Direct Entry Midwifery in Ohio ~ A Brief History

From colonial days to the present, Ohio families have been served by community-based midwives helping families birth their babies safely into the comfort and security of their own homes in both urban and rural areas of the state. The practice and profession of midwifery continues to evolve as a result of consumer need/desire amidst the strong influence of modern mainstream medicine and legislated actions in Ohio and across the United States. Direct-entry midwives are the current providers of care to families choosing to home birth.

Below is a recent-history time line of direct-entry midwifery (DEM) activity in Ohio.

OHIO MIDWIFERY LAW HISTORY

June 14, 1988
HB 529 – transfers licensure/regulation of midwives to the Board of Nursing, regulating the practice of nurse-midwifery; all references to “lay-midwifery” were eliminated in the law.

February 1996
OMA alerted to SB 154, an Advance Practice Nursing Bill, being considered in the Ohio House of Representatives containing language clearly establishing an illegal status for the practice of direct-entry midwives. SB 154 had passed the Ohio Senate unopposed by unanimous vote. Problematic language in opposition to direct-entry midwives were:

“No person shall (4) engage in the practice of lay midwifery, which includes the management of preventive services and those primary care services necessary to provide health care to women antepartally, intrapartally, postpartally, and gyneocologically.”

Ohio Friends of Midwives (OFOM), a non-profit, grass-roots consumer organization is established. Their mission statement is to engage in activities/education, etc. to protect and promote midwifery and homebirth as a continued option for Ohio childbearing families.

March 27, 1996
As a result of tremendous consumer telephone calls/letters to legislators, problematic language for direct-entry midwives was removed from SB 154. A Direct-Entry Midwifery Study Council was formed and given the task of studying the practice of DEMs in Ohio and to make recommendations to the legislature as a result of their findings.

November 21, 1996
Direct-Entry Midwifery Study Council, consisting of 1 CNM; 2 Consumer Advocates; 4 Legislators (2 Senators/2 Rep); 1 Direct-Entry Midwife; 1 Ohio Board of Nursing Member; 1 Ohio State Medical Board Member; and 1 OB/GYN began meeting to study the practice of DEMs. The Study Council held 8 meetings, two of which were public testimony. No other issue in the history of the State of Ohio had received such consumer involvement by letter writing, telephone calls and oral testimony being given.

July 1997
Dr. Mahlman and Dr. Catri, Ohio State University, testified at the Study Council hearing regarding the CPM credential instituted by the North American Registry of Midwives (NARM) stating that:

“The Certified Professional Midwife (CPM) program to establish that practitioners possess the minimum competencies necessary to practice, in my opinion, clearly exhibits all the required characteristics of a competency-based program. Regardless of the educational pathway chosen-apprenticeship, postsecondary education, adult education, at-a-distance education, or a self-paced program-student competency attainment remains the objective. The assessment component of the program provides evidence that successful passage of the national CPM exam ensures that minimum competence has been attained.”

March 13, 1998
Direct-Entry Study Council submits report concluding that the practice of Direct-Entry Midwifery should be made clearly legal in Ohio and legal ambiguities on the issue should be resolved to prevent prosecution of direct entry midwives or the parents who choose to use them to deliver their babies.

This recommendation was endorsed by 8 of the 11 council members. Departing from the majority view, council members from the Ohio State Medical Association, the State Medical Board and the Ohio Board of Nursing recommended that DEMs be prohibited unless the midwife can demonstrate competencies, educational preparation and training that is equivalent to a certified nurse-midwife.

September 1998
Ohio Midwives Alliance “Bill Board” concludes the writing of draft legislation to follow Study Council recommendations and begins process of seeking legislative support for the bill.

January 22, 2002
Representative Diana Fessler (R-43) along with co-sponsors, Grendell, Webster, McGregor, Barrett, Carano, Key, Oakar and Sullivan introduce House Bill 477 to create a Midwifery Board to oversee the practice of DEMs in Ohio.

