Midwife Legislation in SC

Legislation has been proposed in SC that would severely restrict and possibly eliminate the option for out of hospital birth in South Carolina.  http://www.supportscmidwives.com  The following letter is what I have written in support of the certified midwives.

To Our Legislators:

 

Re: H3731

 

I am a family physician practicing in Greer, SC.  I have been delivering babies for more than 25 years.  When I started my practice in Greer in 2005, I was approached by one of the certified midwives and asked to see their patients as needed and to be available for phone consultation when the need arose.  I was initially hesitant because I had heard all of the horror stories and been told how these unqualified ladies were endangering moms and babies with their poor quality care.  At that time most of the traditional obstetrical community had frozen them out, but their popularity among patients was growing so cooperating physicians were badly needed.  The attitude of most obstetricians was that if they refused to cooperate, the certified midwives would go away.  However, because the midwives were filling a need their practices were increasing in size.  For those who claimed they were giving the cold shoulder because they were concerned about quality, I did not understand how making access to traditional care more difficult improved the quality of care for those women using the certified midwives.

 

I decided to make myself available to the certified midwives and their patients.  In working with these ladies I have found, quite contrary to my prior perception, that they are well educated in pregnancy and birth.  They are compassionate providers of quality care and they know their limits and when they need help.  They are not bungling, hicks killing moms and babies.  Just because their training process is based on an apprenticeship model, rather than the college model, does not make them untrained.

 

There is no evidence based data that shows these providers of maternity care are dangerous practitioners.  Studies such as this http://www.bmj.com/content/330/7505/1416   in the British Medical Journal have shown otherwise.  While I am sure that those championing this bill will site anecdotal cases, the reality is the only cases  that most practitioners see are the challenging ones, which gives a false impression as to the risk associated with birthing with a certified midwife.  The average practitioner does not see the hundreds upon hundreds of good outcomes.  The NICUs across the state are full of babies whose mothers were cared for by obstetricians.  Every doctor providing obstetrical care has fetal demises, life threatening postpartum hemorrhages, postpartum infections.  There is even the occasional maternal death.  Does this mean obstetricians should be regulated out of existence?  More likely it means that the certified midwives are being judged by a tougher standard than the obstetricians.  If the obstetricians are so much better at providing care to pregnant women, why do they have a cesarean section rate that exceeds 30%, while the midwives have a rate significantly under 10%.  Maybe the obstetricians have something to learn from the midwives?

 

What is really happening is that the certified nurse midwives are providing an alternative for women from the highly medicalized environment of birthing in a hospital.  This option is being chosen by an ever increasing number of women and the obstetricians do not like the competition.  It is amazing that in the Upstate, where even nurse midwives were resisted for many years, all of a sudden they have opened a nurse midwife practice.  Over the last year the Greenville Health System has begun changing their practices so that they are promoting breastfeeding, immediate bonding between mother and infant and a more natural approach to birth.  The certified nurse midwives have been providing this kind of care for many years, while they have been seriously criticized for doing so.  Now all of a sudden traditional medical care is acting like they discovered it and its benefits.

 

The proposed legislation would effectively eliminate these providers of care for pregnant women.  This would be harmful for all parties:

 

1)   Our political leaders should be working to promote freedom and choice for the citizens of South Carolina.  If the certified midwives are regulated out of existence, freedom has been diminished and choice has been eliminated.

2)  It is being argued this regulation is needed to protect women from unsafe practitioners.  However, other than out of context anecdotal stories, it has not been proven the way things are currently being done is harming women.  One thing is sure, because it is happening in other states, if these practitioners go out of business, not all of their clients will go to the hospital.  The elimination of these practitioners will dramatically increase the number of unattended births or births attended by individuals who have no means to easily access the medical system.  If you want to increase the number of injured and dead moms and babies, this legislation will do it.

3)  The American way is the free market and competition, because it makes all parties provide better and less costly services.  The elimination of this option for women will diminish this needed pressure on the hospital systems to provide the best possible care for all patients.  As I mentioned above, we have seen the positive influence these providers have had on obstetrical care in the Upstate.  Do you really want to go back to the way things were?

