Lohr Proposes Midwife Legislation

Emmy -- January 17th, 2009

Delegate Matt Lohr has introduced two bills to the House of Delegates that may limit the practices of Certified Professional Midwives. HB 2163 is an amendment to § 54.1-2957.9. This amendment would require midwives to give informed disclosure to their clients about the risk of home delivery.

The second bill, HB 2167, would require the Board of Medicine and the Department of Medical Assistance Services to review regulations and policies to make sure that no reimbursement is made to Certified Professional midwives who provide services in high risk situations, including high-risk home deliveries.

Now there are some issues to consider with these two bills. The first bill appears to be rather redundant. Midwives are already required to give informed disclosure to their clients about the risk of home delivery and some specific pregnancy conditions. They are also required to give written disclosure of their training, experience and the risks of home birth at the start of care.

The second bill will impact low income women and any woman who wants to attempt a natural delivery after having a previous cesarean delivery. Any woman on Medicaid is automatically considered high risk because of her economic status. So with this legislation she would not be able to choose a midwife for her care. It also forces women who have ever had a cesarean delivery to have another regardless of the necessity. Source: VA Birth PAC

122 Responses to “Lohr Proposes Midwife Legislation”

  1. Jill says:

    I wish we could have the input of the OB who proposed these bills to Del Lohr. After all, they were based on the wishes of one constituent (a constituent who didn’t even know that her first proposal was already part of the midwifery statute, but ahhhh, I ramble).

  2. Brooke says:

    I don’t know which bothers me more, that the OB who requested the measure didn’t do her homework, or that once proposed, Del. Lohr didn’t see fit to do the research on the subject, until he’d already wasted taxpayer time and money drafting and proposing it.

  3. Dave Briggman says:

    And we know a female OB was behind the proffering of this legislation how?

    After reading Matt’s statement, above, you can obviously tell he hasn’t read the facts.

  4. Jill says:

    Matt, I heard from several different sources. Until I have proof it’s basically hearsay, but I trust the people who told me.

  5. Jill says:

    Oops, I meant to address Dave, not Matt.

  6. Jill says:

    Well Brooke, it’s becoming obvious that Del Lohr doesn’t care much about the taxpayers, as passing this bill will force us to fund $20,000 Cesareans for women on Medicaid who would have been perfectly capable of having VBACs at home. Isn’t there anything better that my tax dollars can contribute to?

  7. Lowell says:

    Please excuse me, I don’t mean to interrupt and change the subject but,

    Whoooooh Haaaahhhh!!!!!

    We got us a new President!!!!!!!!

    O.K. You can go back to your discussion. Thanks.

  8. Renee says:

    @Lowell – Yes!!!!

  9. Jill says:

    LOL Lowell! WOOHOOO right back atcha! :)

  10. hello to all-

    thought you all might be interested in the post i just wrote for the state on this topic. find it here: http://vastate.wordpress.com/2009/01/21/of-local-midwives-matt/

    thanks for this oh-so-important discussion.

    -jill

  11. Mom of 2 says:

    I hope Del Lohr will take the time to look at the science and not make assumptions based on what he was told by an obstetrician. I’m actually flabbergasted to read that he would assume it is the responsibility of a legislator to assert an opinion on something which is not within his area of expertise:

    Del Lohr wrote, “Some procedures are very risky and in my opinion they should be done in hospitals with medical doctors.”

    Is this an opinion based on years of research and experience helping women in birth?

    My problem with statistics, and especially the article that Melody cited, is that we have a tendency to take things out of context. We look at numbers and data and think something is either “safe” or “unsafe”. There is no such thing. There is always risk. We cannot make everything perfectly safe. And, as a consumer, I have a right to examine the evidence, do my own research and thoughtful deliberation, and make a decision that feels right for me and my family. That is the bottom line.

    It is an incorrect assumption to state that because the risk of uterine rupture in a VBAC is 0.4% that it would be safer to give birth in a hospital. In some cases, it may be safer. In some cases it may not. You can’t automatically make that leap. If you decide instead to go to the hospital, you will then have a 31% chance of having a C-section (probably even higher for VBACs) along with all of those complications. Hospital births, VBAC or not, carry their own set of risks and antibiotic-resistant germs along with it. You are choosing one set of risks over another.

