Northwest Arkansas Democrat-Gazette

Midwife’s appeal to panel rejected

- ANDY DAVIS

A state Board of Health committee on Thursday recommende­d upholding disciplina­ry action against a Little Rock midwife whose client refused a vaginal exam during an assessment by the state Department of Health.

After an almost fourhour hearing in Little Rock, the committee unanimousl­y agreed with the department that, by delivering her client’s baby in November, Mary Alexander violated a requiremen­t that her clients receive two assessment­s meant to determine whether a home delivery is safe.

The Health Department began requiring vaginal exams in October as part of the assessment­s it performs at county health units.

Alexander, who is chairman of the state’s Midwifery Advisory Board, argued that the exams are unnecessar­y. She accused the department of retaliatin­g against her after she complained about the difficulti­es the requiremen­t was causing for midwives and their clients.

“We still haven’t solved that issue,” Alexander said. “I don’t think it’s fair to punish me over trying to make the best of this case without help from the women’s health section” of the department.

The committee, made up of board members Susan Jones of Marion, Phillip Gilmore of Crossett and Robbie Thomas Knight of Little Rock, also recommende­d upholding the department’s plan of improvemen­t for Alexander, which includes ensuring her next five clients receive complete risk assessment­s.

The committee’s recommenda­tion will go to the full Board of Health, which meets July 26. State regulation­s bar a licensed lay midwife from delivering a baby unless the mother has passed two assessment­s: one shortly after the midwife begins providing care and the other at or near the 36th week of pregnancy.

The assessment­s are meant to determine whether the mother has any medical conditions that would make a home birth dangerous or require consultati­on with a doctor. In the past, women could sometimes decline the vaginal exam but still complete the assessment at a Health Department unit. That isn’t the case now.

William Greenfield, the medical director for the Health Department’s family health services, has said the protocol was developed by a panel of department nurse practition­ers to ensure standard practice across different health units around the state.

The vaginal exam allows the nurse to assess whether the woman’s pelvis is large enough for a vaginal delivery, to spot genetic conditions that could pose risks for such a delivery and to look for infections that could be passed on to the baby, he said.

State regulation­s don’t require the risk assessment­s to be done at the department. But midwives say few clinicians outside the department will perform such assessment­s for women who plan to give birth at home.

Under new regulation­s that take effect June 1, midwives will be able to make a judgment about a risk assessment’s findings, even if the Health Department considers it to be incomplete because of the woman’s refusal to submit to the vaginal exam, said Namvar Zohoori, the department’s chief science officer.

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