4)  Today all policy makers are struggling to find means of providing lower cost, quality medical care.  These practitioners are providing quality obstetrical care for a fraction of the cost of traditional, hospital based care.  You should be looking for ways to promote their care, rather than eliminate it.

5)  A significant number of the women who use the certified midwives do so because they cannot afford hospital based obstetrical care.  What are these families supposed to do if this is no longer an option?

 

What is the REAL objective of this legislation?  If the real objective is to eliminate certified midwives, than this legislation will accomplish that goal. The obstetricians will NOT in any way assist them in carrying out their mission.  Several times I have personally been threatened, that I will lose my ability to practice obstetrics as a result of the assistance I provide to them.  You can be sure, the obstetricians will not provide direct assistance to them.

 

On the other hand, if the real goal is to provide the best quality care possible for the pregnant women of this state, than we need to increase the voluntary corroboration between the traditional obstetrical world and the out of hospital midwives.  Both groups have things they can learn from the other.  Joint conferences where real people talk to each other and cases are reviewed will do much more to improve everyone’s view of the other and improve care than will increasing the regulatory straight jacket.

 

One of the major criticisms of the midwives is they wait too long to get help.  Is it any wonder this happens when they meet with such hostility when they try to get help.  The fix to this is to provide easy, friendly access to obstetricians and hospitals.   In our local area this approach has already proven to be very helpful.  It should be expanded and carried out in other areas.

 

I applaud the legislators desire to have safe medical care in our state.  I contend this legislation will not accomplish that, so it should not be enacted.

 

Keith Stafford, MD

Greer, SC

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55 Comments

  1. Nicely written! This is why some call you a midwife in disguise.

    Reply
  2. Christieann Mathison

     /  March 8, 2013

    Dr Stafford…very thoughtful and respectful piece , I truly appreciate the respect and reverence you have for what you do.

    Reply
  3. THANK YOU for writing this, and for supporting the midwives in their work. As someone who has given birth under the care of Linda and Amy, I feel so lucky that this kind of care is available where I live. And as someone who hopes to have a second child in the near future, I can’t imagine what I’ll do if my options are taken away.

    Reply
  4. Thank you so much, Dr. Stafford. I have delivered 2 babies under the care of a midwife you directly support and work with. And I’ve seen you for the required physician visits for both of those pregnancies. Your support means more than you can know. Thank you for coming alongside them (and us as women) in this situation.

    Reply
  5. Jolena

     /  March 8, 2013

    Thank you! I just moved to the state and can’t imagine not being able to use a midwife for my next baby. Thanks for your support.

    Reply
  6. Dr. Stafford,
    Thank you so much for your support and genuine care for women. I have enjoyed working with you and appreciate your no nonsense approach to care. We doulas and midwives thank God for you and your service to our community.

    Reply
  7. Sarah M

     /  March 8, 2013

    Dr. Stafford- I was wondering when you would comment! 🙂 I as well have had a baby with Amy and Linda and you were my physician for a few visits because of that. Thank you for providing seamless care and a supportive environment. Thank you for honoring what truly deserves honor and speaking true, kind words. Blessings!

    Reply
  8. Shannon Milligan

     /  March 8, 2013

    Thank you, Dr. Stafford, for speaking out against this legislation, and bringing to light the true issues at hand.

    Reply
  9. Thank you, Dr. Stafford, for your support for maternal and neonatal health, patient/client choice, and midwifery care! ~ Joelle Ceremy, LM

    Reply
  10. Erin Hicks

     /  March 8, 2013

    Dr. Stafford, thank you thank you! I will be seeing you for my ob appointments during my next pregnancy with Blessed Births. You are my daughter’s ped and I will be coming to your office for my own ob/gyn needs because I am leaving Highlands Center for Women after many years there. They are hostile to out of hospital birth so they are losing a gyn client and you are gaining one! Thanks for all you do to support South Carolina’s licensed midwives and natural birthing mamas!

    Reply
  11. Sue H.

     /  March 8, 2013

    I applaud you, Dr. Stafford, for continuing to be a champion of evidence-based healthcare even when you stand alone from your physician colleagues. You are an integral part of the foundation of midwifery care in the upstate. I only pray you remain able to serve that role WHEN this legislation is removed from the table. Thank you.

