Anti-midwifery legislation pending in Virginia

picture by Voxphoto

Virginia, which is actually pretty midwife-friendly (CPMs and homebirth are expressly legal, etc), has unfortunately had some very anti-midwifery legislation recently introduced into the Virginia House of Delegates. Essentially, they would deny Medicaid reimbursement for any Certified Professional Midwife performing services for at-risk women. Apparently "at-risk" initially included simply being low-income, but due to well-crafted protests from the constituency, that has since narrowed to just cover women seeking Vaginal Birth After Cesarean (VBAC). You can read the full story here, as well as other's (well-written) letters here and here. My own modest addition is below:

Dear Delegate Lohr:

I am writing to you as a Virginia citizen, registered nurse, and certified nurse-midwifery student, as well as a pregnant woman, to first applaud you for your commitment to withdrawing HB 2163. This displays a willingness to make decisions based on information and evidence as well as a sensitivity and responsiveness to the concerns of your constituency that is invaluable. I write secondly, however, to express opposition to bill HB 2167. The spirit and letter of this bills were it to become law, would have the chilling effect of denying safe, legal healthcare to recipients of Medicaid simply because they are low-income. This is unconscionable discrimination, especially since countless studies have demonstrated not only the safety but the superiority of midwifery care to women. (The most recent and rigorous of these is the Cochrane review found here: http://www.cochrane.org/reviews/en/ab004667.html, which ends with the conclusion that midwifery care has superior outcomes even to care that is shared between obstetricians and midwives; thus, it continues, midwifery care ought to be offered to all women. No qualifiers as to income, risk status, or previous uterine scar.)

On the contrary, obstetricians cannot cite hard facts, merely overblown scare tactics, in their efforts to deny women midwifery care and thus retain the bulk of the market share of births. While midwives have historically always worked to improve access to care and women's ability to educate themselves and make choices about their own healthcare, obstetricians have increasingly sought in recent years to restrict their options and suppress their access to quality care. As people of all political and economic backgrounds agree that the time has come for a new era of personal responsibility, a choice such as midwifery care (and homebirth, and VBAC versus mandatory repeat Cesarean) which promises to raise health outcomes, improve satisfaction, lower cost, and provide jobs for hardworking and caring women cannot be savagely attacked by such legislation as is proposed in Virginia. Please withdraw your support for HB 2167, which would only hurt women, midwives, and taxpayers.

Sincerely,

Katie Sullenbrand

Surprise, surprise: the delegate introducing the legislation didn't pluck it out of thin air, or craft it out of concern after evidence that midwifery care was unsafe (which doesn't exist): instead, it was proposed to him by a local obstetrician. Who I'm sure is up nights unable to sleep because of the idea that women are able to make an informed choice about the increased risk of uterine rupture posed by VBAC.

How conveeeeeenient: forcing poor women to undergo mandatory repeat Cesareans, and taxpayers to pick up the tab--while funneling 100% of the profits into the pockets of obstetricians.

They've always said doctors are smart.

If you live in Virginia, I'd encourage you to send an email as well. It only takes a minute!