Midwife rules get mixed reactions

Board denies one, approves another

The state Board of Health on Thursday unanimously rejected proposed rule changes that would have prevented the Department of Health from performing vaginal exams on women as part of its assessments on whether they can safely give birth at home.

The changes, proposed by attorney Kesha Chiappinelli of Bentonville on behalf of four women who have given birth at home, also would have allowed licensed lay midwives to deliver babies for women who have previously had cesarean sections.

The vaginal exam isn’t required under the current rules but is part of the department’s assessments to determine whether the mother has any medical conditions that would make a home birth dangerous or require consultation with a doctor.

The rules require midwives’ clients to receive two such assessments: one shortly after the midwife begins providing care and the other at or near the 36th week of pregnancy.

Women who refuse the vaginal exam receive an incomplete assessment. Under rule changes that took effect June 1, the department has allowed midwives to deliver babies for women who receive such incomplete assessments as long as the midwife has a certification requiring extra training on emergency care.

Chiappinelli said this still limits options for women whose midwives don’t have the additional certification. The Health Department also has too much leeway in deciding what the risk assessments entail, she said.

“Our position is the rules are the law, and we want to be able to read the law and know what to expect,” Chiappinelli said. “Nowhere in the rules are the words ‘vaginal exam.’”

William Greenfield, the medical director for the Health Department’s family health services, said the exam allows the department’s nurse practitioners to look for conditions that could pose risks for a vaginal delivery.

He said it’s not safe for women who have previously had cesarean sections to give birth at home, because they have a higher risk of uterus ruptures — threatening the life of mothers and babies — during vaginal deliveries.

Tanya Smith, a member of the state’s Midwifery Advisory Board, argued that the risk of uterine rupture, although higher for women who have had cesarean sections, is still low.

Of the 33 states that regulate midwives, only Arkansas and six other states prohibit midwives from delivering babies for women who have previously had cesarean sections, she said. Two other states that

allow such deliveries have “impractical requirements” in such situations, she said.

Chiappinelli petitioned for the rule changes under the state Administrative Procedure Act, which requires agencies to approve or deny such petitions within 30 days.

In a 9-7 vote, the board approved a separate petition by Fayetteville midwife Martha McBride allowing midwives to obtain medical-grade oxygen that can be used to resuscitate newborns.

Midwives are trained to use oxygen but can’t obtain it unless a client obtains a prescription for it, she said.

If approved by the board again after a public comment period, the rules will go to the Legislative Council for final approval.