RAPID CITY - After watching midwifery legislation fail year after year in the South Dakota Legislature, Dr. Heather Margaret decided it was time to get involved.

The Sturgis physician spoke at the South Dakota Safe Childbirth Options legislative workshop held Wednesday at Canyon Lake Senior Center in Rapid City.

The workshop is the first of four workshops being held statewide in June. The goal of the meetings is to educate people about midwifery laws and the proven safety of home births for low-risk pregnancies, according to Debbie Pease, president of Safe Childbirth Options.

About 40 people attended the workshop, including three state legislators: Don Van Etten, Mark Kirkeby and Tom Brunner.

Margaret, who trained in out-of-hospital births during medical school, has had four home births.

She began her presentation with the analogy of outlawing helmets as a way to discourage motorcycle riding - something viewed as dangerous by some people. She suggested that by refusing to regulate nonnurse midwives - thereby outlawing their participation in home births - the state is essentially pushing homebirth families to go without help from a birth professional.

Margaret said last year, about 20 South Dakota families crossed the state line to have nonhospital births assisted by midwives. Many are going to states such as Minnesota and Montana, which regulate nonnurse midwives.

Others are having their children at home in the state with no professional help. Neither situation is good, Margaret said.

Right now in South Dakota, families have only two choices in birth professionals: physicians or certified nurse midwives who work in collaboration with a physician. Certified nurse midwives, or CNMs, are nurses who also have an advanced degree in midwifery. The South Dakota Board of Nursing regulates CNM.

The law does not specifically outlaw a certified nurse midwife from assisting in a home birth, but the collaborating physician would have to approve such an arrangement. Because of that, there is virtually no chance that anyone in South Dakota can obtain a CNM-assisted home birth.

Wednesday's workshop addressed the second type of midwife: the certified professional midwife, or CPM.

A CPM does not have a nursing degree but is trained in midwifery and must meet the standards of the North American Registry of Midwives, a national certifying agency. Currently, 23 states license CPMs through that organization, according to Ida Darragh of the national agency.

Because the state of South Dakota has no statutes addressing CPMs, they fall into a dicey legal gap. In 2003, Nebraska midwife Margo Wyatt served five days in Pennington County Jail after she was found guilty of practicing as a nurse midwife without a South Dakota nursing license.

Pease said it is the Safe Childbirth Options' intent to address that legal void.

The two bills presented during the 2007 Legislature would have released CNMs from their collaborative agreement with physicians and would have allowed the state to regulate CPMs through the national agency.

Both failed, but members of SD Safe Childbirth Options are hoping the workshops may improve the outcome for next year.

Margaret said she believes if people have statistically accurate information about the safety of home births, they would be more supportive of midwifery bills.

She cited such research and medical organizations as the World Health Organization and the American Public Health Association, which she says find that home births are the safest options for low-risk pregnancies.

A widely-cited study published in 2000 in the British Medical Journal studied 5,000 home births in the United States. The study found that there was no increase in neonatal mortality in low-risk home births, Margaret said.

She also cited the 1998 South Dakota Legislature summer study, led by Rep. Roger Hunt, R- Brandon, that explored midwifery legislation. The committee recommended that the state create a board to certify CPMs.

Darragh of NARM believes it is only a matter of getting that kind of information to the people. "Basically, it's just education. People just don't know enough about this issue," Darragh said. "But if you do the research, you'll see that home birth is a very safe issue for low-risk women."

Although Margaret hopes that people will take the time to do the research, she also hopes people will recognize that home-birth families are not taking undue risks. The majority of home-birth families are educated, informed and caring people.

"They're just practical, rational people making reasoned decisions," she said.

If you go

There are three remaining legislative workshops held by the South Dakota Safe Childbirth Options:

June 28 - 6 p.m. to 9 p.m. CDT, Community Bible Church, Pierre

June 29 - 6 p.m. to 9 p.m. CDT, Aberdeen Wesleyan Church, Aberdeen

June 30 - 12 noon to 3 p.m. CDT, First Evangelical Free Church, Sioux Falls

On the Net:

Click here for South Dakota Safe Childbirth Options online.

Contact Lynn Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com