By Andy Marso
Kansas midwives who say they can safely help women deliver babies without formal physician partnerships made their case this week before a legislative committee.
In a presentation that noted that midwifery dates back to ancient times, Johnson County midwife Catherine Gordon told the House Health and Human Services Committee that more women nationwide are turning to midwives rather than hospitals to help them during childbirth.
“What you’re going to see is a huge change in the U.S.,” Gordon said. “It’s already happening.” But while Gordon said more than 20 percent of babies in New Mexico are delivered by midwives, in Kansas midwives “catch” only 6 percent of the total births.
Several midwives, who are licensed advanced practice registered nurses, said that’s in part because of a state law that requires them to have a signed partnership with a physician. Gordon said formalizing the agreement can be onerous, and Kendra Wyatt, owner of a freestanding Overland Park “birth center,” said some doctors fear use of midwives will divert a steady stream of revenue.
“It’s hard to go to someone who considers you a competitor and say, ‘Sign my agreement,’” Wyatt said. House Bill 2280 would scuttle the requirement that a midwife work with a physician and instead require that any advanced practice registered nurse acting as a nurse midwife have a national certification approved by the Kansas Board of Nursing. The bill has been “blessed” so it is still eligible for a House vote this session.
But Rep. Dan Hawkins, chairman of the House health committee, said it’s “not in play.” The hearing on midwifery was meant only to give legislators background on the topic, as Hawkins reminded the room full of midwives during the briefing. “This is an informational hearing, it’s not a bill hearing,” he said. Several of the midwives who spoke at the hearing stressed that their desire is only to work with women in “normal,” or low-risk pregnancies.
High-risk pregnancies still should be handled by an obstetrician/gynecologist or neonatologist, they said. “The women who develop pregnancy complications are managed either in conjunction with a physician, or if their care became too complex, they were transferred to one of the physicians I worked with,” said Manya Schmidt, a retired midwife who worked at St. Francis Health in Topeka and is now an adjunct professor at Washburn University.
During the briefing, Rep. Barbara Bollier, a retired physician, said sometimes complications don’t emerge until the birth itself. She asked the midwives about meconium aspiration, in which babies inhale a mixture of amniotic fluid and feces as they are born. Cara Busenhart, a midwife educator, told Bollier that her students are prepared for such events, joking that they have buttons that say “Meconium happens.”
In a more serious tone, she assured legislators that her students are trained in neonatal resuscitation. Wyatt said increasing the use of midwives would reduce health care costs throughout the state. Many Kansas counties are without OB/GYNs, which means women must travel far to access them, and Wyatt said cesarean sections and the costly hospital stays that go along with them are less common among women who get their pregnancy care from a midwife.
The savings for Medicaid and the state employee health plan from fewer C-sections could help the state budget, she said. “If truly everything is on the table right now for the budget in Kansas, we have to address certified nurse midwives,” Wyatt said. “It is a solution to your problem. One of the solutions you desperately need.”
Rep. Les Osterman, a Republican from Wichita, was not fully convinced of the cost savings, saying he would expect fewer current C-sections from midwives versus doctors, given the population midwives serve.
“If you basically only do the healthy, your rate’s going to be less,” Osterman said. The Kansas Medical Society, an advocacy group for Kansas doctors that is one of the biggest state’s biggest campaign donors, opposes the midwife bill in its current form.
Andy Marso is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.
