This story is extremely disturbing to midwives, fellow consumers of midwifery care and for public health.
- Utah does not require midwives to be licensed and instead relies on a voluntary licensure program. Due to this lax regulation, ElHalta moved from Michigan to practice in Utah after losing her license to practice midwifery in Michigan and having her Certified Professional Midwife certification revoked in 2003 after a wrongful death case was settled out of court.
- The use of prescription drugs such as Cytotec and a vacuum-assisted delivery are out of the scope of practice for a midwife practicing in a home setting.
- The media has stated a HBA3C is an extremely high-risk case that should not be attempted with a midwife at home.
Why is this case important to Mississippians?
Utah's voluntary licensure program is not keeping women and babies safe or protecting the homebirth consumer from midwives who do not follow protocols to ensure safety in an out-of-hospital setting. Similarly, Mississippi law currently does not have any regulations or a licensure process for homebirth midwives. Our homebirth families have no way to check if a grievance has previously been filed against a midwife, if a midwife is competently trained or if a midwife is participating in appropriate continuing education nor do they have guaranteed continuity of care in the event of a hospital transfer during labor. Just as midwives who practice in hospital settings are bound to regulations and high expectations, homebirth midwives should be expected to be ethical, competent, and knowledgeable in order to keep women and babies safe.
Since Utah only requires voluntary licensure of homebirth midwives, it was an obvious choice for ElHalta to move to Utah after having her midwifery license and Certified Professional Midwife (CPM) certification revoked in Michigan. In essence, Utah became a safe haven for a midwife who was left unable to practice in 27 other states requiring the CPM certification. Likewise, Mississippi's lack of midwifery licensure makes it a logical choice for midwives who lose their license in other states, especially since our bordering states all have laws specifying midwifery requirements. In Utah, as in Mississippi, anyone can be a midwife without requirements regarding training, skills, experience or ethics. Sadly, cases such as this one are a result when there is no system in place to "police" women such as this who do not follow proper homebirth protocols.
Vacuum-assisted births and prescription drugs, such as Cytotec, have no place in a homebirth! Especially concerning is the use of Cytotec during a vaginal birth after cesarean. Although we do not know all the details of the mother's hemorrhage, there is much research pointing to Cytotec as a possible cause of uterine rupture in a previously scarred uterus.
Although the media surrounding the ElHalta case states that a homebirth after 3 previous cesareans is too high risk for a midwife to undertake, Mississippi Friends of Midwives believes that HBACs should be a personal decision for each woman to make with informed consent on the pros and cons of a vaginal birth after cesarean and a repeat cesarean. Licensed Direct Entry Midwives in Utah are legally allowed to take on clients with multiple previous cesareans and our organization believes this is an important component to a bill licensing homebirth midwives. Regardless of the details surrounding a woman's specific risk factors, informed consent and informed decision making are crucial to creating a safe environment for an out-of-hospital birth. A midwife's training and experience level should be considered during the hiring process.
This case outlines many of Mississippi Friends of Midwives concerns regarding potential bad outcomes and the unlicensed state of our homebirth midwives. It is a true horror story and we hope never to see a similar set of circumstances unfold in Mississippi. We will continue to lobby our legislators to license our homebirth midwives and hope you will do the same!
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