-sections and the increase in maternal death because of them. I was convinced enough that homebirth was indeed safe that our last child was born at our home. It was a beautiful and safe experience that I wouldn't change for the world. I encourage everyone to do their own research. Please don't ever feel that you need to blindly follow the wishes of others. It is our responsibility as women and mothers to make informed choices for our families. "

Amanda T. wrote on Jan 26, 2008 7:21 AM:

" My first son was born in a hospital, but our future children will be born at home. All women should have the choice of where and how they give birth. "

Kristi wrote on Jan 26, 2008 6:21 AM:

" Very nice article! Thanks to the Times for helping us get the word out!! "

Birthroot wrote on Jan 26, 2008 5:04 AM:

" Homebirth is legal in all 50 states. It makes no sense for Indiana to forbid midwives who are trained in homebirth, to practice. Homebirth is safe for low risk women, and Certified Professional Midwives are qualified and trained to attend those women. "

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