Missouri should legalize midwives

To the editor:This year the Missouri Legislature will, once again, be asked to consider the issue of midwifery. Missouri is the only state in the nation which says in law that midwifery is part of the practice of medicine. Only doctors and certified nurse midwives are permitted to assist with home births. Current Missouri law places mothers and babies in danger, particularly those who give birth at home.

I am a home-birth physician and an expert in natural childbirth. I take several calls a year from families who live in rural areas and who have rapid labors. They cannot reliably make it to a hospital that provides maternity care. They have no option but to give birth at home. They cannot find a midwife. I don't know what to tell them.

The current legal situation puts physicians like me in a legal bind. If I care for a family who has seen a midwife, I am not supposed to know that -- or perhaps I will be a party to the felony. But if I don't know that they have had care from a midwife, how can I know what has already happened in the pregnancy? How can I provide excellent care if I have to stay ignorant and uninformed? Women and babies do best in a system where doctors and midwives work together.

Nearly 1,000 babies are born at home in Missouri each year. Every one of them deserves the excellent care of a skilled midwife. Legalizing well-trained midwives would be a big step toward that goal.

Dr. ELIZABETH ALLEMANN, Harrisburg, Mo.