January 22, 2002
CHOICE (Center for the Humane Options In Childbirth Experiences) midwives celebrate 25th anniversary of their Columbus, Ohio midwifery practice. Ohio House of Representatives presents CHOICE with Certification of Recognition.

January 23, 2002
HB 477 is assigned to the Commerce and Labor Committee

February 5, 2002
Formal introduction of HB 477 into the Commerce and Labor Committee occurs.

February 26, 2002
HB 477 assigned to subcommittee of the Commerce and Labor Committee “due to the complex nature of the issues surrounding the bill”.

March 1, 2002
Charges filed on behalf of the State of Ohio against a direct-entry midwife surrounding a home birth in 2001. Midwife was charged on three felony counts of (1) practicing medicine without a license (2) possession of dangerous drug for sale and (3) administration of dangerous drug for sale.

March 13, 2002
HB 477 Proponent Testimony occurs. No further hearings were scheduled by the Commerce and Labor Committee for HB 477.

May 1, 2002
Charged midwife accepts plea agreement and pleads guilty on misdemeanor charges of 1 Count of Attempted Unauthorized Practice of Medicine and 2 Counts of Possession of Dangerous Drugs. Sentence rendered was (1) $3,000 fine plus court costs (2) 360 days jail sentence – suspended in lieu of a 3 year probation period which included (a) 200 hours of community service (b) letter of apology to the community to be published in 2 newspapers (c) directive to cooperate with all federal/state/local authorities in any investigation arising from her crimes (d) agreement to not possess any controlled substance or dangerous drug and (e) the development and implementation of a consulting protocol for her to follow with respect to high-risk pregnancies.

October 2, 2002
Guilty midwife appears before grand jury under new subpoena and is questioned as to origin of controlled substances in her previous case. Confusion arises as to her cooperation in assisting the grand jury’s investigation. Judge orders transcription of proceedings to occur and sets continuation of grand jury case.

October 23, 2002
Judge finds midwife in contempt of court with respect to 10/2/2002 grand jury questioning and renders jail sentencing of a maximum of 180 days or until information sought is provided to the court. Midwife presents herself to county jail to begin incarceration, as ordered.

December 16, 2002
Midwife is released from jail pending appeal of her case.

December 31, 2002
HB 477 expires.

January 3, 2003
Judge extends term of grand jury to 6/18/2003

March 4, 2003
Fifth District Court denies Midwife’s appeal and upholds Judge’s decision.

March 14, 2003
Midwife is ordered back to jail unless she reveals specific source of prescriptive drugs.

June 13, 2003
Judge releases grand jury and Midwife is released from county jail. Midwife resumes practice under probation terms and oversight by her county health department.

May 5, 2005
International Midwives Day – end of probationary terms for convicted midwife was verified.

October 6, 2007
Search Warrant executed at home of an Ohio midwife. Butler County judge approved the search warrant based on an affidavit from an Ohio Medical Association, Enforcement Officer. The affidavit followed a complaint to the Ohio Medical Association, from a doctor, regarding the practice an unlicensed midwife. Among other things, the warrant included: “Electronic or written communication between midwife, other unlicensed medical providers, patients and potential patients”

April 8, 2008
Midwife was offered Bill of Information in lieu of being charged with first offense fifth degree felony- Practicing Medicine without a License, and the midwife pleaded guilty to two misdemeanors 1) Attempted unauthorized practice of Nursing and 2) Attempted Aggravated Possession of Drugs. The first charge was based on having documentation found from the search warrant that midwife was being paid by “clients” and the second was based on possession of pitocin, a life-saving anti-bleeding medication.

May 20, 2008
Midwife was sentenced by Judge Charles Pater, to 2 years in jail (1 year for each misdemeanor) and $1000 fine for each, plus court costs. The judge suspended the jail time and put the midwife on two years probation and a $600 supervision fee.  The midwife chose to discontinue the unlicensed practice of midwifery.  The judge admonished the midwife for choosing to practice in what he considered an “illegal” state.

to present
Ohio midwives continue to work to seek legislative action to create a midwifery board to establish a licensure process for Certified Professional Midwives.