Gov. Matt Blunt signed legislation Friday that started out expanding health insurance options and ended up, unbeknownst to most lawmakers, legalizing midwifery.

Under previous Missouri law, midwifery was a felony crime -- punishable by up to seven years in prison -- when practiced by anyone other than certified nurse midwives working in collaboration with physicians.

The provision that Sen. John Loudon, R-Chesterfield, slipped into the health insurance bill allows midwives certified by private groups to legally work in Missouri. After sending the bill to the governor, some legislators worked to undo the language or pass the insurance part separately, but those efforts failed.

"Floor substitutions happen every day at the Capitol, in reality," said Mary Ueland, legislative chairwoman of the Missouri Midwives Association. "It's the legislator's job to look for these things. We were very surprised after it passed the final vote and landed on the governor's desk."

Now she said she's ecstatic.

The Missouri Midwives Association has fought for 20 years to legalize the use of midwives, Ueland said. She said she's had a constant presence at the Capitol building with the goal to increase access to midwives and to make sure they're educated and trained.

Certified professional midwives are legal in 40 other states. According to birth certificate data, about 1 percent of babies in this country are born at home. "It's the right of the mother to have an at-home birth," Ueland said.

Terri Hultman of Blue Springs, Mo., is a registered nurse and a certified nurse midwife. She said she would often receive four calls a week regarding at-home births, but now she may not have to be so sought-after.

For certified nurse midwives to practice in the state with a collaborative physician present was a nonexistent option, Hultman said, because few doctors would take the time to do it. Hultman said midwives differ from physicians because midwives go out of their way to help the mother fall in love with her baby and be a good parent.

"I only became an RN because I wanted to become a midwife," she said. "I'm all about a woman having a great experience giving birth. If you mess with an animal giving birth, that mom will either neglect or hurt the baby."

Having a baby at home is less than half the cost of having one in a hospital, according to Hultman. In a health center women are required to stay for 48 hours, which is expensive, plus there is a time when the mother has to be separated from her baby.

Elizabeth Allemann, medical director of the Columbia Community Birth Center, has been attending births at home for 20 years. She said she's happy for the women of Missouri and for her daughter now that Blunt signed the bill into law.

Allemann was a physician always willing to go to a mother's home to help deliver a baby with a certified nurse midwife as an assistant. She said the few certifed nurse midwives in the state taught her a lot.

"Why does anyone besides me care where I have my baby?" she questioned. "We say it's a free country, but if you can't choose where to give birth and who's going to help you, a lot of the other freedoms don't matter so much."

According to Allemann, critics of the use of midwives say it's an unsafe practice but should look at the fact that the outcomes are the same or better delivering a baby at home than in a hospital.

Kerstin Frueh of Columbia, Mo., has had two healthy sons at home with a physician and a certified nurse midwife present. She has always chosen home, even before the legislation was passed, because she said it's too personal of an experience to have with strangers. The women by her side were her friends before she became pregnant.

"Those were people I could trust. They knew my values, knew what was important to me, respected my space and there was no emergency feeling," she said. "At the hospital it's difficult to get to know your physician on a personal level."

She said at home the physicians followed her lead while she gave birth in her pool.

"When I lifted my baby out of the water there was a strong need to keep my baby with me," she said, adding that water births help relieve the intensity of the pain. "When a baby enters the world, it's where we start our relationship. We did this together. We faced the pain. Those emotions are something to draw from down the road."

When her first child was born, she didn't experience any pain and had a high with every contraction, she said. When she was ready to have her second son, she looked forward to it.

Sarah Linsenmeyer of Columbia, Mo., also is a believer of at-home births. She attempted to have her first child in her house, but due to a prolonged labor, she was transferred to the hospital where she underwent a Caesarean section. "I felt very violated and I was devastated with that birth experience."

She wanted to give birth on her own the next time and had her second baby on her back porch.

"It was an incredible experience. I will never be the same again. It just moves you. It's a life passage that a lot of women are giving up."

Linsenmeyer said people are afraid to have a baby at home because of our culture, but she believes that babies don't need to be born in a hospital setting.

"Home birth is really an OK thing to do," she said. "Our ancestors were born at home."

The Associated Press contributed to this story.

tkrakowiak@semissourian.com

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