~ The medical community is divided over the safety of midwifery

ST. LOUIS -- Many midwives in Missouri continue to help women give birth at home, in spite of the threat of felony charges.

While midwifery without a nursing degree remains illegal in Missouri and 12 other states, an illegal underground network of midwives continues to deliver children here, the St. Louis Post-Dispatch reported. Advocates of midwifery said they will continue to fight to legalize the practice, which they say empowers parents who want more control over the birthing process.

Parents don't face a legal danger if they use midwives, and many still use the private practitioners instead of going to a hospital to deliver a child. It's difficult to gauge how many babies midwives deliver in Missouri each year because the process happens outside legal channels.

Midwifery is a tradition that goes back centuries, whereby women support each other through pregnancy, birth and early infancy. Much of that tradition was born out of necessity, when few doctors and even fewer hospitals were available.

Today, about 37,000 women in the United States use midwives annually.

Prenatal care

Midwives, advocates say, stay with the mother throughout labor, and check on moms and their new babies at least six times in the first three months after delivery.

"The biggest aspect of good prenatal care is education, but education takes time, and it takes developing a relationship between the midwife and the family," said Dr. Laurel Walter-Baumstark, a family physician in Hermann, Mo., who has worked with midwives and sits on the board of the National Association of Birthing Centers. "There is just no better model of preventive maternity care than the midwifery model."

Advocates point to the most rigorous study of home births with Certified Professional Midwives, published in 2005 in the British Medical Journal, which reviewed the outcomes of more than 5,400 births in Canada and the U.S. The study found significantly lower medical interventions with births supervised by midwives. Mothers also were highly satisfied, with less than 2 percent saying they would choose another type of caregiver next time.

But such statistics can't tell the whole story, said Dr. Gordon Goldman, the Missouri section chairman of American College of Obstetricians and Gynecologists.

"Most of the time, they are going to get away with" a midwife birth, Goldman said. "But when [a death] happens -- even if it's one in 1,000 -- it's 100 percent for you and your baby."

Right to choose

The medical community is divided over the safety of midwifery. The American Public Health Association, the world's largest organization of public health professionals, advocates increased access to out-of-hospital births attended by midwives. The World Health Organization says midwives are the most appropriate care provider for low-risk births.

"The real issue for the people of Missouri is not safety, it is the freedom and right of women and their families to choose the kind of birth best for their own needs," said Dr. Marsden Wagner, former director of women's and children's heath for the World Health Organization.

After almost 20 years of legislative debate, midwifery was legalized in Missouri last summer, when Sen. John Loudon, R-Chesterfield, inserted a vague clause into a larger bill. A circuit county judge, however, ruled that legislative procedures were not followed and struck down the law, which has been sent to the Missouri Supreme Court on appeal.

Whatever the outcome, midwife advocates and doctors promise another showdown this legislative session over a more comprehensive bill that would license and regulate midwives.