LITTLE ROCK, Ark. (KTHV) - A central Arkansas midwife was under fire Thursday for not dropping a client who refused to have a state-mandated vaginal exam during pregnancy.
For decades, mothers have turned to midwives as an alternative to hospital births.
Mary Alexander, a Licensed Lay Midwife, appeared before a Department of Health committee Thursday, arguing her case for why she shouldn't be required to either coerce clients into having a vaginal exam, or be forced to drop them.
"It's just a matter of ethics. We don't want to abandon a client for no reason than her choosing her legal right to not get a vaginal exam,” Alexander told us at the hearing.
A new addition to Arkansas Department of Health's regulations means mothers utilizing midwives must have a vaginal exam by either a Health Department clinician, a certified Nurse midwife, or a physician before giving birth. Even if those health care providers won't be a part of the delivery.
"They're wondering why should that nurse do a vaginal exam that they don't want, when the licensed midwife could do that. If it's needed. I think at 36 weeks, that's a completely unfair position to put the midwife or the pregnant woman in."
ADH audited the paperwork surrounding a birth performed by Alexander after realizing the mother hadn’t gotten a vaginal exam as part of the risk assessment. That mother was present Thursday and testified to the committee the decision was hers and hers alone.
The argument of the mothers that presented Thursday was essentially they are the mothers, they know what's best for their babies and they don't think the government should tell them they have to have a vaginal exam if they don't want one. They also don't think their midwives should be punished for supporting that decision.
The ADH argues, it's all about the safety of the children.
"The pelvic exams are specifically designed to access the pelvis to ensure adequacy and identify any causes that could be complications later at the time of delivery. It's a standard part of an exam. That's not just limited to the patients that are getting the risk. It's actually a standard of care that pretty much applies to all patients receiving pre-natal care,” explained Dr. William Greenfield
The committee gave Alexander a plan of improvement with a number of stipulations to ensure there wouldn't be further disciplinary action. That decision will be reviewed by the full Board of Health. At that point she can appeal.
Alexander says the decision made today doesn't address the bigger issue about the authority of midwives.
"I think the Health Department has a very paternalistic kind of attitude towards women, that they know better than women about what they should do, and are not allowing them to make those choices for themselves,” the midwife told us finally.
June 1st a new set of regulations will take affect that will allow mothers to decline the vaginal exam on a case-by-case basis. It's unclear how that will affect the care of midwives.