Midwifery is an ancient tradition that is present in almost every culture all over the world. The earliest recorded history bears witness to the fact that midwives have played a significant role worldwide. Egyptian hieroglyphics, early Chinese and Hindu writings, and the Bible all refer to midwives.
Throughout history, midwifery has always been separate and distinct from the practice of medicine.
In the 1920s in the United States, physicians began to attend more births in the hospital. By the late 1950's there was a nationwide effort to eradicate midwives. Most states, including Missouri, put new laws on the books strictly regulating or eliminating the practice of midwifery. Fewer and fewer midwives were left practicing.
Thankfully, in the 1970’s there was a revival of midwifery. Most states repealed the old 1950's laws or enacted new midwifery laws. Missouri was one of only nine remaining states in which direct entry midwifery was illegal.
Our Challenges and Perseverance
During the 1980’s and 1990’s MMA presented bill after bill to the Missouri Legislature, usually passing through the Missouri House of Representatives only to die in the Senate under the threat of filibuster.
In 2002, a Legislator in the Missouri House of Representatives, Cynthia Davis from O'Fallon, happened to be on a long flight from Paris, and was seated beside none other than Ina May Gaskin and Robbie Davis-Floyd. They talked all the way home, and Cynthia made legalizing midwifery in Missouri a priority. Starting in 2004, Davis wrote and rewrote bills to help legalize midwifery, consulting and cooperating with MMA every step of the way. It was important that the bill pave the way for all types of midwives to share their knowledge and experience. After multiple drafts, and finally consensus, members of Missouri Midwives Association and Friends of Missouri Midwives (FoMM) joined forces and educated legislators for the entire 2005 legislative session about a bill that would at least prevent midwives from being illegal. The bill passed the House of Representatives Children and Families Committee by a UNANIMOUS YES VOTE, passed the House of Representatives during a vote in the wee hours of the morning, went to the Senate and sadly expired in the Senate General Laws Committee when the 2005 session came to a close.
Missouri homebirth families and midwifery supporters did not give up. They tried again with a similar bill in 2006, but this bill stated that the midwife must be a Certified Professional Midwife. The decision to add the CPM requirement came after many, many hours of debate among MMA Members, resulting in the addition of a "Grandmother clause" for experienced midwives, and a religious exemption. Months of negotiation and compromise ended with a disappointing filibuster by Senator Chuck Graham from Columbia.
The momentum driving the midwifery bills would not stop. As Senator Cauthorn, a midwife-friendly legislator committed to our goals, was term-limited out, Senator John Loudon from Chesterfield took up the midwifery bill. He filed the same bill that had passed out of Senate Committee the year before, but it was filibustered on the senate floor, again by Senator Chuck Graham. The legislative session closed in May 2007 with the passage of a provision to legalize Certified Professional Midwives (CPMs) in Missouri. It was not our ideal bill, but it did legalize the CPMs in Missouri. It reads:
"Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 r-6(b)(4)(E)(ii)(I)."
Finally, Certified Professional Midwives could legally provide services related to pregnancy (including prenatal, delivery, and post partum services).
But, the fight wasn't over yet. The Missouri State Medical Association and other opponents of midwifery in Missouri promptly persuaded a judge to place an injunction against the provision in August 2007. A year later, after the dedicated efforts of the Missouri Midwives Association and it's supporters, the Missouri Supreme Court ruled in midwives' favor, stating: "certified midwives are exempted out of the unlawful practice of medicine under section 334.010."
The Midwifery of Today and Tomorrow
For almost 50 years, midwives were barred from legally practicing in the state of Missouri. Now, homebirth families easily find a midwife to attend their births at home or several birth centers across the state. When transport to a hosptial is necessary, the midwife is able to accompany the mother to the hospital and interact as a professional. When prenatal care requires evaluation and referral to physicians, it can be done in a smooth and timely manner.
Missouri Midwives' Association opposes any legislative action to remove the tocology provision from Missouri law. In keeping with the standards practiced throughout the world, midwifery must be an autonomous profession without the requirement of physician approval in order for midwives to practice within the scope of their training.