    Reply
  12. Tiffany Oliver

     /  March 8, 2013

    THANK YOU sooooo much for writing this!!!!
    I am 1 of 4 babies my mother had with the help of a midwife!! We were all born without assistance from a hospital at all! And I have always wanted to have my children the same way! Brilliantly written, sir!! 🙂

    Reply
  13. Leah M

     /  March 8, 2013

    Yes!!! Thank you!!!!

    Reply
  14. jkkyker

     /  March 8, 2013

    More than four years ago and after delivering four babies in the hospital, I was expecting my fifth and seeing you for my prenatal care. I expressed to you that I’d always wanted to have a homebirth and you told me that I should do it. I worked with a midwife whom you support and it was such a wonderful decision. She has since delivered my sixth baby as well and I feel so thankful for the excellent care that I received from her, as well as the support and encouragement from you. Thank you so very much for understanding how important it is that we maintain the freedom to make choices such as these for ourselves and our families. This is the main reason that we are so thankful to have you as our family physician!

    Reply
  15. Icie Graff

     /  March 8, 2013

    Thank you!

    Not having choices is a scary place to be, and I applaud your efforts to make these birth choices available to women. I wish you success.

    Reply
  16. Cinda

     /  March 8, 2013

    Thank you Dr. Stafford for ALL that you do and the care with which you do it. You are a gift to our community!

    Reply
  17. Scott Miner

     /  March 8, 2013

    Excellent response to this legislation. And thanks for your honest eye and real care for the concern of others.

    Reply
  18. Lee

     /  March 8, 2013

    This is one of the reasons why I choose you as my doctor sir. Thank you for all you do and making the care you give affordable.

    Reply
  19. Heather Overstreet

     /  March 8, 2013

    Dr. Stafford,
    Thank you so much for standing in the gap and being an advocate for the rights of mothers. We need more good men like you. I was priviledged to have you deliver my first baby girl four years ago and to have you as her peditrician for the first year of her life. I was also blessed to deliver my next two baby girls with Amy Leland at Blessed Birth. I have been incredibly thankful for the care I have recieved from both of you. I will be praying for your continued success as well as the continued success of good midwives in the area. Again thank you and God bless!

    Reply
  20. Great stuff, thanks doc!

    Reply
  21. Rachel Clark

     /  March 8, 2013

    As an aspiring CNM I am glad there are docs out there like you!!!!! Let’s all oppose this legislation together!!!!

    Reply
  22. Kristen

     /  March 9, 2013

    Thank you, Dr. Stafford! We love you as our family doctor and while I’ve had 3 wonderful out of hospital births, you’d be my first choice for an OB if I needed a hospital birth! I recommend you to all my friends because of the quality care and balanced thinking your practice represents.

    Reply
  23. Thank you Dr. Stafford. You are truly an advocate for women and we appreciate all you do .

    Reply
  24. Very nicely written. I had a natural water birth at Covenant Birth Center (shout out to Lisa && Alex!!) with my son. When asked about the experience, I ALWAYS tell the inquirers that I couldn’t have imagined having my birth any other way. It nearly brings me to tears to even think about the possibility of me and my fellow mommas not having the option to birth the way our bodies are intended to. Before there were doctors, there were midwives and I love how you highlighted the fact that physicians have essentially inherited the practices of midwives and claimed rights to them.
    I have been very inspired by this article and I want you to know that you have a large community of mommas (and daddies!) who are encouraged by your boldness and who stand by you 100%!!!

    Reply
  25. Mandy

     /  March 9, 2013

    Thank you, Dr. Stafford. You do honor to your profession.

    Reply
  26. Thank you for your well written article. I appreciate your clear explanation and the factual data that you reference.

    Dr Stafford and a doula helped us deliver our son naturally at Greer Memorial almost a year ago. He was excellent. We had a great experience! Keep up the good work!