    For example, there are risks in standard testing often recommended across the board for pregnant women over the age of 35, like chorionic villus sampling, or amniocentesis. These are tests that carry a risk of procedure-induced miscarriage and other complications, tests that are done routinely! CVS also has a risk of causing limb problems in the fetus. That should be a choice that is made with all the information disclosed and all the options and possible outcomes laid out on the table. And the woman should be able to decide what’s the best choice for her situation at the time. Maybe the benefits outweigh the risks for one person and not for another. But a lot of that is going to be subjective. You can look at the science, but in the end I want to have the right to choose what makes the most sense to me. And I shouldn’t have to fight for that or be made to feel that I am making a negligent decision by choosing something different.

    To disclose my background, I have given birth to two children in out-of-hospital settings, I have a degree in public health, I am a certified health educator, and I believe that women can only be empowered by information and access to choices in health care. You can’t make an educated choice when you don’t know what your choices are. We must overcome the notion that we can simply turn the responsibility for our own health over to someone else and expect them to do it all for us perfectly. No one is infallible, whether doctor, midwife, or consumer, but we cannot make choices based in fear. There are many women who will want the option of giving birth in a hospital, and no one would argue that they shouldn’t have that choice. The same should be true for women who choose to give birth out of the hospital.

  12. Renee says:

    Mom of 2, thanks for your valuable contribution to this discussion!

  13. Melody says:

    as to jhumphrey comments on her blog, wonderfully written and well said … I couldn’t agree more with your comments on our fragmented system and the need to build trust between all the parties involved in caring for our system: the mothers, the hospitals, the doctors, the midwives, the nurses, etc …

  14. just for clarification: it is a broken system – not individual providers – that i am referring to when talking about not being able to replicate a “lovely, safe, supported” homebirth here in harrisonburg!

  15. Melaine says:

    It has been very interesting to follow this thread. I’ve been happy to see so much dialogue. Something I’ve wondered about was batted about a good bit at the beginning of the discussion – why would he introduce this legislation in the first place? He assured us it was not money from the medical world but the fact that

    “The medical community met with me this year about incidents involving midwives and the safety of mothers and children.”

    I’m wondering how Del. Lohr confirmed the alleged incidents that prompted him to submit these bills. How was he able to verify that the complaints made by the medical community were based in fact? Was there facilitation of a private meeting of those making the complaint, the midwife/midwives and the mothers involved in these incidents? Seems to me that way everyone involved could have a voice and get the story straight – transparency, right?

    jhumphrey made a great suggestion along these lines…for all parties involved to come to a common table for some real discussion, face to face, to acknowledge a fragmented system and begin the work to fix it, outside of the “incidents” which concern Del. Lohr. As she wrote, all involved share the goal of providing excellent maternity care for women. Can just that be the focus? Could we really get a good sampling of those involved to come to the table, willing to work together?

    And, although Del. Lohr pledged to pull HB2163, it seems as though he has changed his mind and plans to keep his bill. Again, it would be so interesting to learn what he’s hearing that has him digging his heels in so deep.

  16. Renee says:

    I had TLC on while working and ‘A Baby Story’ was on, and I just heard the doctor ask the pregnant mom if she preferred to deliver vaginally if possible, or if she definitely wanted a C-section since she had delivered her first child that way, even though it was likely a C-section could become necessary because of past complications. Reminded me of this thread. It was nice to hear a doctor ask the mother what she preferred.

  17. Matt Lohr says:

    After all the discussion on this thread over the past few weeks, I wanted to give an update on the two bills. Today in full HWI Committee both bills were heard.

    The first bill HB 2163 passed committee almost unanimously. Originally I said I would pull this bill after the midwife lobby told me that the notification practice was already being done. Although information on midwifery is reviewed with the patient, nothing specifically addresses high risk deliveries. This is the intent of my bill….make patients aware that certain high risk procedures or circumstances like VBACS, breech birth, multiple birth, obesity, diabetes, etc are indeed high risk. All of the cases that have gone before the Board of Medecine for review have involved someone who was deemed high risk and probably should have never chosen to deliver at home. It is not restricting their practice…just making sure patients are fully aware if they fall into that high risk category. Even the midwife lobby didn’t fight it…and it came out like 19-1…or close to that.

