The medical associations, which wanted to strike down the law, had argued that they were defending the challenge, arguing that doctors could face disciplinary action if they worked with midwives and that they should be allowed to challenge the law on behalf of patients as their representatives. The Court disagreed on both issues, noting that the groups did not have the power to challenge the constitutionality of the law. They overturned the lower court`s decision and upheld the law legalizing obstetrics in Missouri. Ironically, organized medicine now devotes considerable energy to resisting the approval and regulation of certified professional midwives (CPMs, now officially recognized in 24 states), and in mid-June, the American Medical Association passed an anti-home birth resolution (proposed by ACOG), which many see as a step toward a trial. to make home birth ultimately illegal. Despite the lack of evidence that a planned home birth with trained caregivers is completely less safe than a hospital birth, AMA and ACOG do not appear to apply the principle of reproductive choice when it comes to this area of decision-making for a pregnant woman. At 36 weeks, the mother was reportedly concerned about the size of her baby. After an ultrasound and assuming that induction of labour would occur after 38 weeks because the woman was diabetic, the obstetrician estimated a birth weight of 3.9 kg. In fact, the baby was born shortly before 39 weeks and 4.25 kg. While the obstetrician obviously underestimated birth weight, the legal question is, “What should she have done to avoid possible or probable complications?” She explained: Our Bodies Myself was among those who filed an amicus curiae letter to support the lifting of an injunction against the law and thus legalize midwifery in the state. Judy Norsigian, Executive Director of OBOS, also addresses the central issue: Maryland law defines nurse midwifery in COMAR 10.27.05.01 as the management of the health of newborns and clients throughout their reproductive life cycle. In Maryland, unlike other jurisdictions, a midwife must be a registered nurse. Maryland no longer allows lay midwives to give birth.

The same COMAR regulation states that a certified nurse midwife must be a “registered nurse certified by the [American College of Nurse-Midwives Certification Council] and the Council.” Yesterday, the Missouri Supreme Court overturned a lower court decision in a 5-2 decision, upholding a 2007 law that would allow legal midwifery work in the state. The law states that “anyone holding valid ministerial or toxicological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services” – this would include both NJCs/CMs certified by the American Midwifery Certification Board and CPMs certified by the North American Registry of Midwives. The National Institute for Health and Care Excellence guidelines (NICE, 2011: paragraph 1.1.1.1) state that “pregnant women should receive evidence-based information and support to enable them to make informed decisions about their care and treatment”. Montgomery offers the highest level of legal support for this position. So in Maryland today, there are no midwives of yesterday`s “old grandmother.” Midwives are no longer untrained women whose formal training served as an apprentice to another midwife. Today, Maryland midwives are registered nurses with advanced specialty training in obstetrics. “The vast majority (about 98%) of midwife-assisted deliveries take place in hospitals, with one per cent in birth centres and one per cent in the client`s home environment. A number of previous medico-legal cases have considered how much information about possible risks to give to patients, and it is perhaps not surprising that there have been conflicting opinions and judgments over the years. In the Sidaway case in 1985, it was decided that disclosure of risk should be equivalent to the “reasonably competent physician” test, roughly summarized as “physicians know best.” However, one of the judges in that case (Lord Scarman) disagreed and ruled that patients should have much more leeway to decide for themselves; To do this, they need information. The question remains: what level of risk should practitioners disclose? Is it the physician`s responsibility to provide the information, or is it the “patient`s” responsibility to request it? In Montgomery, it turned out that the obstetrician would have disclosed the relevant risks if the woman had requested it, but in the absence of such a request, the information was not provided. The woman in this case is a small insulin-dependent diabetic.

The increased risk of fetal macrosomia is recognized in such cases, and she was “told she had a larger baby than usual” (para. 13), but apparently was not informed that mechanical problems might occur during labour. The obstetrician believed that the risk of shoulder dystonia causing serious problems was very low. Your reasoning was that if women are made aware of such a risk, is it neglectful not to warn pregnant women of the possible clinical risks? This issue is at the heart of an ongoing court case that has a significant impact on practitioners as it gives legal weight to the advice of the national guidelines. Consent must be voluntary; the person must have legal capacity; and, above all, must be informed. “Today`s Missouri Supreme Court decision is a tremendous victory for Missouri families who have been working for 25 years to gain legal access to professional midwives. The decision improves access to maternity care in the state, providing women and families with more birth opportunities and reaffirming their ability to exercise their right to decide how their babies are born. “Most cases of birth injuries against midwives stem from seeing or seeing signs of problems such as an abnormal fetal heart strip and not interrupting the mission and going to an obstetrician. If there are signs that the mother or baby is struggling, this is a higher-risk case that requires a more comprehensive obstetrics team.

This decision follows recent statements by WADA/ACOG, in which the organizations expressed their intention to support laws that restrict or prevent both home births and non-NJC midwives. Susan Jenkins, legal counsel for the National Birth Policy Coalition and attorney for midwives of Missouri, said, “After the bill, which addressed many health issues and included the midwifery designation, was passed and signed by the governor, the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri Academy of Family Physicians and the St. Louis Metropolitan Medical Society filed lawsuits. to strike down the section that would authorize the legal practice of midwifery in the state. The lower court declared the law invalid, but the state of Missouri appealed along with the Friends of Missouri Midwives, the Missouri Midwives Association and others. A professional naturopath may be considered liable for damages under the law if the physician causes damage to the client through a negligent act or omission. So far, most health-related litigation has been directed against the medical profession. A minority of cases are directed against health facilities in relation to the practice of nursing and midwifery. In recent years, there have been a few cases in England where midwifery has been a problem.

The purpose of this article is to report on such a case. It is important for all midwifery practitioners to know what facts and circumstances midwives have been found to be negligent and how the courts have dealt with contentious issues. The Supreme Court – the UK`s highest court – ruled that an obstetrician who failed to inform a mother of the potential risks of shoulder dystocia was negligent (Montgomery v Lanarkshire HB, 2015). Shoulder dystonia occurred and the baby, born in 1999, had a significant disability. This case will have far-reaching consequences because of the now recognized legal obligation to warn against risks. Previous advice on informed consent (e.g. NHS Choices, 2014) is now supported by the UK`s highest court. Midwives can also commit the same medical malpractice that can cause birth injuries as obstetricians. Why do you not hear about $20 million verdicts against midwives for birth injuries? Because in cases of birth injury, the key is to find negligence on the part of the deep-pocketed hospital that has the coverage and assets to execute a judgment. It`s rare to find a midwife who has more than $1 million in coverage. Cases of meritorious birth injuries against the midwife alone usually result in the insurance company offering the full insurance policy fairly quickly.

Parenthetically, this is why the Internet has a hundred thousand pages to attract lawsuits for birth injuries, but few mention midwives giving birth to so many babies. Organizations that support the midwifery profession in Missouri issued a press release in response to the ruling that there are good midwives.