Midwives In Kansas Sue To Practice Without Physician Oversight

Two nurse midwives in Johnson County, Kansas are suing to overturn a law that prevents them from practicing without physician oversight. Earlier this year Kara Winkler and Julie Gorenc lost the ability to deliver babies at an area hospital when a doctor ended their partnership.

Winkler and Gorenc work with Midwife Partners in Women’s Wellness and previously had a collaborative practice agreement with Dr. Janetta Proverbs. Together they had planned to help 25 clients give birth at the Shawnee Mission Medical Center, but the two midwives lost those clients when Proverbs ended the agreement and no other laborists at Shawnee Mission would take them on. Laborists are hospital-employed physicians who deliver babies for women whose OBGYNs can’t be there at the delivery, or who don’t have a regular OBGYN.

Represented by attorney Keith Williston, the women are suing Proverbs, four laborists, Adventist Health Mid-America (the parent organization of Shawnee Mission), and the president of the Kansas State Board of Nursing over the nurse midwife regulations. They are pursuing the lawsuit to recoup lost income.

According to The Kansas City Star, laws that restrict midwives to practicing only in collaboration with doctors also affects midwives in 18 other states. In 2015 and 2016 certified nurse midwives in Kansas had pushed for legislation that would allow them to practice independently. Their bill was opposed by a lobbying group for Kansas doctors. The two groups struck a compromise in which midwives could practice independently if they got one medical license from the state’s nursing board and one from the doctor’s board. This arrangement has since been bogged down in the regulation-writing process.

In this agreement, physicians still have the authority, as they can restrict midwives from practicing unless they give the doctors a cut of the revenue. Midwives generally have to accept any terms and conditions the doctors lay out. Mark Finkelston, an experienced OBGYN in Johnson County, says that doctors need to work with midwives in case the mother needs a C-section or other emergency care, and to give mothers a realistic picture of labor.

If an expectant mother chooses to use a midwife, it is typically because she wants to experience a natural childbirth and have personalized care throughout her pregnancy.

During childbirth, endorphins are produced that have a natural morphine-like effect, creating an altered state of consciousness and decreasing a woman’s perception of pain. While physician-regulated pain medication can help women during labor, this natural process facilitates a woman’s ability to cope with the birthing process as she shifts to an instinctive mindset. While midwives aren’t physicians, they are trained to help guide mothers through this natural process.

Winkler and Gorenc hope that soon the legal landscape will shift so that they, and other midwives, are able to deliver babies assisted only by their extensive training and the natural hormones of a woman in labor.