Bill would put new limits on Utah midwives

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Posted: 5:01 PM- For the second year in a row, Sen. Margaret Dayton is sponsoring a bill that midwives claim will put them out of business.

Dayton, a former labor and delivery nurse, said Thursday her intent with SB93 is not to eliminate home births. Instead, she said, she and the Utah Medical Association want to stop midwives from attending "high-risk" pregnancies that could result in the harm or death of baby or mother.

The bill would put new limits on direct-entry midwives, who are licensed and attend home births. By defining a "normal" birth, it bans them from administering to women with a host of medical conditions, from diabetes to hypertension.

They also would be stopped from assisting women whose babies are breech or who want a vaginal birth after a previous cesarean section (VBAC).

Ann Deneris, a certified nurse midwife who works in hospitals, said she supports both the bill and a mother's right to deliver at home. She pointed out discrepancies in the law that bar her from attending breech deliveries or VBACs without doctor assistance, but allow midwives to do it at home.

"I am in support of women to deliver at home," she said, adding, "I'm passionate about the safety and well-being of mothers and babies," she said.

But a dozen or so women at Thursday's committee hearing opposed the bill, concerned it would severely curtail their right to choose an unmedicated, home birth.

"For the rest of my children, I'd like to have them at home," said Heather Farrell, while holding 8-week-old Asher, whom she delivered in her living room. "I'd like to protect my right to do that."

The bill passed the Senate Health and Human Services Committee 3-2 on Republican-Democrat lines. Sen. Scott McCoy, D-Salt Lake City, objected it would "essentially eliminate any kind of home birth." The midwife community - there were 16 licensed direct-entry midwives as of June - supports parts of the bill. Midwife and registered nurse Holly Richardson said they don't want to deliver women with HIV or pulmonary disease. But she said other portions of the bill - including one stopping them from attending women with a history of babies weighing less than 5 1/2 pounds or more than 9 lb. 14 oz. - would eliminate 90 percent of their practice.

The Utah Medical Association disputes that, saying midwives would be excluded from 10 percent of births.

Midwives also want to continue delivering twins, babies who are breech, and certain VBACs.

Direct-entry midwives have cared for 334 women since 2006, when the state started licensing them and tracking their outcomes. They have delivered six breech babies, three sets of twins and 17 VBACs.

Just one of those women went to the hospital, according to state-mandated reviews. The reports, written by Richardson, deem the outcomes of those complicated births "excellent."

But Deneris said 1 percent of VBACs will result in a rupture of the uterus, which could kill the mother and baby without immediate surgical care. "Do we need to have a bad outcome to change the law?"