Midwives Push For Access To Meds

September 27, 2013

Women who give birth at home are looking for a different kind of labor than a hospital typically provides, namely one that is drug-free. But in an emergency, medication can sometimes be a lifesaver, for them and their babies. So, Arizona midwives are asking the state for permission to buy, carry and administer drugs.

jera Sarah Butterfly has delivered more than 100 babies, including Jera, above. Now, she and fellow midwives are looking for legal permission to administer drugs to patients in the event of an emergency. (Photo provided by Sarah Butterfly)

Meet Sarah Butterfly and her bulletin board of babies. Imagine pictures of wet newborns, plump toddlers and one incredibly long umbilical cord. The mini scrapbook of sorts overlooks the midwife’s home office in Phoenix.

“This was our biggest baby, who came in at almost 11 pounds,” Butterfly said, pointing to an enormous newborn. “And this is our smallest baby who was only five and a half.”

 And how did that 11-pound birth go?

“Great,” she said, smiling. “Yeah, she birthed on her bedroom floor, like a champ.”

Home births like that, without complications or drugs, are the norm, Butterfly added. She is a certified professional midwife, licensed in Arizona, which means she is trained to perform at-home births. She has overseen about 110 so far.

Most were smooth, but four became emergencies requiring a transfer to a hospital, and that small percentage is why Butterfly and the Arizona Association of Midwives want the authority to administer potentially live saving drugs. Under today’s law, that is a felony, unless done under a doctor’s supervision or standing order, and due to liability that is a very hard thing to get. Butterfly has to explain this to her patients, long before they get to the birthing process.

“And it usually makes the clientele pretty angry that that’s the legal situation,” Butterfly said, “that they have to make a choice with it.”

So she and fellow members are asking the Arizona legislature to allow midwives to administer certain medications. This could be voted as early as spring, but truth is, for at least some of the 60 or so midwives in the state, these drugs are not new. Midwives are trained how to use them and some have been, outside of the law, for years.

That’s just fine by Nicole who had her first baby, Sunnie, at home. He is now a curious 2-year-old with a full head of long, black hair, and she is pregnant again.

sunnie Sunnie, now nearly 2 (and seemingly in love with radio equipment), was born with the help of a midwife. The planned home birth became an emergency when his breathing got labored and his mother started to bleed excessively. So, the midwife administered medical oxygen and an anti-hemhorraging medication - currently a felony in Arizona. (Photo by Stina Sieg - KJZZ)

Nicole wanted her last name withheld, not to protect her, but to protect her midwife. After Sunnie was born, his breathing was raspy, and Nicole started to bleed excessively. So, the midwife used oxygen on him and an anti-hemorrhaging drug on her as they waited for an ambulance. That was illegal, of course, but Nicole has no complaints.

“That’s what drugs should be there for, to help when there is an emergency,” Nicole said. “However, pregnancy and labor is not an emergency. It’s a natural, physiological function of the body.”

For some, Nicole’s story explains perfectly why midwives need legal access to drugs, but for others, it illustrates why midwives should not be granted any additional powers. A spokesman for the Arizona Medical Association declined to be recorded on tape for this story but said the organization feels “lay midwives,” meaning those who did not go to medical school, “lack the medical experience and clinical training to administer drugs.”

But some doctors have a more nuanced response.

Dr. David Kells actually works with midwives who have nursing degrees at his practice in Chandler. They do not do homebirth, and neither does he, but he believes midwives should definitely have access to lifesaving medication. However, for some patients, he believes home delivery will still always be risky.

“Part of what I’m concerned about is I see patients who are having home birth experiences who probably should not be encouraged along that avenue,” Kells explained.

That is a call that midwives like Butterfly have to make with each new client, but her predictions can sometimes fail. The unexpected can happen. Then what? Butterfly is clear.

“I tell my clients in my practice, and I’m happy to say this, but in my practice, I will always choose safety – over legality,” Butterfly said.

If being safe includes administering medication, that puts Butterfly and other midwives at risk. At least until the next legislative session.