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Midwife Crisis : Bill Certifying Non-Nurses to Deliver Babies Could Be a Step Toward Ending the Turf War With the Medical Establishment

September 19, 1993|JEANNE WRIGHT | SPECIAL TO THE TIMES

Midwife Lorri Walker suspected there was something terribly wrong about the pregnant patient and her mother who walked into her Buena Park office that day.

They were not the jubilant expectant mother and grandmother whom Walker was accustomed to seeing. These women were nervous, demanding and hostile. Unknown to Walker, one was carrying a gun.

Suddenly, as Walker prepared to examine the patient, the women identified themselves as undercover investigators for the state Department of Consumer Affairs, flashed their badges, handcuffed Walker and told her she was under arrest for practicing midwifery without a license.

"I thought it was all a bad dream," Walker says.

Thus Walker, 33, became a celebrity in the war between midwives and the established medical community in California.

For many unlicensed California lay midwives, Walker's arrest last May at the office she uses in her home when not working at the South Coast Midwifery clinic in Huntington Beach was more than just an embarrassing and frightening experience. It was seen as yet another example of the kind of harassment they contend some midwives have suffered during their struggle to be recognized as legitimate care-givers by the medical community.

But their struggle may be coming to an end. A new midwifery bill recently passed by the California Legislature will be a big step toward resolving the midwifery war by allowing the certification of non-nurse midwives if they meet tough training requirements and aresupervised by physicians.

Until now, only registered nurses with accredited midwifery training were certified in California to deliver babies. They may be employed by a doctor, hospital or birthing center, or work independently, but they must be supervised by doctors. Lay midwives, most of whom have little or no formal training, are not allowed to deliver babies, unassisted, in the state. Midwives such as Walker, who is a graduate nurse midwife awaiting certification, are qualified to assist a certified nurse midwife in a delivery.

Criminal charges were never filed against Walker in connection with her May 1 arrest. After reviewing the evidence, the Orange County district attorney's office decided not to prosecute. Walker has since filed a claim for damages against the California Department of Consumer Affairs, alleging false arrest and false imprisonment.

The bill, which Gov. Wilson has not publicly opposed, would make California the 15th state to allow lay midwives to legally deliver babies.

For years, midwives have lobbied state lawmakers unsuccessfully to ease the licensing restrictions to allow the certification of non-nurse midwives. The California Medical Assn. and other interest groups opposed the previous legislation, contending the education and monitoring requirements for the midwives were too lax.

Currently, there are between 700 and 800 certified nurse midwives practicing in California, Chavez says. The bill's passage could enable about 200 lay midwives to be licensed in the state, said Nancy Chavez, who works in the office of state Sen. Lucy Killea (I-San Diego), who introduced the bill.

Supporters of the proposed measure say it will offer more women--especially low-income women--safe, low-cost, low-tech births as an alternative to having their babies in hospitals. Even women who do opt for hospital deliveries would have the opportunity to rely more on midwives for prenatal care, an important aspect in healthier births.

Chavez noted that while a hospital fee for delivery of a baby could run about $5,000, a midwife's fee for an out-of-hospital birth could range from $900 to $1,800.

"The issue is money, not safe medicine," says Sherry Johnson of the California Assn. of Midwives. Doctors see midwives as a threat to their business, she contends.

On one side, there is a segment of midwives who view arrests such as Walker's as part of a witch hunt waged by the medical community and state regulators. Their intent is to harass midwives who practice legally or illegally outside the realm of physician-oriented medical practices, Johnson contends.

Strict licensing requirements, opposition by the medical community and arrests by state regulators have forced some midwives to go underground and practice secretly, according to Johnson.

On the other side, there are state medical regulators who deny capriciously targeting midwives, and physicians who insist their concern isn't money--it's adequate health care for women and infants.

"Harassment is too strong a word," said Anthony Argil of the California Medical Board. "We are trying to enforce the law . . . put there to protect the public. Whether it was ill-ordered depends on who you talk to."

If midwives are properly trained and supervised by physicians, the medical community welcomes the service they can provide, says Dr. Charles W. Plows, past president of the California Medical Assn., which dropped its opposition to the bill after those requirements were added.

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