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Lay midwives should not give medications New law gives potentially dangerous drugs to minimally trained home-birth helpers
Kennebec Journal & Morning Sentinel 04/25/2008

In the old days -- by that, we mean the 1940s and 1950s -- childbirth was a pretty cold, clinical and over-medicated affair.

Mothers -- often highly sedated -- got wheeled into a delivery room, fathers paced along an outlying hallway and the doctors (almost all of them men) got the credit for making it all go smoothly, largely because their wishes ran the show.

Indeed, in the language of the time, it was actually doctors who "delivered" babies, not the mothers themselves.

All that changed sometime in the '60s, when male dominance of traditionally female realms began its well-deserved decline. With that pendulum swing came home births, mothers who delivered babies without anesthesia or painkillers and the growth of a population of women whose profession was to assist a mother during childbirth.

These women were called midwives. Their calling was an ancient one that predated the shift to hospital deliveries and their professional organization had been around in one form or another since the 1920s. A large pocket of midwives had survived the shift to hospital births by working with the Frontier Nursing Service in the hollows and hills of Appalachia.

By the mid-'70s, there were 900 midwives across the United States, a number that ballooned to more than 7,000 in the year 2000.

The majority of these midwives were trained as nurses and called certified nurse midwives.

Many have masters' degrees and all of those certified by the the major credentialing organization, the American College of Nurse-Midwives, have college degrees, practice primarily in hospitals and can prescribe medications.

But there's another, much smaller group of lay midwives, who practice largely in private homes. They do prenatal checkups, assist in births and with post-partum care and they largely eschew the high-tech trappings of modern medicine.

These lay midwives are not necessarily college graduates and while they may be credentialed by a number of professional organizations, they do not have the level of medical training of certified nurse midwives. Most of them are trained through apprenticeships, not through formal university-based programs.

And they shouldn't be prescribing medications.

But Maine's almost two dozen lay midwives went to the Statehouse this session and asked for just that -- the privilege of prescribing a group of emergency drugs and other substances.

The Legislature granted their wish and Gov. John Baldacci has just unwisely signed the bill.

Now, lay midwives can prescribe and administer potentially dangerous prescription drugs and other medical treatments.

They can give newborns Vitamin K injections, which if done the wrong way can cause life-threatening bleeding. They can administer oxygen which, if given in large amounts can cause blindness in children.

They can give oxytocin to a mother who is hemorrhaging which, if not monitored correctly, can cause the uterus to rupture.

We have no quarrel with mothers-to-be choosing to be attended at home births by lay midwives. That's a choice they are free to make.

But those lay midwives should practice to their level of education, which does not include the medical background to prescribe medication.

Why the Legislature and the governor just allowed them to go beyond that training remains a mystery. We hope that a future Legislature finds within itself the fortitude to repeal this ill-advised law.

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