I am writing to inform citizens on the state of midwifery in Iowa.

At present, Certified Professional Midwives, midwives who attend the majority of out-of-hospital births, are not licensed in Iowa. 28 states in the U.S. offer a license to CPM’s; 3 of those 28 states border Iowa and the other 3 states which border Iowa have introduced legislation that would offer a license for CPM’s. No state that has licensed CPM’s has ever rescinded that license, and in fact, have found licensing midwives to produce reduced healthcare costs.

The lack of licensure in Iowa means that CPM’s can (and have been) be charged with the felony of practicing medicine without a license. The irony is that midwives who have been charged with such a crime are not being charged because of bad outcomes but rather because anonymous reports from those who disagree with the idea of home birth.

One midwife was prosecuted because a family she served wrote a glowing letter to the editor about their home birth. Their attempt to educate the public and share their amazing story is what resulted in that midwife being charged.

One of the concerns that come up when legalizing CPM’s is talked about is safety, of the practitioner and of home birth. Study after study has consistently shown that home birth with a CPM is just as safe as hospital birth and in some cases, safer. The most recent study, released just this year, surveyed almost 17,000 planned out-of-hospital births. Of all the women in this study, just 5.2% ended up with a cesarean, compared to a national average of 32.8%. In other words, women giving birth at home have a 1 in 20 chance of having a cesarean while those entering the hospital to give birth have a 1 in 3 chance of having a cesarean. 1 That is just one example of the many ways that CPM’s working in home birth settings reduces interventions and healthcare costs.

Another concern that is voiced is that of the education CPM’s receive. CPM’s, to receive the CPM credential, must have 1,350 clinical hours of training and must attend at least 55 births before even applying to take the 8 hour written and 4 hour skills exam.2 Compare this to the birth training of Certified Nurse Midwives (currently licensed in Iowa) who can attend as few as 20 births with 700-900 clinical hours and receive their license.3 CPM’s are required to re-certify every 3 years while CNM’s are required to re-certify every 5 years. CPM’s are trained exclusively in out-of-hospital births while only 3% of births attended by CNM’s happen outside of the hospital.

Right now in Iowa there are 3 bills waiting to be moved on in the Iowa House and Senate. Senate bill SF 2152, sponsored by Senators Boettger and Sodders, has been assigned to a State Government Sub-committee where it rests in the hands of Senators Horn, Danielson, and Smith. If those Senators choose not to put this bill through by the first funnel deadline, which is this Friday, February 21st, this bill is dead this session. Representative Mary Mascher has filed a companion bill in the House, and is HF 2178. This bill has ended up in a State Government Sub-committee and is in the hands of Representatives Watt, Grassley, and Mascher. A third bill, HF 2086, sponsored by Representatives Heartsill, Kaufmann, Pettengill, Gassman, and Schultz, is in the hands of Representative Miller.

These legislators need to hear from their constituents today, letting them know that access to safe midwifery care in Iowa is a priority. They need to be reminded that a Scope of Practice Review, ordered by their own legislative body in 1999, came back in 2000 with the following recommendation: “The Review Committee agrees that licensure for Certified Professional Midwives should be done through the legislative body.” 14 years after that committee review was presented, CPM’s are still not offered a license in Iowa.

Thank you for your time and please, contact your legislators and urge them to license Certified Professional Midwives, the only midwives exclusively trained to work in out-of-hospital settings.

Bethany Gates, A.S., CD (CBI)

Vinton, Iowa

1. http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full

2. North American Registry of Midwives Position Statement, Education Requirements to become a Certified Professional Midwife, updated September 2012. http://pushformidwives.org/wp-content/uploads/2011/09/New-NARM-Requirements_2013.pdf

3. American College of Nurse Midwives, Accreditation Commission for Midwifery Education, Criteria for Programmatic Accreditation of Midwifery Education Programs, Revised June, 2013, Pages 35-36. http://midwife.org/ACNM/files/ccLibraryFiles/Filename/000000003304/Prog%20Criteria%2012%202009%20%28rev%206%202013%29%207%2025.pdf

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Comments (4)

Thanks for sharing this information. When my wife and I were expecting our first child, while living in Oklahoma, we considered our birthing options and felt the traditional medical model of birth wasn't in line with what we'd hoped experience.

For this, our first midwife attended birth, we chose a free-standing birthing clinic with a midwife and on-call physician. The experience was wonderful and without any complications.

