In this episode, Cristen speaks with Kesha Zaffino, an Arkansas lawyer who represents consumers working for better midwifery regulations.  Right now, for example, the law requires a number of vaginal exams for home birth midwifery clients–something Ms. Zaffino describes as “state-sanctioned rape.† (The regulations are similar to what is described in Arizona: Mandatory Surgery or Forced Vaginal Exams.)

SEPT. 2017 CONSUMER ALERT: The Arkansas Department of Health will hold a public hearing on September 21, 2017, at 10:00 a.m. in the Auditorium of the Arkansas Department of Health, 4815 West Markham Street, Little Rock, AR in conformance with the Administrative Procedures Act, Ark. Code Ann. § 25-15-201 et seq. It is proposed to revise the Rules and Regulations Governing the Practice of Licensed Lay Midwifery in Arkansas pursuant to the Administrative Procedures Act as amended, and by authority of Ark. Code Ann. §§17-85-101 et seq. and Arkansas Code Ann. §§20-7-109.  A draft copy of the proposed revisions is here under the heading “Midwifery.â€Â 

Interested members of the public can submit written comments no later than 8:00 am on September 21, 2017 via

Email at [email protected]

Or mail to:
Attn: Womens Health Section Chief
Arkansas Department of Health
4815 West Markham Street
Women’s Health Slot # 16

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Arkansas Licensed Lay Midwives are regulated by the Arkansas Department of Health. Current rules require mothers to prove they are medically fit to endure a midwife-assisted birth by undergoing two medical assessments with a qualified medical provider or public health clinician. Midwives must relinquish care of any client found to be at risk, or risk losing their license.

Midwifery advocates worry that new draft rules up for adoption this month will require mothers to submit to even more medical scrutiny, potentially pushing them into the arms of unlicensed midwives.

Kesha Zaffino is an attorney and a member of the national Birth Rights Bar Association who represents Arkansas Birth Matters, a grassroots consumer group.

“The new rules are broader,” she says. “Now she’ll be subject to a third risk assessment.”

Attorney Kesha Zaffino is a member of the national Birth Rights Bar Association representing the interests of licensed midwives and home birth advocates in Arkansas. CREDIT KESHA ZAFFINO

Zaffino says mothers are reporting that the medical assessments are already too invasive.

“The rules state that the mother must submit to a vaginal exam, unless the clinician makes that call,†Zaffino says.

Act 481, passed in 1987, authorizes and directs the Arkansas State Board of Health to adopt regulations governing licensed midwives, and the act directs the Arkansas Department of Health to administer the regulations. A Midwifery Advisory Board serves as community liaison.

The draft rules were approved earlier this year and posted online for public comment. The rules give mothers the option to refuse certain tests if her midwife is certified under the North American Registry of Midwives which maintains rigorous standards for knowledge, skills and experience.

Failing an assessment, mothers seeking a home birth, Zaffino says, may struggle to find an obstetrician or qualified family medical provider to take over.

“So rather than let a trained licensed midwife continue to care for mother, mother is now left without maternity care, placing her and the baby in a very dangerous position.â€

Arkansas licensed lay midwives are currently barred from caring for clients who’ve previously delivered surgically, although American College of Obstetricians and Gynecologists guidelines cite natural delivery as a safe and appropriate choice for such mothers. One-third of all deliveries in Arkansas are surgical according to the U.S. Centers for Disease Control and Prevention. Some are scheduled for medical reasons, others for convenience — preferred by busy obstetricians and moms.

But with surgery comes certain risk. A complaint filed by Arkansas Birth Matters points to a National Institutes of Health report issued seven years ago stating concern about barriers to natural labor after cesarean. And recent national datashow rates of maternal morbidity are higher for cesarean compared to natural deliveries.

The Arkansas Department of Health is charged with protecting the welfare of mothers under the care of licensed midwives. CREDIT DEB PHILLIPS

Zaffino says licensed lay midwives who are trained in prenatal, labor, delivery, and postpartum care are able to recognize childbirth risks, know when to reject a client, and know when to transfer them to a medical provider.  Certified professional midwives, credentialed though the North American Registry of Midwives, including several in Arkansas, offer even higher levels of medical expertise, as do certified nurse midwives trained in dual disciplines. Lay midwives, who have no license, also deliver babies in Arkansas — but below regulatory radar. And mothers who fail risk assessments, Chiapinnelli says, may resort to paying an unlicensed midwife for birthing services.

“Midwives have to show they have certain education and training, and are held accountable to the public, like a regular obstetrician.â€

Currently 28 licensed midwives, which includes certified nurse midwives, operate in Arkansas, delivered several hundred babies in 2014 (the last count available), among the more than 38,500 statewide that year.

A public hearing on the final draft rules posted on the Arkansas Department of Health website Lay Midwifery page is set for Thursday September 21 at 10 a.m. in the agency’s auditorium on Markham Street in Little Rock. Written public comment is requested.

This story is produced by Arkansas Public Media, a statewide journalism collaboration among public media organizations. Arkansas Public Media reporting is funded in part through a grant from the Corporation for Public Broadcasting, with the support of partner stations KUAR, KUAF, KASU and KTXK and from members of the public. You can learn more and support Arkansas Public Media’s reporting at arkansaspublicmedia.org. Arkansas Public Media is Natural State news with context.

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The latest on unconstitutional state agency rule making in Arkansas. After having a baby in California with a midwife and doula in a baby friendly hospital in Woodland California and moving back to Arkansas I found the midwifery rules, created by the Arkansas Department of Health, to be onerous and unconstitutional. The rules compel women who hire a state licensed midwife to see a local health clinic nurse and the rules require a vaginal exam among many other tests and procedures. Think about that for a moment…. A mother is getting quality prenatal care in the comfort of her own home on the same schedule as an O.B. from a licensed midwife but is compelled to go to her local health clinic nurse for a vaginal exam and other tests. If she declines this clinic visit will lose her midwife and may be left without any prenatal care depending on how far along she is. The rules state that the pregnant mother cannot decline the vaginal exam. After talking to members of Arkansas Birth Matters I have encountered at least 10 women who were coerced into having vaginal exams at the local health clinic under these rules beginning in 1999 up to 2017. Some of the women were purposefully treated in a rough manner and felt shunned because of their decision to have an out of hospital birth. There is no complaint mechanism for these women and the Arkansas Department of Health has been made aware of the issue. Click the links below for reports from NPR and other local news stations about these forced vaginal exams.

Stay tuned for more information about public comment and the opportunity to speak against rules like this that compel medical treatment on competent adult women.

http://arkansaspublicmedia.org/post/arkansas-midwives-home-birth-advocates-pains-new-stricter-midwifery-standards

http://katv.com/news/local/mom-wants-adh-to-take-hands-off-approach-to-midwifery

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