    Reply
  27. Marjorie Dannelly

     /  March 9, 2013

    I should mention first that I have spent some time working with young patients in pediatric physical therapy. My late husband & father were physicians. I am a 64 year old woman for whom stepping outside the box of the conventional has often been appealing & rewarding. However, I have seen the sad result of a friend’s “midwife assisted” birth gone wrong & it is not pretty … a child facing a life with severe disabilities …. in this particular case, certainly, would have been avoided had she been delivered in a hospital setting. Hopefully, your opinion about this matter, as a physician, is not common. I believe this position is dangerous & foolish.

    Reply
    • Shelby

       /  March 25, 2013

      I am sorry that your friend has suffered this however, that is a choice the mother makes as possibly taking some risk. This is just as you take on risks at the hospital. I feel this is a personal choice. You do not have to choose it but i feel it should be an option for women who do not want to be FORCED to obey things inside the hospital.

      Reply
    • Marjorie, I too have a friend whose child has life-long debilitating disability due to birth attendant error. However, her son was born in a hospital under the care of an OB. Does that mean I think the setting was the problem? No. I personally know the doctor & he is steller, kind, thoughtful and he still made an error in judgement. Another friend’s baby died 24 hours after birth- again, in a hospital- despite all the best care they could offer– and they still don’t know why. Birth isn’t safer than the rest of life. We can’t possibly predict or foresee, and no human has perfect judgement every time– we just aren’t God.

      Reply
    • Olivia

       /  December 19, 2013

      Not everything can be prevented in a hospital. To assume so is foolish. More babies and mamas are injured or die at the hands of doctors and where is the press about that? What you refuse to see are the scores of healthy, protected mothers and babies walking around who were born peacefully at home. I only wish women knew the great risks they take when walking into a hospital–a place where they are often coerced into interventions, where the mother-baby dyad is not respected, where the fear of litigation rules decisions. Women are treated as if they can’t possibly know what is good for them. Whether or not you would choose a midwife for yourself is not the issue. The issue is that ALL women deserve to choose who they will have attend the birth. We are perfectly capable of making those decisions.

      Reply
  28. Chad

     /  March 9, 2013

    Dr Stafford thank you for speaking out for personal freedom on this issue. My wife and I recently moved just across the border in NC due to work but wish we had stayed on SC side because of this issue. It seems to us that money and control is what drives the major opposition to midwifery in many cases (though no doubt some truly think it is dangerous)

    Reply
  29. Thank you!! During my first pregnancy with Amy and Linda I saw you. I had a severe cervical infection (not, there fault, I ended up in the hospital during labor). My OBGYN refused to see me because I switched to a midwife. They told me I could return 6 weeks postpartum. I was in so much pain I could not get out of the bed without help and you suspected appendicitis. What would I have done without you? The emergency room? Thank you for supporting Upstate midwives and families! You are a true blessing to this community.

    Reply
  30. Kim Coleman

     /  March 9, 2013

    Dr. Stafford, it sounds like the women are the Upstate are truly blessed to have you as an advocate. We need more doctors like you realize that they aren’t loosing patients, but that they are gaining colleagues (with whom they can collaborate for even better patient care) and gaining a whole new set of clients who are thankful to find a doctor who respects their freedom of choice. Keep up the good work, and thank you for your support.

    Reply
  31. Reblogged this on Ripe-tomato.org and commented:
    Think midwifery is tough in UK. Take a look at South Carolina.

    Reply
  32. My wife and I had two in hospital with OB, two at birthing center with midwife in and four at home with midwife.

    Without question, the best care that my wife received was from our midwives.

    Thanks for the great article and for your support of midwives.

    Reply
  33. As a NICU nurse, my first thoughts on midwifery are negative…I’ve seen a couple too many “gone bad” midwife cases in the NICU. But contrary to my training, I see the truth in what you have written. The NICUs are NOT full of home births and birthing center babies that have received deplorable care at the hands of midwives. We ARE, however, full of hospital births…whether it is a baby born at 23 weeks or one born at 42 weeks. No matter what the cause, it is sad to see a baby who will have lifelong disabilities because of a mistake. But for every case we see, there are hundreds that turn out healthy.

    This legislation may seem a positive way to prevent the occasional “home birth gone bad,” but what is it really preventing? What is it fundamentally doing? It is stripping women of the ability to choose, based on principles and informed decisions, what they feel is the best option for their delivery. And if our rights are impinged upon by this legislation, what is next?

