Regulating midwives

Below is the written testimony I provided today during a hearing for a bill that would essentially sanction home birth midwives in Massachusetts -- some home birth midwives.

Good morning. My name is Tina Cassidy. Some of you may recall that I spent many years here in this building as a member of the Boston Globe’s State House Bureau, covering many of these sorts of hearings. If I learned anything from that experience relevant to the task before me today – it’s do your research, keep it brief, and make your case clearly. So stop me if I fail on any of those points.

First, I wholeheartedly support the concept of what you are trying to achieve with House Bill 2368. Anything that promotes midwifery care – especially out of hospital midwifery care -- is good for women’s health, and the health care system, because better care can be provided for much less. Numerous rigorous studies prove this to be true.

I also support this bill’s mandate that out-of-hospital births be covered by insurance for the reasons stated above. In the UK, the government is actually encouraging more women to give birth at home as part of the National Health System because they, too, understand the benefits of home birth, not just for women but for all of society – and the public coffers.

However, I am dismayed that in an attempt to “allow” homebirths, this bill prevents women from choosing a lay midwife, a person who could have more experience and more knowledge than those who are regulated. That is something I viscerally oppose.

At a minimum, this bill prevents many worthy and wise women from practicing an ancient tradition – a deeply respectable and important tradition as old as human history – a tradition that stopped about 100 years ago when medical colleges in the US began churning out “educated” doctors ready to deliver babies without having ever seen an actual birth. But those male doctors were regulated. The midwives, with millennia of hands-on practice, were not, and they were forced to the brink of extinction, with mothers paying the consequences when that continuum of knowledge passed on from generation to generation was all but lost. Want to know how to naturally deliver a breech baby? Ask a midwife.

I urge you today, please don’t have this bill be referendum on one lawsuit, or one midwife, or one story about a birth that went awry. Sadly, bad outcomes happen with even the best doctors with years of practice and all the technology money can buy. There are fantastic doctors in this room who have said, it’s not whether, it’s when.

When women choose a lay midwife, they often do it with far more research than a woman choosing an obstetrician. I say this from experience – as someone who was a first-time pregnant busy journalist who blindly chose the first OB with an opening for an appointment – and ended up a statistic in America’s unabiding cesarean epidemic, attended by a doctor whose definition of “normal birth” becomes more constricted every year, due to increasingly onerous guidelines and rising malpractice premiums.

For my second birth, I would have been blessed to have any of the certified professional midwives in this room attend the home birth. But the midwife I choose was a lay practitioner, someone I deeply trusted and connected with. She supported me emotionally and physically during an amazing and gentle experience, as well as in the weeks postpartum. It was blue chip care that I was willing to pay for out of my own not very deep pockets.

As she supported me, I am here to support her and others like her. In an effort to allow greater access to midwifery care, please don’t limit it.

Doing such will only drive underground those practitioners who are not CPMs and lead to the persecution of women who choose them.

Finally, please accept this additional written testimony – a chapter on the history of midwifery – from my book, Birth: The Surprising History of How We Are Born. It tells the story of the role that Massachusetts played in the near-final crusade against midwives. I believe if we don’t understand history we are doomed to repeat it.

Thank you so much for your hard work on this important issue.

Tina Cassidy