Our second child was born at home, in Michigan, with lay midwife who was absolutely wonderful. Caring, patient and understanding. While the first birth experience was very good, it still followed the traditional medical model (birth ought to follow a predictable pattern) and was rushed to the detriment of the patient. However, this, at-home birth, was the epitome of what home-birth is all about: quiet, loving, safe and wonderful.

Not all births need to be treated as medical emergencies and while home birthing isn't for everyone it ought to at least be an option for the people of Iowa.

By: Brad Johnson on February 17th 12:06pm
"Study after study has consistently shown that home birth with a CPM is just as safe as hospital birth and in some cases, safer. The most recent study, released just this year, surveyed almost 17,000 planned out-of-hospital births."

According to the study you linked to for homebirths: "The overall death rate from labor through six weeks was 2.06 per 1000 when higher risk women (i.e., those with breech babies or twins, those attempting VBAC, or those with preeclampsia or gestational diabetes) are included in the sample, and 1.61 per 1000 when only low risk women are included."

According to the CDC Wonder database (wonder.cdc.gov), the neonatal death rate for low risk white women at term from the years 2004-2009 is 0.38/1000.

While 0.38 for hospital births and 1.61 for home births (which you are basically subtracting any and all complications to get the statistic that low) doesn't seem like a large difference, it means that your baby is 4.2X more likely to die during a home birth than a hospital birth. Please explain how a 320% increase in infant mortality is anywhere near safe or safer than a hospital birth.

Also according to your study: "Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period."

So the homebirth death rate for breech was 20/1000 compared to approximately 0.8/1000 (again from CDC's Wonder database) in the hospital. That’s a breech death rate 25X higher (2400%) than the hospital.
By: Chris Michael on February 19th 6:10pm

The trouble with the data (or rather the control factors the website allows for) is that it is taking into account only births in which the babies died after birth. The 2.06% number given from the MANA study included babies who died in-utero, which in this study was 1.30%:
“Of the 22 fetuses who died after the onset of labor but prior to birth, 2 were attributed to intrauterine infections, 2 were attributed to placental abruption, 3 were attributed to cord accidents, 2 were attributed to complications from maternal GDM, one was attributed to meconium aspiration, one was attributed secondary to shoulder dystocia, one was attributed to preeclampsia-related complications, and one was attributed to autopsy-confirmed liver rupture and hypoxia. The causes of the remaining 9 intrapartum deaths were unknown.”

Infections, placental abruption, cord accidents, maternal GDM, etc., these are all things that would have happened regardless of birth place location.

When you look at the numbers the study I referenced gives, “The rate of early neonatal death (death occurring after a live birth, but before 7 completed days of life) was 0.88 per 1000;”-as compared to the database YOU referenced which shows a .91% mortality rate occurring after birth. I did not control for low-risk white women because that is not the only group utilizing the home birth option. Your own web source shows that home births has a lesser rate of infant deaths than those of babies born in the hospital.

I also noticed that you didn’t mention maternal mortality-The Maternal mortality rate in this study was about 6.25 out of 100,000 compared to a United States average of 21 maternal deaths per 100,000 births (http://data.worldbank.org/indicator/SH.STA.MMRT).

It might have helped if you had gone to the website yourself instead of doing a google search and presenting numbers from a blogger who devotes her entire blog to criticizing midwifery and home births. If you run the numbers for yourself, you’ll see that the numbers she presented are inaccurate at best and downright false at worst. It also appears that your web source didn’t want to mention the extremely better outcomes for mothers as it would lead people to research the other information she gave, showing it was false.

Please do your own research. If you don't trust my words, look up the facts for yourself instead of doing a google search and presenting what you read from someone else as facts without actually verifying the accuracy of the claims.

By: Bethany Gates on February 19th 7:22pm
I wrote a response to your reply and posted it as a downloadable pdf on my Microsoft Skydrive account here: http://1drv.ms/1c69Sfi

I found it easier to include proper hyperlinks to sources and images than by trying to post the response directly into this forum. I would encourage you to read it and follow the citations. Thanks!

To the editors: If this is a problem I can certainly reformat it and post here, it would just look really messy and prove challenging to follow along with all the unclickable links in this format.

Editor's note: we will leave this reply on, however, we will note that other replies with this same link, with different web address, tend to make us believe that this may be spam. -V
By: Chris Michael on February 21st 12:40am

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