    Thank you, Dr. Stafford, for helping bridge the gap in healthcare and for standing for the rights of primary care providers in South Carolina.
    -Sincerely,
    A NICU nurse in training for Nurse Practitioner

    Reply
  34. Sharron

     /  March 9, 2013

    Dr. Stafford, thank you very much for your expert opinion. Also, for sticking your neck out for the women who would like an alternative to the highly technological world of the American hospital. I speak from experience, having birthed two children into the sterile world of the hospital, and two at home with a woman Dr. who chose to do home deliveries. The births all went well, biologically, but the stress level for the last two was much lower. I have no doubt that many midwives not only have sufficient education, but, many have the actual experience of having a baby. No male OB has had that experience to guide him. History: Probably most of the billions who have ever lived have been birthed at home or in a place more similar to home than to the modern hospital. Hospitals are wonderful places for those with triplets, or some health challenge that may need the more extensive expertise and equipment.
    We are daily losing the ability to make individual choices in this country. I pray that many more will stand up for this life-affirming right to choose!

    Reply
  35. Salem

     /  March 9, 2013

    Thank you for standing up for women’s ability and freedom to make informed choices.

    Reply
  36. Irina

     /  March 11, 2013

    Brilliantly written! I love the seamless care that I receive from Linda and Dr. Stafford during both my pregnancies and its a blessing to see a symbiotic relationship that both parties respect, trust and appreciate.

    Reply
  37. H. J. Colacino

     /  March 12, 2013

    Thank you for helping my friend Keri Shadden and her daughter Rose. More choices should be available to everyone. I’m glad you support this one.

    Reply
  38. Grace Olvera

     /  March 21, 2013

    Thank you, Dr. Stafford for supporting home birth and birthing centers and recognizing that certified midwives make the best birth attendants for women with low risk pregnancies. I am so glad I had two home births with two different midwives who were wonderful. Thank you for the service you gave me when I considered another home birth for my fifth child.

    Reply
  39. Liz

     /  April 22, 2013

    I’d really like to see your take on some posts by a woman who blogs under the “skeptical OB.” I think the woman has a point but she is so abrasive and militant it’s hard to see her true point.

    Reply
  40. Amen! Thank you so much for writing so clearly, truthfully, and wisely. Wonderful points and of course, I hope it is well and widely read. If only all doctors could be more like you – seeking for the welfare of the patient(s) above all else. I applaud you!

    Reply
  41. Thank you so much for writing this. If only more doctors could see things as you do, that is about freedom of choice and increasing safety for women and babies. You sound like an amazing man and docotr.

    Reply
  42. Dr. Stafford, it seems the more things change the more they stay the same. I had a home delivery with a nurse-midwife in 1983 in Columbia, SC. I chose a home birth after being traumatized by the Charleston Navy hospital with my first child. I gave birth to a 10.6 pound baby boy with no complications. I was also a representative on the SC DHEC Lay midwifery advisory board. I was educated, in good health, and had a wonderful midwife. The day my third child was due I ended up in the hospital due to a placenta Abruptio. When the doc on call saw that I had planned a home birth he turned to me and said, “Well maybe this will teach you a lesson”. Like I said, things haven’t changed in the last 30 years. Women continue to be told what is best for them by a medical system that does not meet their needs.

    Reply
  43. I wish North Carolina would change their views on home birth and CPM’s. As a doula working in hostile hospital environments, I tire of being viewed as a “crazy natural birth lady” when really we’re just there to help mom feel like she has some control over what’s happening to her. Birth in this country is in a sad, sad state. Thank you for being an open-minded and responsible physician!

    Reply
  44. THANK YOU!!! I had my first child in the hospital under midwife care (CNM) and it was wonderful. No c-section or meds despite a tricky posterior presentation, “non-progressing” labor for 24 hours, and a 45 hour total labor. Perfect baby girl. Excellent care & helpful support. We thought that was as good as birth got! Then I had my son in a birthing center with an LM, and wow. Even my husband was impressed at the level of care & support we received as the only patients there. Despite using less technology, my midwife seemed even more in touch with what my body was doing and what I & baby needed. I also LOVED not having anyone pressure me to do anything I didn’t want to do. 6 hr labor in the water, 10 lbs 5 oz boy born in 2 pushes with no tearing. No one around that we didn’t know & trust. Slept in our own bed that night. It was beautiful. I hope the next one will be a home birth!

