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Midwives Seek Expansion

By Jason Callicoat
State Capital Bureau

January 17, 1995

JEFFERSON CITY _ Lisa Roberts, director of clinical nursing and certified nurse midwife, will spend the Fall 1995 semester teaching midwifery to the first six students participating in M.U.'s nurse midwifery education program.

Upon completing the program, the students will have earned master's of science degrees and will be eligible to take a national exam to become certified nurse midwives.

Current state law allows only certified nurse midwives to practice midwifery in Missouri. But a bill in Missouri's House would bring some new members into the group allowed to practice midwifery.

The bill is sponsored by Rep. Carol Jean Mays, D-Independence. It would allow midwives without nursing degrees to practice so long they have undergone training and have passed an exam comparable to the one that certified nurse midwives must pass.

The bill to license these "direct-entry" midwives has been introduced and defeated four times in past legislative sessions.

The standardized exam for certified nurse midwives ensures safety, but the nursing degree also is necessary, Roberts said.

``I certainly support (midwives') having a nursing degree and further education in midwifery,'' Roberts said. ``A standardized, approved, accredited exam protects patients, nurses and the public.''

But the training that direct-entry midwives receive qualifies them, even without a nursing degree, to assist with healthy deliveries, Mays said.

``The Medical Association has said from the beginning that midwives are untrained,'' Mays said. ``That's not true. They are highly trained, but not through the usual schools or methods.

``They may be trained through correspondence with a number of schools nationwide with strong curricula and rigid rules and tests. Then they are apprenticed to practicing midwives.''

But the Missouri Medical Association, which represents physicians in the state, maintains that the training is insufficient.

``We still believe the minimum requirements to (practice midwifery) should be the minimum requirements to be a certified nurse midwife,'' said C. C. Swarens, executive vice president of the association.

There are several advantages to choosing midwives as alternatives to physicians, Mays said.

``In Kansas City, a physician charges $3500 for a birth, while a midwife may charge $700 to $1,200,'' Mays said. ``Also, obstetrics has gotten to be very impersonal. Midwives can work with the mother and father much more closely'' throughout the pregnancy.

Currently, licensed doctors have a virtual monopoly on this type of health-care service, and this has always been a big factor in the issue, Mays said.

``This is very turf-oriented,'' she said.

But if doctors have a monopoly, it is justified, Swarens said.

``Doctors have a monopoly because that's what they're trained to do,'' Swarens said. ``Lay midwives are not qualified to care for mothers and babies during delivery.''

Even if midwives cannot deal with every last-minute complication on their own, they are trained to take precautions to minimize the risk if complications occur, Mays said.

``Trained midwives know to map out a route to hospital and have a doctor there alerted to deal with any situation that might come up,'' Mays said.

``Also, women with high-risk pregnancies can be identified by trained midwives and are referred to a physician to begin with.''



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