Oregon's thriving midwife community has long operated outside the bounds of state regulation, but a recent increase in safety reports combined with the highly publicized death of a Eugene, Ore. newborn during a homebirth this July has revived debate over whether midwives should have to be licensed to practice in the state.
Among the 40 states that allow midwifery, the laws regulating them vary greatly. Oregon and Utah, however, are the only states that have optional licensure of midwives.
It was to one of the unlicensed midwives, Darby Partner, that Eugene resident Margarita Sheikh turned to this summer when preparing to give birth to her son.
Sheikh told local news affiliate KVAL in Oregon that she felt comfortable with Partner.
"I didn't go into this thinking, 'Oh, there's going to be a chance that my son's going to die,'" she said.
But tragedy struck as Partner and her assistant, Laura Tanner, were delivering Sheikh's son Shahzad. He was born not breathing and attempts to revive him failed.
Sheikh said Partner initially ignored her requests to be taken to a hospital and that Partner and Tanner panicked when her infant was not breathing, arguing over how to perform infant CPR. They eventually took Sheikh to a nearby hospital shortly after her son's birth but it was too late to save him.
"At the hospital, they just basically asked me if I wanted to be in the room with him," Sheikh told KVAL. "I had asked, 'Well, did you guys revive him?' and they said, 'No.' And as soon as I went into the other room, that's when I saw him. And they were just cleaning off his face>"
Though Partner has more than a decade of experience, according to her online midwife profile, she does not have the optional state licensure nor certification as a professional midwife (CPN) that is offered by the North American Registry of Midwives.
Calls made to Partner and Tanner were not immediately returned. KVAL reached the two midwives in August, but both declined to comment on the birth outcome.
Because unlicensed midwives are not regulated by the state, Sheikh cannot file a complaint against this midwife.
Now, Sheikh is calling for mandatory licensure of all midwives so her baby's death is not "for nothing."
Many midwives and advocates of midwifery contest the notion of mandatory licensure, arguing that it will not change the safety of home births.
"We're not in favor of mandatory licensure," said Susan Moray, press officer for Midwives Alliance of North America. "We don't see that it makes a difference in birth outcomes. It doesn't create more safety."
The alliance supports the CPM training, but hesitates to say that midwives need even that training because there are many qualified midwives with years of experience that have neither. Instead, Moray said, women should look to standards of care set by the midwife community.
"We do peer reviews several times a year and ask the midwives how many births they've delivered, what complications they've handled, and which medications they can use," she said. "I would encourage any woman seeking a midwife to ask the same questions."
But now, the Oregon deaths of Shahzad Sheikh and a premature infant delivered by midwives who practice faith healing through the Followers of Christ Church has raised concerns in the mind of Melissa Cheyney, a licensed midwife and an Oregon State University medical anthropologist.
Though for years the Oregon Midwifery Council has supported a woman's right to choose between a variety of providers, both licensed and unlicensed, Cheyney said, "these cases bring the question of voluntary versus mandatory licensure back to the table."
Cheyney's primary concern is that the state track birth outcomes with midwives so that there can be "quality assurance."
"Oregon just passed a house bill that enables us to capture both planned place of delivery [home versus hospital] and birth outcome," she said. "Licensed midwifes are also now required to report their outcomes, so with this new data we can hopefully form evidence-based guidelines for how to regulate midwives."
As of now, there is no legislative move to change the midwife regulations.
"I'm sure it will come up in the next legislative session," said Silke Akerson, a licensed midwife and president of the Oregon Midwifery Council.