An administrative law judge (ALJ) just wrote an opinion that, if it is not defeated on appeal, will make all out of hospital births unavailable in Missouri. The ALJ, writing for the Board of Nursing, ignored the opinions of every expert with actual experience with out of hospital birth, and adopted the opinions of the hospitalists who formed their opinions without knowing the facts. Essentially, the ALJ decided that the standard of care requires that all babies be born in a hospital because the people who work in hospitals say so. It isn’t that home birth is illegal, but if attending a birth outside the hospital violates the standard of care, then midwives will not be able to attend them.

The ALJ reached the impossible conclusion that every birth professional “must either be able to perform . ..  surgery or be equipped to obtain for the patient the surgery that is required.” Read in context of the case (page 27 of the decision below), the standard of care requires immediate surgical services available, even for out of hospital birth. Of course, it would also violate the standard of care to attempt surgery at home or in a birth center.* This means that there is no way to provide care at home.

This is another in a growing line of cases where the pre-formed biases of hospitalists triumphs over evidence-based care. As we continue to fight for the rights of mothers and families to choose evidence-based care outside of a hospital, we also must fight for the right of providers to offer that care. These rights are inextricably interconnected: if nurses and midwives cannot attend births outside the hospital, women will have to choose between unattended birth and simply giving up their right to choose a reasonably safe alternative.


*There may be extreme situations where this is not true, but probably only situations a lawyer or a novelist could dream up.