Finding common ground requires interaction

“Holly, we love you. You’re a smart lib.” I laughed when a Toledo midwife told me this on a recent Zoom meeting with several other Ohio midwives, who nodded their heads in agreement.

Being a Democrat or Republican, liberal or conservative, is not the same as ticking off a preset list of requirements. Or, as I often tell my college students, never trust anyone who tells you anything is a simple, binary issue. People are complex, issues are complex and, as a result, so is history.

Holly Christensen:Protecting community midwifery for all Ohioans

In his 2000 book, “Bowling Alone,” author Robert Putnam claimed “our stock of social capital – the very fabric of our connections with each other, has plummeted, impoverishing our lives and communities.” As an example he pointed out that while more Americans were bowling than before, fewer were doing so in leagues.

It is important to seek out situations that are not just echo chambers of already held beliefs. In a recent New Yorker article, “Can Pickleball Save America?” the increasingly popular sport is described as “transcending socioeconomic lines” and “bringing Americans out to meet other Americans in ways they normally wouldn’t.”

The pickleball players I know are evangelically enamored with the game. Similar to tennis and pingpong, pickleball was designed for adults and kids to play together. Baked into the rules is being friendly, while size and strength matter little. Recently a tiny grandma in Pittsburgh made news when she won a pickleball doubles match. Her partner and the other two players were all Pittsburgh Steelers.

To say I’m not athletic is an understatement, so, for now, pickleball is off the table. But I am a Democrat with a strong commitment to social justice. I also have Libertarian leanings.

According to the Libertarian Party’s website, “Libertarians strongly oppose any government interference in your personal, family, and business decisions. Essentially, we believe all Americans should be free to live their lives and pursue their interests as they see fit as long as they do no harm to another.”

Holly Christensen:Museums for all should not be a secret

Like other so-called alternative choices, such as chiropractic care (love it), locally raised food (love it) and home schooling (not for me), home birth appeals to those on the far right, the far left and many along the spectrum of the two.

In the mid-’90s, I worked on protecting the legal status of Ohio’s community midwives for over two years, becoming friends with legislators, midwives and home birth mothers, many of whom were very conservative.

Holly’s sons Jules and Hugo hold their new brother, Leif, moments after watching his birth in 2010.

Many Democratic legislators were resistant to the continued practice of unregulated community midwifery in Ohio. They then feared a two-tiered system of health care delivery based upon the historical lack of access for poor pregnant women to birth in hospitals prior to the enactment of Medicaid in 1965.

Today, in what first looks like an about-face, some Ohio Democrats hope to expand midwifery care to address the unacceptable maternal and infant mortality and morbidity rates of Black mothers and babies. But they would have done so by regulating community midwifery out of existence by criminalizing non-licensed midwives. Their bill, House Bill 402, was introduced in September 2021, then quickly fizzled.

Republican state legislators remain largely uninterested in regulating community midwives. So it was surprising that in one of his final pieces of legislation before he retires, Republican state Rep. Kyle Koehler of Springfield sponsored a bill similar to HB 402.

I’ve participated in virtual meetings with Rep. Koehler and he sincerely hopes his legislation will help address the plight of Black mothers and babies in Ohio. I don’t think it will, but I respect him and believe his efforts arose from earnest concern.

Meanwhile, the very real problem of Black maternal and infant mortality and morbidity needs real solutions and HB 496 is not it.

Working closely with Ohio’s state legislators, both Republicans and Democrats, has taught me not to make broad, iron-clad assumptions about people in either party. At the same time, working with other citizens on community midwifery has taught me that the common ground shared by all Americans is not as small as what cable-TV talking heads would have you believe.

Once the midwifery legislation is settled, perhaps I’ll reconsider joining a pickleball league and get to know people who are diverse in multiple measures over a game known for how fun it is. I know a few retirees who’d love to teach me (and you and everyone) how to play.

This was first published in the Akron Beacon Journal on Sunday, October 16, 2022.


Protecting community midwifery for all Ohioans

Community midwife Pam Kolanz with Brittany Kash and Kash’s two children and newborn, Theodore, the day of the baby’s planned home birth in North Olmstead. Photo courtesy of Julie Ann Johnson

Benjamin Franklin once wrote, “Nothing is certain except death and taxes.” However, prior to both death or taxes, one must first be born. And throughout human history birthing women have been attended by midwives. Today, this remains true in most countries except for the United States where the majority of women are attended by obstetricians. 

That said, a wide array of midwives do exist in the US. Nurse midwives practice mostly in hospitals and birthing centers under the oversight of doctors.  

But an array of non-nurse midwives, also known as lay, direct-entry or community midwives, practice under laws that vary from state to state. These midwives specialize in the care of mothers and newborns, with the understanding that much of what a nursing degree entails is not relevant to their practices. 

Holly Christensen:Museums for all should not be a secret

Because I had a mother who birthed my two younger sisters at home, I was familiar with midwifery when I became pregnant with my first child in 1993. The same two midwives attended the home births of my first two sons in Columbus while my last three were attended by the same midwife in Northeast Ohio. 

