Another Perspective, Support for the Midwifery Bill with Diana Snyder
[This is also an episode of Friday Free Talk on The Tranquility Tribe Podcast on iTunes. Listen here.]
Hey Tranquility Tribe! Thanks for joining us for this episode of the Tranquility Tribe podcast. Last week, Hehe talked to Joyce Hunt-Kimball about Bill H. 1189, more recently drafted as H. 4655, about why she opposes the bill and the impact that it could have on women’s health. Today, Hehe is speaking to Diana Snyder, who is a strong supporter of the proposed bill.
Who is Diana?
Diana Snyder is a healthcare attorney who graduated from BU school of law in 2011 with a focus on the intersection of healthcare and women’s rights. After she graduated, she moved to California, where she practiced for four years. During her time in CA, a friend who worked in a hospital asked her for legal advice on forced compliance issues that she had observed in her workplace, including forced cesareans and forced inductions. This conversation with her friend inspired Diana’s passion for advocating for women who had faced moral and ethical issues at the hands of their doctors, particularly their ob-gyns. Since then, she has spent a large amount of her time using her legal skills to assist women in lawsuits against doctors who had subjected them to non-compliant care.
Diana began thinking about starting a family, but she knew that she would not be comfortable in a hospital after she had learned about the experiences of her clients. She began to start exploring the idea of home births, and after doing some research she was surprised that more women didn’t consider home births as an option. She was especially impressed by the amount of information about and access to midwife care as well as the prevalence of birth centers in California. As Diana explains, this access was largely made possible by the regulations surrounding midwifery in California.
After relocating to Massachusetts on short-notice, Diana had to restart her home birth research, and she quickly realized that the home birth landscape in MA was drastically different than that in CA. She found very little transparency, no data, and zero independent birth centers, which in turn made it difficult for her to find a midwife and a prenatal provider who would coordinate with her midwife. Frustrated by this experience, Diana joined with midwives and other lawyers to support legislation surrounding midwifery practice in Massachusetts.
What changes would Bill H. 4655 make?
At present, certified nurse midwives (CNMs) who hold a bachelors in nursing and receive a graduate degree in midwifery are the only midwives licensed in Massachusetts. Because there are no other relevant statutory laws regarding midwifery in the state, basically anyone can set up shop and call themselves a home birth midwife. This means that for individuals who work as home birth midwives in MA, there are no minimum education requirements, no minimum credentials, and no transparency or accountability, making it more difficult for consumers to find information about their home birth options. Even practitioners who have had their license or credential revoked can still practice in Massachusetts, without being required to give any information about their background to consumers.
Bill H.4655 authorizes the formation of a board of midwifery to issue licenses, handle complaints, and promote self-regulation and transparency within the home birth profession. However, the bill does not only benefit consumers; it would also provide protection for midwives. Under the current system, if a certified professional midwife (someone who completed an apprenticeship with a midwife and then sat for the certification exam) became involved in a legal battle, their lack of licensing could work against them because they would be held to the standard of other practitioners, such as nurses and doctors, who are licensed. The creation of a midwife licensing board in MA would legitimize the important work that home birth midwives do.
In order to preserve the voice of midwives in Massachusetts, the proposed licensing board would be an independent board under the Board of Public Health, just like the Boards of Medicine and Nursing. It would consist of a majority of CPMs to make sure that midwives are not outnumbered by another group that may have different interests in mind. As is standard, the board would also have at least one doctor, which is especially important for discussing safe home birth transfers. In addition, the board would have a nurse midwife to and a consumer rep to provide other important viewpoints on the topics surrounding midwifery.
By ensuring that all midwives in Massachusetts are licensed, the proposed bill would also help protect moms and babies by making it easier and safer for midwives to collaborate with prenatal and emergency providers rather than feeling forced to do their work under the table. This increased communication between midwives and other practitioners will allow women to obtain supportive prenatal care and make emergency transfers less dangerous to perform for all parties involved.
In addition to improving safety, the new bill would also increase the transparency and accessibility of home births in MA. Mandated licensure puts in place an infrastructure that will help decrease the stigma surrounding home births and allow midwives to no longer be forced to practice underground. This enables more information about home birth to be collected and circulated, making it easier for people who are considering a home birth to do as much research as they need. Furthermore, while the bill does not mandate that care from a midwife be covered by insurance (which is typical for this kind of bill), the ACA has a clause that requires insurance companies to cover care from any licensed provider. When all midwives are licensed, public state insurance will have to begin covering midwife care, which in turn will put pressure on private insurance companies to do the same. This will allow more women to be able to access care from a midwife if they choose.
As Diana explains, the proposed bill does not contain a protection clause for midwives because it is not necessary. The bill contains no bans on home births at all and because the board is made up of a majority of CPMs, there is little risk of the freedoms and views of home birth midwives being restricted.
While this bill has been around for three decades, it has had difficulty being passed previously because many were worried that it would limit the practice of midwifery. However, many changes have been made to the bill in the hopes of helping it pass. Most recently, similar bills in other states have been analyzed to assess their pros and cons, and bill H. 4655 has been adjusted accordingly to put an infrastructure in place while avoiding any restrictions that could take away a woman’s choice for a home birth. These changes include taking the regulatory body out from under the Board of Medicine and removing all references within the bill to “normal” or “low risk” pregnancy. And these changes were made just in time - with all of the current discussion around women’s rights and freedoms in healthcare and society as a whole, it is more important than ever to ensure that women have access to a safe and supportive birthing process in whatever setting they choose.
If you are interested in getting involved or contacting Diana, visit the Bay State Birth Coalition at baystatebith.org. If you would like to learn more about the bill, you can find it by searching for H. 4655 on the MA legislature website, www.malegislature.gov.
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Written by our Guest Blogger, Kyra Shreeve. She is a Biochemistry, Health Policy, and Music student at Brandeis University.