Virginia HB 2163 and HB 2167 Seeking to Limit Scope of Practice for Licensed Midwives Serving Women Seeking VBAC

Delegate Matt Lohr of Harrisonburg, Virginia recently introduced two bills (HB 2163 and HB 2167)seeking to limit the rights of Virginia women seeking homebirth with a licensed midwife after a prior cesarean section. I recently wrote to Delegate Lohr to ask him to pull both bills. Here is a copy of the letters we have exchanged. They're shown below with the newest one first. My original email to Delegate Lohr is at the end. I hope others will be moved to write to Delegate Lohr at DelMLohr@house.virginia.gov and let them know what they think of these bills.

1/19/ 2009 My letter in response to Delegate Lohr's letter to me

Dear Delegate Lohr:

Thank you so much for taking the time to answer my letter. And, thank you for supporting midwives and homebirth. I would like to take a few moments to respond to some of the points in your letter, as it appears more clarification might be helpful.

Midwives DO practice safely, regardless of any legislation in place (or not in place) to regulate their practice. Time after time, studies have continued to prove both the safety of homebirth and the improved outcomes associated with midwifery care. Midwives were practicing safely in Virginia before the CPM credential was recognized, and they continue to provide evidence-based care and have excellent outcomes now after the passage of the law that allowed for the licensing of Certified Professional Midwives here in Virginia.

VBAC is NOT a procedure. It is a physiologic outcome to a normal pregnancy. This is an important point. Repeat cesarean section IS a procedure, one which carries greater risks to both mother and baby than a normal vaginal birth. I contend that it is repeat cesarean section that should be looked at more closely, and not vaginal birth (with or without prior cesarean section). When serving a woman seeking a vaginal birth after cesarean section, midwives in Virginia disclose the risks associated with both vaginal birth and cesarean birth after prior cesarean section. Consumers use this information, in addition to their own research, when making their informed choice to have a normal vaginal birth at home rather than being forced into having a repeat cesarean section at their local hospitals.

I urge you to consider the options women face with their pregnancy after a prior cesarean section. The two choices are either a vaginal birth or a repeat cesarean birth. That’s it. The bottom line is that cesarean is more dangerous for mothers than vaginal birth, regardless of whether the mother has had a previous cesarean birth. Many hospitals in Virginia have NO-VBAC policies, forcing mothers seeking hospital birth to either have a more dangerous repeat cesarean section or seek a safe vaginal homebirth. If licensed midwives will be unable to legally provide care to women seeking vaginal birth after cesarean section, many will choose to birth unassisted, with friends, or with an unlicensed midwife.

Limiting Medicaid funding to not cover VBAC for Virginia women is discriminatory towards low-income women, who are already at greater risk just by being low income. These women especially would benefit from the extensive nutritional counseling and one-on-one support of a licensed midwife. Outcomes for poor women are greatly improved through midwifery care. So, by denying their right to receive the same care options as other U.S. residents (mandated by Federal Medicaid Law, I believe), Virginia would be unfairly discriminating against an at-risk population by denying them the care they need and rightly deserve.

I agree that there are some procedures that are very risky and that those procedures are best left in the hands of obstetricians, who are trained in the pathology of pregnancy and in the management of high-risk obstetrical care. Cesarean sections, for example, are best left in their hands. However, for women seeking normal vaginal birth, the evidence shows that homebirth with a qualified midwife is as safe or safer than hospital birth with an obstetrician.

Thank you for your help in protecting the interests of Virginia mothers and babies.

Sincerely,
Kim Pekin
Student Midwife
Purcellville, VA
www.gentlehomebirth.com

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1/19/2009 Delegate Lohr's response to my email on 1/16/2009

Dear Kim,

Thanks for contacting my office regarding the proposed midwife legislation.

Throughout the year, legislators meet with hundreds of constituents about issues of importance. Some of those concerns warrant possible legislation. The medical community met with me this year about incidents involving midwives and the safety of mothers and children. I have always supported midwives and greatly appreciate the work they do. I do not support shutting their practices down. This is not a bill to bash midwives. It is a bill to make sure that their practices are done safely.

The first bill I introduced was just a requirement that midwives have full disclosure with patients about their practices and associated risks. This is not directly stated in the code, which is why I introduced the bill. After visiting with the midwife lobby last week…who by the way were great folks…I actually decided to strike this bill because this process already takes place. I found out that part of their licensure process requires that they do this. That bill will be stricken from the docket. I was glad to see that this important step was already being done.

The second bill will be amended. The new amendment will narrow down the scope of the bill. To deter midwives from taking on very high risk deliveries, the original bill said they would be denied funding if they chose to do this. Some procedures are very risky and in my opinion they should be done in hospitals with medical doctors. I met with the midwives lobby last week at length and had very positive discussions. The new bill will only apply to the VBAC procedure (Vaginal birth after C-section). This procedure is deemed unsafe and risky by the medical association. Now, a midwife would only be denied funding if they conduct a VBAC delivery. All other high risk deliveries will remain in place. I am all for choice, but in my opinion certain choices deemed “very risky like a VBAC” should not be taking place in homes with a midwife.

Midwives provide a great service to our society, but I do have concerns over them attempting very delicate and complex procedures that place mother and baby in dangerous situations. I appreciate your opinions on this matter.

Sincerely,

Delegate Matt Lohr
26th House District of Virginia
Room 526
Richmond, VA 23219
(804) 698-1026


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1/16/2009 My initial email to Delegate Lohr about these bills

Dear Delegate Lohr:

As a citizen of the Commonwealth of Virginia, a midwifery student, and mother of 7 children (2 born at home with a Certified Professional Midwife), I urge you to pull HB 2163 and HB 2167 from the docket and to work to help INCREASE access to midwives rather than restrict it. Homebirth with CPMs is as safe or safer than hospital birth. With the outrageously high c-section rates in Virginia hospitals, more than 1 in 3 mothers are having surgical births now, and each of those mothers who have had c-sections are finding it nearly impossible to find a health care provider to support their informed choice to have a vaginal birth (VBAC) for their future births. These women, being very well-informed as to the safety of VBAC, are increasingly finding support for their informed choice through the support of CPMs and are choosing to have their babies safely born at home.

Further, these bills seek to restrict access to CPM care for low-income people. A homebirth with a CPM costs around $3000, and that includes all of the prenatal care, the birth, and care for mother and baby through 6 weeks postpartum. An uncomplicated vaginal birth in the hospital easily costs at least 3 times as much money, and a c-section costs much more. Legislators committed to reforming health care, cutting costs, and improving outcomes support CPM care as a way to meet those important goals.

Midwives and the clients they serve care very deeply about preserving the rights of women to continue to receive evidence-based care and to receive support for their informed choice of homebirth. Please do all that you can to help us increase access to CPM care.

Sincerely,

Kim Pekin
Student Midwife
Purcellville, VA
www.gentlehomebirth.com