Legalization of midwifery ... a technicality that began with a tuck

The State Supreme Court ruling that, in effect, legalizes the practice of midwifery in Missouri brings to an end a long trek for a legislative effort that has had its share of ups and downs.

The effort was championed by Senator John Loudon (R-Chesterfield) who had been trying to put forward legislation allowing certified midwives to practice their craft in Missouri. But the effort was stymied by Senator Chuck Graham (D-Columbia) who filibustered Loudon's effort back in 2007.

After a good deal of filibustering, a stand alone midwifery bill was perfected in the Senate ... that means it was passed once and required one more vote to clear the chamber. But it was done in a rather interesting way. On that occasion Loudon took advantage of Graham's absence from the chamber to bring up the bill and have it voted on. With none of the other Senators really opposed to the idea of legalizing a practice that is considered quite run of the mill in more than 40 other states, the bill easily passed. But the effort could not get approved a final time ... which is known as third reading.

Then came the maneuver that became the topic of conversation throughout the halls of the Capitol as the 2007 session wound down. Loudon pulled off what is known as a legislative tuck ... slipping his midwifery provision into a huge bill dealing with health insurance. Nobody noticed it had been added ... they voted on this huge bill (HB 818), and midwifery was on its way to Governor Matt Blunt for his signature. That did not sit well with Loudon's fellow Senators. In fact, Senate President Pro Tem Mike Gibbons (R-Kirkwood) removed Loudon as chair of the Senate Small Business Committee as punishment for the tuck. Loudon's chairmanship was later restored.

Once the legislation became law, opponents of midwifery - the Missouri State Medical Association - challenged the law in court. In so doing, attorneys for the doctors claimed there had been a violation of Missouri's Hammerschmidt rule - a constitutional requirement that any provision of any bill relate to the original purpose and title of that bill. The Association's challenge was successful in Cole County Circuit Court, but that ruling was appealed to the State Supreme Court.

As the issue worked its way through the legal process ... the 2008 legislative session - Loudon's last - got underway and he launched another effort to legalize midwifery. He began making headway with his nemesis from the year before - Chuck Graham - when Graham proposed naming part of a Boone County road in honor of Columbia NASCAR driver Carl Edwards. Loudon reached out to Graham, stating both Senators wanted pieces of legislation passed ... and Loudon suggested it would be a shame if one Senator were to filibuster the other Senator's legislation ... and vice versa.

It seemed to work. Graham abandoned his anti-midwifery crusade and it appeared as though the stand-alone midwifery bill might clear the Legislature. But it died as the session ended. It was a disappointment for Loudon as he had supported this cause and, being term limited, he realized he would not get another opportunity to give midwives the right to practice in the state.

I vividly remember those final days and hours of the session. I chatted quite frequently with midwives and their supporters who lost out on a lot of sleep as they hoped, beyond hope, that the midwifery bill would pass both chambers and be sent to the Governor. On the final afternoon of the session, Gina Loudon, who is running for her husband's seat, came up to me in the hallway outside the Senate chamber, and we started talking. I asked her if she had any inside information as to whether the midwifery bill might get through by the 6 pm deadline and she did not appear to have a lot of hope. What was heart-warming was Gina's admission, to me, that she hoped it would pass because it was such an important issue for John and this would be his last chance to get it done.

The session ended without the midwifery bill passing ... and all hopes were pinned on the State Supreme Court and how it would rule on the 2007 midwifery legislation. Whenever I raised the issue with Loudon or the midwives, they told me they would just wait and see what the Supreme Court had in mind ... but it was clear to me that optimism was in short supply.

Finally, more than a year after midwifery legislation cleared the General Assembly and began its journey through the legal system, the Supreme Court has spoken ... and both John Loudon and the midwives celebrate a victory. What is interesting is that the Supreme Court did not rule on the question of whether Hammerschmidt had been violated ... it ruled the Medical Association lacked standing to be part of the challenge to the legislation. That decision, in effect, made midwifery legal in Missouri.

I spoke with Mary Ueland of Friends of Missouri Midwives and the Senator after the ruling came down. Both are very pleased ... and it doesn't seem to matter to either of them that victory came on what could be considered a technicality. They won ... and a legal technicality victory is just as satisfying as a victory on the merits. And, truth be told, twenty years from now when midwifery is a common practice and a new generation of Missourians assumes midwifery has always been legal ... it's a safe bet nobody will look back and say they only won on a technicality. After all ... they had a little help from a tuck.

- Steve Walsh

Comments

[Mary Ueland]

Thank you, Steve, for your accurate story covering the long road of the Missouri midwives' legalization!
I guess it's been quite a story for everyone to watch... and probably isn't over yet!

[Hannah]

Great article, very informational.

[Lily]

This post talks about midwifery becoming legal based on a "technicality," which sounds like a tiny almost irrelevant issue. Actually, this "technicality" is a pretty significant accomplishment for midwifery supporters--particularly pregnant women like me who believe in making educated choices about where and with who to give birth. Not only does it allow the law to stand, thereby legalizing midwives, but it gives the message, loud and clear, that physician groups have no business challenging Missouri midwifery law. THAT is huge, in my opinion.

[John Loudoon]

Great job Steve. You pretty well nailed it. Two finer points I would add: There is no way the tuck would have happened without the tireless "midwives" working as co-conspirators, including home schooler Sarah Greek (ironically named) who came up with the greek word "tokology" on the website www.awordaday while studying for the ACT. Secondly, since the court held an "all or nothing" proposition, I practically begged the doctors to negotiate a reasonable compromise bill. They were so confident in a court victory that they bet on the come.

[Jane Kelley]

This is a great re-cap of our legal "labor" which birthed freedom for all Missouri mothers. Many Thanks!

[Kim Nisbett]

Excellent article. I would like to add that midwifery bills have passed the House multiple times on "merit" as well as passing the Senate. What always stopped them were the "technicalities". After 20 years of watching this frustrating process, it is very satisfying that ultimately right triumphed despite a system that favors the powerful. What should have come to pass long ago is now done. Many thanks to John Loudon, Mary Ueland, Debbie Smithey and a host of dedicated crusaders.

[Uli Pele]

The rest of the story -- Graham, as an incumbent, lost his bid for reelection to a republican in a HUGELY dem area. The home birth community formed a PAC and mothers from across the country descended on Columbia to show elected officials what happens when they mess with Mothers!