Risks to practicing midwifery increasing in Minnesota

This article submitted by Linda Stelling on 3/24/98.

More and more people have looked at childbirth alternatives during the last few years. Among those alternatives is home birth with a midwife and birth assistant present. However, that option, which dates back to the middle ages, has been eliminated for many local residents.

Due to failing attempts to update a law from 1908, the risk to practice midwifery in Minnesota is increasing for many nonlicensed midwives. Midwives in Minnesota are legal by statute, but licensure from the Board of Medical Practice has not been made available since the 1930s. The Minnesota Midwivesí Guild (MMG) and Minnesotans for Midwifery, a consumer group, have been working toward change for the past several years. The rules and regulations date back to 1908 and efforts began about 10 years ago to establish new rules.

The Midwifery Regulation Task Force set up by the Board of Medical Practice met from June 1997 through January 1998 to determine interests, position, and to recommend a regulatory model which would be unopposed by the interested parties. The task force consisted of people from the Minnesota Nurses Association, Minnesotans for Midwives Association and Minnesota Medical Association.

In November 1997, the task force was told it would be terminated in a few months if no substantial progress can be made. The Board of Medical Practice informed the task force it was going to the legislature to request they be removed from regulatory responsibility for midwives. Many midwives immediately discontinued practice fearing the removal of the 1908 midwifery law would leave them vulnerable to charges of practicing medicine without a license.

According to Kim Pilgrim of the Minnesota Midwives Association, members of the task force couldnít reach an agreement on various concerns held by midwives. Among the concerns were how the license should be written; the need to have a proficiency exam in place; and the need for consent forms and disclosure.

ďThere is a legal writ in place,Ē Pilgrims said. ďIt is not illegal for midwives to serve families but itís not fully legal either. A legislative bill is being prepared for committee work to change the law and make it legal for certified professional midwives to practice in Minnesota,Ē she said.

Pilgrim explained certified nurse midwives (CNM) are nurses first and midwives second. There are about 120 CNM in Minnesota working in hospitals and clinics. Certified nurse midwives became active in 1972.

ďTo be a nurse midwife, a four year nursing degree is required,Ē according to Claire Nelson, CNM, of the Hennepin County Midwife Service, Minneapolis. ďAdditional obstetric training and experience in a hospital setting are required as well. There are 27 midwife services in Minnesota.Ē

A traditional midwife is also referred to as lay midwives, direct entry midwives, or non-nurse midwives. A key distinction between traditional midwives and certified nurse midwives is that traditional midwives typically enter the profession without prior training or licensing in the nursing profession. They practice outside of a hospital; and a certified professional midwife is nationally certified through tests and apprenticeships but is not always recognized at the state level (varies from state to state).

In the late 1980s, then Rep. Sandy Pappas tried to develop a parentís right bill. ďItís reached an impass,Ē now Senator Pappas, District 65, St. Paul, said. ďA new bill was introduced this year but because it arrived too late it didnít receive any hearings, but it is on the agenda for next year. Hearings will be held this summer to discuss the licensing/regulation issues.Ē Pappas knows first hand about home births as she has had three.

ďThe issue is very difficult to resolve. It isnít a legal profession in Minnesota,Ē Pappas added. ďThe good news is that a couple who has had a home birth can be a more demanding client/patient and they will try to replicate a home birth in a hospital or clinic setting. They are encouraging hospitals to change with the times and offer different birth alternatives.Ē

Related stories:
Local midwife stops practice
Area family wanted second home delivery

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