In 1996, while I was pregnant with my second son, community midwifery in Ohio was suddenly jeopardized. In an advanced-practice nursing bill, the State Medical Board tried to have the State Nursing Board take on the oversight of community midwives. 

The State Medical Board mislead the nursing bill’s sponsors when telling them that community midwifery remained only in Ohio’s Amish communities. An early draft of the nursing bill would have made community midwifery, outside of a religious community, a felony for the midwife and a misdemeanor for the birthing mother.  

The bill’s language was so aggressive most community midwives were afraid to speak out for fear their names would be collected and they’d be charged with a crime should the bill pass. Instead, home-birth mothers became the face of community midwifery at the Ohio Legislature.  

As the founding director of Ohio Friends of Midwives, I informed the sponsors of the nursing bill that the Amish are not unique when it comes to home births with midwives. Furthermore, the majority of midwives attending Amish mothers are not Amish themselves. 

The criminalizing language was stripped from the nursing bill and a legislative study council, of which I was a member, was created to help state legislators better understand how community midwives practice in the state and what, if any, regulations should be considered. 

Holly Christensen:Investment of time with oldest friends pays huge dividends

The study council met monthly for 12 months, heard testimony from some in the medical community opposed to community midwives and testimony in support of community midwives from sociologists and nationally recognized community midwives, including Ina May Gaskin, who for many years taught several birthing techniques to obstetrical students.  

But it was the testimony from families who had birthed children with community midwives that perhaps had the most impact on the study council. 

At the July meeting supporters filled a large hearing room and the hallways at the Statehouse. The turnout was higher than at any previous public testimony event for any other issue in the state’s history. A second session of testimony was scheduled and equally well attended. 

In the end, the Direct-Entry Midwifery Study Council decided to leave community midwifery legal and unregulated in Ohio. The Ohio Department of Health created a registration process for community midwives to sign verifications of pregnancy and live births, including birth certificates, and the ODH supplies newborn screening tests to community midwives. 

Also, under the Ohio Administrative Code, community midwives are allowed to practice at exempt birthing centers, of which there are currently six operating throughout the state. 

In the 25 years since the study council submitted its final report, Ohio’s community midwives have continued to attend women throughout the state, serving families from all backgrounds, educations and incomes, in rural, urban and suburban communities. 

And they’ve done so with remarkable outcomes.  

One reason for this is that mothers with high-risk pregnancies, the definition of which is debatable, are referred out to obstetricians. But secondly, the Midwifery Model of Care, which provides a wholistic approach with pregnant women, consistently results in better outcomes.  

While doctors and hospitals have an important role in maternity care, the current system in America needs improvement. The statistics for infant and maternal mortality and morbidity in the U.S. are unacceptably grim. In 2018, the U.S. ranked 32nd among developed countries for infant mortality, while preventable maternal deaths rose nearly 200% from 1993 to 2014.  

When the statistics for Black mothers and babies are removed from the U.S. data, however, the numbers noticeably improve, revealing a complex problem that was the subject of an entire issue of The New York Times Magazine in 2018. 

Holly Christensen:Color my world, or at least my home

Here in Ohio two recent bills propose to radically change the way community midwifery is practiced in the state. Sponsors of both bills claim their legislation will address the unacceptable outcomes of Black mothers and infants by expanding midwifery care.  

Of the two bills, House Bill 496 seems to have the most traction. As written it requires the licensure of community midwives with the goal of providing care in birthing centers, and possibly hospitals, where Medicaid is accepted. But it would also criminalize the practices of all non-licensed community midwives. 

On June 9 of this year, while listening to the local NPR program “The Sound of Ideas,” I was stunned to hear two supporters of HB 496 claim that Ohio doesn’t have what they called “granny midwives” (a condescendingly quaint and grossly inaccurate term). I called the show and informed the host that Ohio has, in fact, more than 100 community midwives practicing everywhere in the state. 

In response to my call, one of the guests, who had just claimed community midwives don’t exist in Ohio, stated that these very real midwives can’t bill insurance, so Ohioans pay for them entirely out of pocket. This is also not true. I’ve given birth to five children at home in Ohio and all were covered by whatever private medical insurance I had at the time, including my last birth in 2012.  

If the practices of community midwives, who are currently legally recognized in the state of Ohio, become criminalized, many women in Ohio will continue to birth at home, particularly in Plain communities, but without the benefit of a midwife. As a result, maternal and infant mortality and morbidity will increase.  

One way to bring the Midwifery Model of Care to mothers on Medicaid without criminalizing community midwifery is to enlist the assistance of what are known as doulas. As pointed out in the New York Times Magazine issue on this topic, when doulas, who provide preventative and supportive care to mothers, work alongside obstetricians, outcomes improve.  

But the simplest solution would be to make licensure optional for Ohio’s community midwives as other states, such as Minnesota, have done.  

There is no reason for Ohio’s legislature to endanger one population in an effort to help another population. For as long as Ohio has been a state, community midwives have been attending birthing women with great success. Their practices present no problems that need solved by criminalizing their profession. 

This was first published in the Akron Beacon Journal on Sunday, October 2, 2022.