Midwifery: Bill to expand midwives' scope of practice passes House committee unanimously

A bill to expand midwives' scope of practice in Colorado that's seen its fair share of compromises may have had its easiest day in the spotlight yesterday.

After several hours of testimony and questions about infant death rates and medical liability insurance, the House Judiciary Committee passed the bill unanimously and intact.

But the bill isn't everything wanted by some, including Westword profile subject Indra Lusero and the group Delivering Natural Care for Families. Earlier this month, a provision that would have allowed midwives to suture women who experience tears during childbirth was removed by a different House committee after doctors and nurses objected.

Yesterday, there was little mention of suturing. Instead, the lawmakers focused on whether midwives should be required to carry liability insurance. Currently, the law says midwives must carry it when it's "available and affordable."

Rose McCool of the state Department of Regulatory Agencies, which oversees the registration and discipline of midwives in Colorado, testified that while the insurance is narrowly available, it's far from affordable. She estimated the cost at $20,000 to $50,000 per year. The average midwife, she said, makes about $30,000.

In lieu of insurance, midwives testified that they require mothers to sign informed consent agreements that clearly state they do not carry liability insurance. The agreements also list the midwife's education, the number of years she's been practicing and the number of births she's attended, as well an "emergency plan" that details what would happen in the case of a complication and the distance to the nearest hospital.

Mike Kaplan, a Denver attorney, testified that he and his wife decided to have their third child at home with a midwife despite the fact that their midwife didn't have insurance.

"We felt comfortable going forward, and we had a beautiful baby girl," he said.

Even if something had gone wrong, Kaplan said that he was well-informed about the risks, and though he spends his days filing lawsuits as a civil attorney, he would not have sued their midwife -- which supports McCool's testimony that midwives rarely face litigation.

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Not everyone at the hearing supported midwifery. Several people from the group Colorado Citizens for Science in Medicine testified against the bill, which at its most basic would allow midwives to continue to practice legally here. Member Linda Rosa called midwives "poorly educated" and said they provide "substandard care."

Dr. Mark Johnson, the director of the Jefferson County Department of Public Health and also a member of the group, said the reason midwives are rarely sued is because the families who hire them are "going against the normal." If something goes wrong, he said, "they will feel guilty or they will feel ashamed" -- too ashamed to sue.

In the end, the committee members approved the bill, which is called Senate Bill 88. It now moves to the House Appropriations Committee before heading to the full House. It already passed in the Senate, with suturing included. If it passes the full House, the House and Senate will have to resolve their differing versions of the bill. Stay tuned!

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