Midwifery: Bill to expand midwives' scope of practices passes legislature, but without suturing

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A bill to expand midwives' scope of practice will likely become law, having passed both the House and Senate this week. While the bill allows midwives to administer certain drugs and IVs, it isn't everything that advocates, including Westword profile subject Indra Lusero, had hoped for. A provision that would have allowed midwives to suture women who experience tears during childbirth was removed as part of a compromise between lawmakers.

But that doesn't mean the issue couldn't come up again in the future. An amendment to the bill states that, "as soon as practicable, representatives of the medical community, the midwife community, and other interested parties shall meet and discuss the issue in an effort to reach an accord."

Doctors and nurses are generally opposed to granting midwives the ability to suture, while most midwives are in favor. For legislative purposes, the Colorado Midwives Association fell somewhere in the middle; while they support suturing, they were willing to forgo the privilege in order to reach consensus on the bill.

Lusero, along with the group Delivering Natural Care for Families, actively campaigned for suturing. At a hearing in January, Lusero testified that, "After giving birth, I felt more like an athlete than a sick person. I fancied myself a boxer with a split lip who needed my trainer to just give me a quick repair so I could stay in the game."

In the end, Lusero says she's happy with the bill. "I feel good about the final bill," she says. "The vast majority of things we were aiming for wound up in the bill. I think it was a definite success -- not just in terms of the outcome of the bill, but in terms of the organizing we did and the people we activated, and in terms of having a consumer group, which I believe changed the conversation."

But there's still work to be done -- and Lusero and Delivering Natural Care for Families plan to be part of the conversation. "One of the things I learned was that even though ultimately, the medical lobby wasn't officially opposing the bill in the end, there was still a general lack of trust of midwifery and midwives. We still have more work to do," she says.

For a complete rundown of changes included in Senate Bill 88, check out this handy document, courtesy of Delivering Natural Care for Families.

More from our Politics archives: "John Hickenlooper to sign Senate Bill 60 today: Raise a glass of any beer you like!"

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Linda Rosa
Linda Rosa

I worked three years at St. Joseph Hospital postpartum when Kaiser patients went there for labor and deliveries, of which there were an average of nearly 500 each months.  So I have a lot of experience with postpartum hemorrhage.

 In legislative hearings, I heard two DEMs and one non-OB physician supporter recount the proposed protocol for dealing with a hemorrhage -- apparently to reassure clueless legislators that calling 911 would be part of that protocol.  Not once, in these testimonies, did I hear  mention of massaging the uterus -- a maneuver that can often stop a hemorrhage in its tracks  by expelling a large clot that keeps the uterus from contracting down.   This is what DEMs should be doing instead of *trying* to insert an IV.

Apparently DEMs will now be fumbling around with trying to start an IV -- something that takes continual experience, especially if you are going to do this successfully on a woman whose veins have collapsed because she's hemorrhaging and you need to get in a large needle!  But Colorado DEMs won't have that experience since they are birth-hobbyists who have an average of one delivery per month.  Will they watch for fluid overload, etc ?

 This is all crazy!  Situations like hemorrhage need immediate emergency care -- it needs physicians who can quickly determine the cause of the hemorrhage.  It takes a team of health care professionals. 

Suturing by DEMs is equally insane.  Repairing tears is tricky for obstetricians who do it all the time.  One hint that DEMs don't know even how to start talking about this issue is that they asked for permission to stitch up first degree tears -- which don't require suturing at all!  And then there was talk of SuperGlue...

DEMs first were legalized in Colorado in 1993 with the claim that birth is not a medical but a natural event.  Now that DEMs want all sorts of medical privileges.

The home birth movement is all ideology-driven to create "female empowerment"; it is all about keeping women and infants from stepping foot in a hospital.  This mania to keep birthing at home NO MATTER WHAT leads DEMs to hesitate when women and infants should be speeding to emergency care which is hopefully no further than across the street. 

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