Oregon Midwives Face New Regulations

I read a very interesting article published just about a month ago discussing a few things relating to what we have covered in class this past week. It was about new regulations midwives in Oregon now face, the challenges they do face now and how the systems we have currently in place restrict low income mothers from using a midwife or having a home birth. It made me upset to see how much more low-income mothers must go through in order to achieve a basic right they have, and usually they cannot achieve it.

So first, there is legislation being finalized that will require all midwives to be licensed. This legislation comes after concern about a specific case in Oregon where an unlicensed, self-educated midwife acted negligently during a birth and it resulted in the loss of the infant. My first concern is about why someone would choose a midwife with no formal education. I am not sure whether this is an issue of poor state regulation on midwives or family negligence for choosing a self-taught midwife. It turns out that about half of midwives in Oregon are unlicensed. Which really means a variety of things. Births using midwives in Oregon still result in low infant mortality rates that births using the traditional medical route. Also, interestingly enough, only 5% of births using prenatal care result in early births and 15% of births using traditional medical prenatal care result in early births.
It was difficult to find information on the results of birth in Oregon using an unlicensed midwife and using a licensed midwife. I believe that would help to determine whether this regulation just adds for difficulties for midwives to practice or if it is necessary for the health and safety of pregnant mothers and their babies.

Just to note: This would require midwives to pay a $1,200 annual fee. Many midwives in Oregon report making less that 30,000.

Secondly, The Oregon Health Plan is seriously flawed when it comes to covering midwives. If the women is on the OHP before her third trimester then a midwife birth will not be covered. If a women is determined to have use a midwife she may typically wait till her third trimester to apply for the OHP to ensure it will be covered. This presents a lot of risk as she may not be getting proper prenatal care without health coverage.
It is extremely risky for midwives in Oregon to accept a women with the OHP or Medicare. Under these plans the midwife does not get compensated until after the birth. This means if there is any complication with the prengancy and the women must give birth at a hospital, the midwife will not receive any compensation for care done up until that point. For those reasons, midwives typically do not accept these patients.

So for most low-income women who are on the OHP or federal plans they simply do not have the option to have a home birth or use a midwife if they desire to. This is extremely saddening. The systems currently set up do not promote proper birthing right for women and especially low-income women.