Arkansas Licensed Lay Midwives are regulated by the Arkansas Department of Health. Current rules require mothers to prove they are medically fit to endure a midwife-assisted birth by undergoing two medical assessments with a qualified medical provider or public health clinician. Midwives must relinquish care of any client found to be at risk, or risk losing their license.
Midwifery advocates worry that new draft rules up for adoption this month will require mothers to submit to even more medical scrutiny, potentially pushing them into the arms of unlicensed midwives.
“The new rules are broader," she says. "Now she’ll be subject to a third risk assessment."
Chiappinelli says mothers are reporting that the medical assessments are already too invasive.
“The rules state that the mother must submit to a vaginal exam, unless the clinician makes that call,” Chiappinelli says.
Act 481, passed in 1987, authorizes and directs the Arkansas State Board of Health to adopt regulations governing licensed midwives, and the act directs the Arkansas Department of Health to administer the regulations. A Midwifery Advisory Board serves as community liaison.
The draft rules were approved earlier this year and posted online for public comment. The rules give mothers the option to refuse certain tests if her midwife is certified under the North American Registry of Midwives which maintains rigorous standards for knowledge, skills and experience.
Failing an assessment, mothers seeking a home birth, Chiappinelli says, may struggle to find an obstetrician or qualified family medical provider to take over.
“So rather than let a trained licensed midwife continue to care for mother, mother is now left without maternity care, placing her and the baby in a very dangerous position.”
Arkansas licensed lay midwives are currently barred from caring for clients who’ve previously delivered surgically, although American College of Obstetricians and Gynecologists guidelines cite natural delivery as a safe and appropriate choice for such mothers. One-third of all deliveries in Arkansas are surgical according to the U.S. Centers for Disease Control and Prevention. Some are scheduled for medical reasons, others for convenience -- preferred by busy obstetricians and moms.
But with surgery comes certain risk. A complaint filed by Arkansas Birth Matters points to a National Institutes of Health report issued seven years ago stating concern about barriers to natural labor after cesarean. And recent national data show rates of maternal morbidity are higher for cesarean compared to natural deliveries.
Chiappinelli says licensed lay midwives who are trained in prenatal, labor, delivery, and postpartum care are able to recognize childbirth risks, know when to reject a client, and know when to transfer them to a medical provider. Certified professional midwives, credentialed though the North American Registry of Midwives, including several in Arkansas, offer even higher levels of medical expertise, as do certified nurse midwives trained in dual disciplines. Lay midwives, who have no license, also deliver babies in Arkansas — but below regulatory radar. And mothers who fail risk assessments, Chiapinnelli says, may resort to paying an unlicensed midwife for birthing services.
"Midwives have to show they have certain education and training, and are held accountable to the public, like a regular obstetrician.”
Currently 28 licensed midwives, which includes certified nurse midwives, operate in Arkansas, delivered several hundred babies in 2014 (the last count available), among the more than 38,500 statewide that year.
A public hearing on the final draft rules posted on the Arkansas Department of Health website Lay Midwifery page is set for Thursday September 21 at 10 a.m. in the agency's auditorium on Markham Street in Little Rock. Written public comment is requested.
This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State news with context.