White Ladies Love Them Some Homebirths; Meanwhile, Midwives Win in Colorado
These two articles came my way this week and I thought they were both interesting.
First, USA Today posted an article on the rise in homebirth that included this interesting turn of phrase:
Home births rose 20% over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.
The article has some good numbers overall and is worth a read, but that line gave me pause; why is race being called out so specifically? I would guess the AP writer was just looking for an interesting hook to hang his or her story on. But it comes across as though the reader were being reassured that hey, it’s just a small subculture of white women doing something weird, not any kind of big change to see here…don’t worry, America!
Meanwhile, in a post about the legislative victory in Colorado for direct-entry (CPM) midwives (who appear to serve all or mostly homebirth clients in Colorado) Radical Doula writes:
In political environments that are often very midwife unfriendly, these battles can be particularly challenging. Midwives are afraid if they push too hard, they might lose altogether and no longer be able to practice in the state. So often what results is compromise laws that can severely limit the midwives’ ability to practice as they are trained to do.
Indra [Lusero]’s group [Delivering Natural Care for Families] though, presented a different advocacy effort–that of consumers, not the midwives themselves. Their stake in the fight is different, and can be received by elected officials in new ways…
…Here are a few of the changes they were able to achieve:
- Registered CPMs can now be simultaneously licensed as nurses (and vice versa). This was prohibited in the original law.
- Registered CPMs can now obtain and use these drugs: Vitamin K, Rhogam, antihemorrhagic drugs, and eye prohylaxis.
- The language that spoke negatively of midwifery was removed.
She also linked to this piece on Ms. Lusero’s personal battles to have homebirth and aid midwives, which is fascinating and inspirational in its own right; my favorite part of it, though, was this capsule history of Colorado midwifery:
In 1917, under pressure from doctors, Colorado enacted a law requiring midwives to pass an exam and apply for a license in order to attend births. In addition, midwives were forbidden to use any instruments to deliver babies or administer any drugs. Despite this, many babies were still born at home. But in 1941, state lawmakers passed a law preventing any more midwives from obtaining licenses; already-licensed midwives could continue to practice, but no new ones could join the field. It was an attempt to make midwifery disappear, and though the number of babies born in hospitals skyrocketed in the 1950s, the law didn’t completely succeed. Midwifery just moved underground.
The profession experienced a national resurgence in the 1970s, fueled by feminism, the burgeoning health-rights movement, and government reports that anesthetizing women during childbirth could harm their babies. In Colorado, nurse-midwives — nurses who specialize in midwifery and deliver babies under the supervision of a doctor, often in a hospital — won legalization in 1977. A group of so-called lay midwives — midwives who deliver babies at home without medical intervention — wanted the same thing. They’d been practicing off the radar for decades, risking arrest and charges of practicing medicine without a license. In 1979, they formed the Colorado Midwives Association in Boulder.
For the next several years, they fought to legalize their profession. “We threw ourselves against the state legislature again and again,” says Jennifer Braun, a midwife who started practicing in Boulder in 1982 and now runs a nonprofit called International Midwife Assistance that offers birth services in Uganda. “It was a David and Goliath story.”
Bills to regulate lay midwifery failed in the legislature in 1983, 1984, 1985 and 1991. Each time, doctors, nurses and even nurse-midwives testified against them, arguing that delivering babies at home was unsafe. Meanwhile, supporters said that women were going to give birth at home regardless of whether it was legal. State regulation of midwifery would make it safer, they argued, not the other way around.
In 1993, after several midwives were arrested and one case reached as high as the Colorado Supreme Court, the legislature finally agreed. The resulting law decriminalized lay midwifery and set up a process by which “direct-entry midwives,” as they are now called, could register with the state Department of Regulatory Agencies, or DORA. The law directed DORA to set education standards and rules for when midwives could and could not provide care, as well as a disciplinary process for when they broke those rules. The law also protected doctors and nurses from liability for a midwife’s “mistakes.”
It was a victory, but an imperfect one. The resulting rules included several restrictions: Midwives could not care for pregnant women with diseases such as diabetes, sickle-cell anemia or hepatitis. Midwives could not suture. Midwives could not administer common pregnancy-related drugs. Midwives could not deliver breech babies or twins.
The legislature also set a date — July 1, 1996 — to review the law and decide whether it should continue, in accordance with Colorado’s sunset process. The 1995 sunset review report, written by DORA, illustrates that the attitude toward midwifery in Colorado was still hostile. Even so, DORA recommended that the profession continue to be legal.
Speaking of white women (we were, right?) Delivering Natural Care for Families was aided by COLOR, the Colorado Organization for Latina Opportunity and Reproductive Rights as a “lead coalition partner.” COLOR was also instrumental in getting a law passed banning the use of shackles on incarcerated women during birth. I thought it would be nice to call out COLOR and thank them for the good work they appear to be doing for all the women of Colorado, regardless of subculture size.