Physicians sue Missouri over midwifery law

Doctor organizations joined to file a lawsuit after certified professional midwives won independent practice.

By — Posted Aug. 13, 2007

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Four Missouri physician organizations have sued to have declared unconstitutional a law that would allow certified professional midwives to deliver babies without collaborating with a physician.

In July, a state judge granted the groups -- Missouri State Medical Assn., Missouri Assn. of Osteopathic Physicians and Surgeons, Missouri Academy of Family Physicians and St. Louis Metropolitan Medical Society -- a restraining order preventing the law from going into effect on Aug. 28. As of press time in late July, the Circuit Court of Cole County, 19th Judicial Circuit, was expected to reconsider the restraining order on Aug. 2.

In June, Gov. Matt Blunt signed into law a bill to make health insurance more affordable for the state's citizens. The law includes a provision granting certified professional midwives the right to practice independently.

Previously, delivering babies was considered the practice of medicine, limited to a physician or a nurse-midwife working with a physician.

The lawsuit brought by the physician organizations said when the health insurance bill was withdrawn from the Senate floor to incorporate wording for an amendment, an unrelated provision was added. That provision used the word "tocological" (related to the science of childbirth, midwifery or obstetrics), the lawsuit states, and the Senate was unaware of the word's meaning.

The Missouri Constitution states that no bill shall contain more than one subject, and that subject should be clearly expressed in the bill's title. The lawsuit also notes that another bill with a provision clearly addressing midwives' scope of practice failed.

The doctors expressed concerns about the patient safety impact.

David Redfern, MD, an ob-gyn in Springfield, Mo., speaking for the plaintiffs, said the law puts mothers and babies at risk because it does not provide regulation or oversight for midwives. It also allows certified professional midwives to deliver babies without an emergency plan, he said.

"A midwife doesn't have the skills to handle the complications that can happen instantaneously during a birth," said Dr. Redfern, who has testified on MSMA's behalf against previous midwifery bills. He said 10% to 15% of women who deliver at home need emergency transfer to a hospital.

According to the Missouri Midwives Assn., certified professional midwives complete a three-year educational program and must meet certification standards set by the North American Registry of Midwives.

Mary Ueland, spokeswoman for the state midwives association, said certified professional midwives must also participate in 40 births and make individual emergency plans for clients as part of their training.

Missouri Attorney General Jay Nixon declined to comment.

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State actions

Here is what happened to some of this year's key scope-of-practice bills:

Scopes not expanded

  • Hawaii Gov. Linda Lingle vetoed a psychologist prescribing bill. Bills also failed in California, Georgia, Illinois, Mississippi, Missouri, Montana, Tennessee and Oregon.
  • Texas lawmakers defeated a bill that would have let optometrists perform lid surgeries and other procedures.
  • Louisiana's Legislature let a bill die that would have let certified registered nurse anesthetists perform interventional pain management procedures.
  • New York lawmakers let a bill die that would have given oral surgeons without a medical degree authority to perform elective cosmetic facial surgery.

Scopes expanded

  • New Mexico optometric practices can include minor surgeries.
  • Indiana physicians can delegate prescriptive authority to physician assistants.
  • Pennsylvania expanded physician assistants, certified registered nurse practitioners, clinical nurse specialists and nurse-midwives' scope but did not allow independent practice.

Sources: Hawaii and Pennsylvania state legislative sites, American Academy of Ophthalmology, American Psychiatric Assn., American Society of Plastic Surgeons, American Society of Anesthesiologists

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