    Reply
  45. Doctor Stafford, I delivered with Labors of Love and saw you before the birth of my firstborn. Your manner and treatment restored my faith that there ARE good doctors in the world. THANK YOU for not letting fear hinder your voice and for supporting quality care for moms, like myself, who would have most certainly found a traditional hospital setting quite traumatic and frightening. THANK YOU! THANK YOU! THANK YOU!

    Reply
  46. Thank you so much for writing this.

    Reply
  47. Olivia

     /  December 19, 2013

    There is a huge difference between certified nurse midwives and certified midwives. I hope you are really referring to Certified Professional Midwives (CPM) who are licensed by the state and use the apprenticeship model. Your choice wording has an impact. Please check which group is trying to be eliminated.

    Reply
    • Sara Smit

       /  December 19, 2013

      I’m an old, old lady, who delivered 5 children, “naturally”…and I’d take an experienced midwife aided home delivery, any day.
      Certification is irrelevant to proficiency. Look at all the licensed drivers who drive horribly, and certified teachers that are atrocious. I disagree that someone has to have a full fledged nursing degree to be a great midwife. A mother & father to be should be very careful about who they choose, of course. But, it seems to me that one of the sins of modern medicine is to monopolize healthcare, cutting off all but a very few “elites”…

      Reply
  48. I like the helpful information you provide in your articles.
    I’ll bookmark your blog and check again here frequently.
    I’m quite sure I’ll learn a lot of new stuff right here!
    Best of luck for the next!

    Reply
  49. Hannah Moon

     /  September 5, 2014

    Hello Dr.Stafford,

    Thank you for writing this.

    I am moving to the area soon and would like to know if you could give me some midwife recommendations.

    Thanks so much.

    Reply
  50. Rose Dawson

     /  September 9, 2016

    I would say more people would choose to birth in hospitals if they weren’t doing things against the mothers consent such as testing that leads to social workers stealing babies the day they are born. If a mom comes in with nothing but marijuana, a natural herb, they get crazy baby snatching state workers after their children for the adoption chains. I think this is another factor that leaves some moms especially addicts not wanting anyone touching them for the things they need help with are not kindly given. Instead, they work against the mothers for the state to remove their child or take them through more state funding grabbing organizations and courts. I would say as long as the baby comes out healthy, leave them alone. And they should quit stealing blood as a requirement too unless the patient shows signs of illnesses. It should be with consent and with consent only to test them and their baby. They quite frankly aren’t even necessary if a woman could have unattended births why should the hospital get to ruin her chances at mommyhood. I can’t understand why they take it upon themselves to ruin peoples lives instead of just giving them counseling and helping in positive ways. After all we know, weed has never killed anyone. The other drugs, I can’t speak for but I know prescription pain killers cigarettes and booze killed my friends baby as she had a miscarriage on all legal governed state owned products. So how can the public explain how this is ok? They’ll let a pregnant woman have all those harmful manmade products, and miscarry, but not marijuana? I mean how safe are the prescriptions by people in lab coats and the legal substances apparently much more toxic than weed? I would say these people in hospitals wouldn’t mind if mothers miscarried BC off of their legal drugs, but of course trying to steal a mothers kid only happens when a baby lives and something illegal like weed is in their system, so they are then a hospital profiting off a bunch of bs. OB-GYNS are highly dangerous for pregnant moms, I heard of two miscarriages this year after two of my friends went and seen them. I’d like those OB’s to explain those miscarriages and how my baby lived with no testing and a midwife and no drugs to push my baby out? I’d love for OB-GYNS to produce documentation of how many miscarriages happen after doing their procedures on pregnant mothers. I will say this, babies die with OBGYNS frequently and they don’t put them on the news as they would a midwife and the parents who lost their child in a home birth. The truth is you OBGYNS are notorious for covering up the bs and deaths you cause so frequently, acting like it was just some kind of “medical error”.

    God bless all midwives for safely delivering babies.

    Reply

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