A Summary of the Illinois Home Birth Safety Act

Here's a summary of the Home Birth Safety Act (Illinois SB 3712). I meant to write this ages ago; I hope it's not too late for people who want to be informed about this bill!  You can read the full text of SB 3712 here.

It legalizes CPMs but establishes the title of Licensed Midwife (LM). You can also call yourself "LM, CPM" if you hold CPM certification. However, see below; it sounds like CPM certification is a requirement for licensure.

Licensure requirements (pp.27-28):

1. An Associate's degree, either a general degree or nursing or midwifery, including life sciences, biology, and pharmacology.
2. Complete a 3-5 year midwifery education program approved by the North American Registry of Midwives including "clinical internship"
3. Pass a written and practical exam
4. Hold a valid CPM credential

It sounds like existing CPMs could be "grandfathered in" before August 2010, but since the bill didn't pass before then, would that date be moved? Interestingly, no evidence of practice submitted for licensure can be used against midwives if it occurred before the Act legalized such practice (p. 28 lines 9-13) though don't trust me on that, I'd figure it out for yourself before endangering yourself!

Midwives would be enabled / required to (pp.6-7):

1. give prenatal care and testing according to ACOG guidelines
2. provide 24 hour on-call availability
3. provide labor support and supervise delivery
4. provide postpartum observations until mother and baby are stable, for no less than 2 hours
5. complete birth certificates
6. offer metabolic blood screening of the newborn
7. offer vitamin K injections
8. offer administration of antibiotic eye ointments (gonorrhea prophylaxis

Medications midwives would be enabled to use, with strict dosing limits written into the bill (pp.8-12):

1. Oxygen for fetal distress
2. The aforementioned eye antibiotics (tetracycline and erythromycin)
3. Oxytocin or Pitocin for postpartum hemorrhage prevention or treatment
4. Methergine for postpartum hemorrhage
5. Cytotec for postpartum hemorrhage
6. Vitamin K
7. Rhogam
8. Intravenous fluids (lactated Ringer's solution, which is water with electrolytes) for "maternal stabilization"
9. Lidocaine injection for local anesthesia for repairing perineal tears
10. Sterile water injections to the lower back for nonpharmacological pain relief (?? I don't know anything about this!)

Midwives must have a formal relationship with an obstetrician or certified nurse midwife (p.21), including quarterly reviews of client records, but not requiring their presence for clinical care, and must consult with them when needed, such as (pp.13-20): 

1. Pregnancy-induced high blood pressure or persistent severe headaches
2. Persistent urinary tract infections
3. Significant vaginal bleeding, not associated with labor or uncomplicated spontaneous abortion
4. Rupture of membranes before 37 weeks
5. Notable decrease in fetal movement, or no fetal movement
6. Anemia (low hemoglobin) that doesn't respond to supplements (i.e. iron, B vitamins?)
7. Fever > 102 degrees for more than 24 hours, or > 100.6 at delivery
8. Nonvertex presentation (i.e. not head down) after 38 weeks
9. Persistent vomiting or dehydration (hyperemesis)
10. Rh negative sensitization
11. Elevated blood sugar levels resistant to dietary changes
12. Positive HIV or genital herpes
13. Malnutrition
14. Suspected blood clots (deep vein thrombosis)
15. Low-lying placenta after 28 weeks
16. Labor before 37 weeks
17. Gestation longer than 42 weeks "by reliable confirmed dates" (remember the Day 14 myth!)
18. Multiple gestation
19. Prior uterine incisions. Home midwives may attend not attend first-time VBACs but may attend subsequent VBACs. In other words no initial HBAC, home birth after cesarean.
20. Abnormal ultrasound findings (low fluid, restricted growth, etc)
21. Failure to void the bladder 6 hours postpartum
22. Signs of significant maternal depression
23. Dozens of findings related to the infant, including Apgar < 6 at five minutes, respiratory distress, low birth weight, failure to pass meconium by 48 hours, jaundice, etc.

Consultation does not precluding the possibility of out-of-hospital birth.

Guidelines for emergency transfer to hospital include the emergencies you'd expect, but explicitly delineated (pp. 19-20).

Midwives may NOT (pp. 22-23):

1. Give prescription medications to induce or augment labor
2. Use vacuum extractors or forceps
3. Perform "major surgical procedures" including "abortions, cesarean sections, and circumcision"
4. Accept primary care for a woman with significant organ system disease, cancer, insulin dependent diabetes, confirmed Rh disease, alcoholism, drug abuse, current serious psychiatric illness, and several other conditions 

The seven-member Illinois Midwifery Board will consist of (pp.23-24):

1. Four CPMs with three years out-of-hospital birth practice
2. One obstetrician or family practice physician with at least two years out-of-hospital birth practice
3. One certified nurse midwife with at least two years out-of-hospital practice
4. One "knowledgeable public member" who has given birth with the assistance of a CPM at home (interesting)

After three years of the passage of this Act, no one may act as or give themselves out to be a home birth midwife without being licensed under this Act. Midwives who are unlicensed but still practice are subject to a civil penalty up to $5,000 in addition to any other penalties under law.

The rest of the bill has to do with administrative issues, how Board membership is managed, and disciplinary actions and license suspection/revokation (nothing seemed out of the ordinary here, basically revolving around people who violate the Act).