Panel sits on midwife bill

By Mary Garrigan, Journal staff | Thursday, February 15, 2007

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Despite a creative media campaign featuring a hugely pregnant woman urging lawmakers to PUSH! HB1267, a bill that would allow certified nurse midwives in South Dakota to practice more independently and to attend home births failed to emerge from the House Health and Human Services Committee on Wednesday.

HB1267 would have eliminated the written collaborative agreement with a physician that is now required of all nurse midwives in order to get a license to practice in South Dakota. Current state law restricts nurse midwives, who are registered nurses with advanced training in midwifery, from delivering babies at home.

Those written agreements are hard to come by in South Dakota unless the nurse midwife is employed by the physician's practice, according to Sarah Coulter Danner, a certified nurse midwife who is the director of nursing at Oglala Lakota College on Pine Ridge Indian Reservation. They are non-existent for any nurse midwife who wants to do home births.

"It's difficult to find a physician to sign for you if you are not employed by their group," she said.

Those restrictions help explain why just 21 of the 6,000 nurse midwives in the United States are licensed to practice in South Dakota, Coulter Danner said.

"I think so few of them are in South Dakota because it's an unattractive place for them to practice because it is so restrictive," she said.

That shortage not only hampers women who want trained professionals to attend their home births; it also limits other health services to women.

"It really limits the access to care for women in some areas of the state," Coulter Danner said.

She would welcome the opportunity to deliver babies or provide Pap smears, breast exams and other women's health care, but is hampered by the need for a physician's agreement. She has practiced midwifery in New Hampshire, Ohio and Massachusetts, none of which require nurse midwives to have a physician's agreement. The American College of Nurse Midwives opposes the requirement for written collaboration agreements with physicians.

Coulter Danner said the demand for home births is growing across all socio-economic groups, and legislators who voted against HB1267 are only causing the kinds of dangerous, unattended home births they want to prevent.

"We know of families who are having home births with no one present," she said.

Another bill that would license and regulate certified professional midwives in South Dakota was rejected 28-42 Wednesday in the Legislature. Professional midwives are not registered nurses and do not necessarily have medical training.

Rep. Roger Hunt, R-Brandon, offered HB1207. He said South Dakota is one of just 11 states without such a law.

Hunt added that there are many women who do not want to have their babies in hospitals. Professional midwives could help those women, he said.

"Many of them do not have insurance, and all they want is the opportunity to be able to have their children born at home," Hunt said.

Opponents, however, said giving birth can have many complications, and certified professional midwives who largely gain experience by watching women have babies do not have the education and skills needed to cope with serious problems that can occur.

"Although childbirth is natural, the opportunity to observe a natural childbirth does not give you any skill in dealing with complications of child birth," Rep. Don Van Etten, R-Rapid City, said.