Thursday, February 21, 2008

Oregon's voluntary licensure

In response to my post about the prospective study that Missy Cheney from the Oregon State University is creating, my friend Linda wrote this:

(note: Kraig Bohot is the Communications Director for the Oregon Health Licensing Office, the office that oversees the Licensed Direct-Entry Midwifery Board)

Linda said...

Melissa seems to be very happy to answer questions about the study. Her email is cheyneym at

I've corresponded with Kraig Bohot. His stance is basically that the regulatory board is made up of people who support the midwifery model of birth (whatever that means, I'm not so sure anymore) and that therefore they can be trusted as an authority. Their function, then, is beneficial to all, so that it makes no sense not to protect consumers by holding midwives to the board's standards. (The context of part of my response below was that he had explained in detail to me how the regulatory standards are devised, and that the OHLA realizes that this is an emotional issue.) I wrote to him,

"I know how the regulatory standards for licensed midwifery practice are decided on in the state of Oregon and I appreciate that it's a much better situation for midwives and homebirthers than in most states. The fact remains, however, that the people responsible for establishing those standards are fallible and biased toward what they personally value and believe to be true. There are others who do not share their values and beliefs, and therefore do not accept them as an authority in determining what is and isn't appropriate in birth. This is why it is wrong to make midwifery licensure mandatory.

If Oregon decides to mandate regulation of all forms of midwifery it will have crossed the line from protector to police state. That might not be a problem
if we could assume that the standards are and will remain appropriate for all people. But it's a slippery slope. The regulatory board will change over time and it's quite possible that it will become more restrictive. I'm sure you're aware that in Washington and California, despite these being relatively progressive states, standards for licensure and laws regarding birth practices in general are far more restrictive than they are here. And in most other states, they are even more so (even to the extent of homebirth midwifery being illegal.)

Oregon is in a leadership position in this respect, representative of the fact that birth cannot be objectively defined in only one way, with one set of beliefs governing how an autonomic bodily process should be handled. Oregon has so far refused to define birth as inherently a medical event necessitating management by a medical professional. Mandating licensure would negate that.

Women already have the option of selecting a state-sanctioned care provider, if they agree with the beliefs of those people the state has appointed to determine how licensed care providers must operate. We also have the option to select a support person outside of that closed system, in accordance with other beliefs. In a moral society, that option would remain available.

Yes, this is emotional, and that's because it matters. Many have been harmed by the obstetric model of care, which unfortunately informs much of modern midwifery. This model is not wholly evidence-based and is not the objective pinnacle of birth wisdom. It makes no sense, then, to give it the ultimate right to dictate that all births and types of midwifery must fall under its rule. The state should not be able to tell anyone that they cannot step outside of that model and self-tailor their care in the interest of a better outcome. If the state decides to regulate midwifery, it will be doing so ostensibly to protect me and others like me from ourselves. This is arrogant and demeaning. It assumes
that the midwifery regulatory board knows better than any individual what is best for them.

I am sure that those who are pushing for mandatory licensure are well-meaning. And I agree that it is important to advocate for consumers. But this is simply not a case in which we can say without question that one set of standards is right and all others are wrong, and to not only insist that this is so, but to *force* others to abide by it is *not* in the best interest of consumers. Allowing all of us to make our own informed choices, even if they are different from the norm, is."

As an addendum to what Linda has written: The Oregon Licensed Direct-Entry Midwifery Board is made up of a homebirth-friendly MD, two CNMs and three Licensed Direct-Entry Midwives. It is NOT overseen by a board of physicians without knowledge, education and experience of homebirth. It is, in my experience, the most peer-friendly board that oversees non-nurse midwives in existence.