    The second bill HB 2167 did not report. This one put restrictions on midwives performing VBACS at home. This is a sticky issue…OB’s all say that VBACS are very risky and the procedure should only be performed in hospitals. Midwives say they are find doing them. In reality I suppose the truth is probably somewhere in the middle. The good part of this bill is it has begun discussions and dialogues between the two sides. The advisory board of midwivery is already beginning some good discussions on this topic and I think those will continue.

    I have learned much about midwives and certainly appreciate all the input on these bills. My email inbox has been full with emails these past few weeks. I hope positive discussions continue. Thanks for the chance to share my final thoughts on the issue.

  18. Greta says:

    Disappointment sums up my sentiment toward Matt Lohr’s decisions and actions. For me, his explanations about both the concerns the of “medical community” and the necessity of the bills are insufficient. He flip-flopped on his pledge to pull HB2163. It’s passage was wasted time for our lawmakers who should have had higher priorities. As others have pointed out in this discussion, bills like this represent neither small government nor are they fiscally responsible.

    Consumers and CPMs worked to make information available to him and we shared our concerns and stories. As far as I have known, no mothers who were affected in the “incidents” raised concerns. Neither were there any organizations that oversee CPMs raising concerns. Since there hasn’t been transparency about what the actual concerns have been or who raised them, we are left assuming that a, probably even just one, medically trained person was allowed to bend the ear of our lawmaker more than the rest of us. This person was likely not trained as rigorously in natural birth as the CPMs are. And Mr. Lohr seems to have done little, if any of his own research.

    Midwives do not attempt “complex procedures” at home, as Mr. Lohr said. It is irresponsible of the local OBs to turn down relationships with CPMs so that when there is need, medical attention is given without a past relationship. It is irresponsible of the state to deny CPMs access to substances that make transfers to the hospital safe or even unnecessary.

    As for VBACs, a recent report in USA Today states that doctors tend to underestimate risks related to C-Sections. When I was in labor and trusted the OB to relate to me the risks of a C-Section, I was not told that subsequent births would be high-risk. I had no idea that I would be putting myself or my baby in greater danger in future births. No one asked me if I planned to have more children, and that I should consider that. A bill that addressed issues of information such as this would have affected many more of Mr. Lohr’s constituents.

    Many kudos to Melody, who has been the lone provider to discuss this important topic! She is a caring and honorable provider for sure! I respectfully disagree, however, that VBACs should be in hospitals, since modern techniques for performing C-Sections make vaginal births statistically equal to natural births(as cited in the book, Birth After Cesarean: The Medical Facts, by Bruce Flamm, MD). In making my decision, I surmised that when one considers that increased hospital monitoring during a VBAC labor results in a higher chance of a repeat Cesarean, and that the risks of major surgery are greater than that of a natural birth, (even after a C-Section,) there is statistically more risk of complications for VBAC in a hospital than in a supported out-of-hospital setting. We do need to be aware that certain VBACs carry more risk than others. Unfortunately, no medical establishment can accommodate the fact that not all VBACs are the same.

    I wouldn’t trade my home-birth VBAC, backed by an OB for any amount of money. In fact, I spent thousands of dollars in another state to have the safe, out-of-hospital birth that I demanded. Had I given birth here in Harrisonburg, I would’ve had to transfer to the hospital for stitches for a burst blood vessel and other minor stitches. In TN, my baby and I stayed right in the cabin that I delivered in and received the care that we needed.

    It is patronizing to pass legislation that tries to save mothers from themselves. We can make these decisions because in our day and age the information is out here! We must be empowered to make these decisions because we are the ones responsible to raise our children in the years after their birth.

  19. Mom of 2 says:

    I don’t know if anyone is still keeping up with this or not, but I found some great links here on VBACs, articles and research:

    http://emilyavalon.com/VBAC.html

  20. The Valley Progressive says:

    Lohr,
    Your arrogant sarcasm is well noted, as stated previously you have done little to benefit our community and this bill is yet another foolish attempt at stroking your ego at the expense of the common good. Luckily for us nothing that you sponsor actually makes it very far.

    For everybody else, you obviously don’t understand the economics of a “pay as you play” medical system. The reason why colonoscopies are done in a surgical suite versus a doctor’s office is because they hospital can charge 2-3 times as much for the same procedure. C-sections are the same way folks, now birth becomes a surgical procedure which means big bucks for everyone involved (except the mother). Is it a coincidence that the US leads the world in C-sections by about 10 times? Hmmmm.

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