[JURIST] The Supreme Court of Missouri ruled [opinion text] Tuesday that four physicians associations do not have standing to challenge the constitutionality of a state law that legalizes midwifery [American College of Nurse-Midwifes backgrounder]. The Missouri legislature passed the provision [text] last year as part of a larger health insurance reform act [HB 818 text, PDF]. The Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri Academy of Family Physicians and the St. Louis Metropolitan Medical Society [professional websites] challenged the law on the grounds that physicians could be subject to disciplinary action for aiding unlicensed midwives; the groups also argued that the bill violated the Missouri constitution [Article III text] because it had more than one subject and because the midwifery provision changed the bill's original purpose. Officials for Missouri Midwife Supporters said that the ruling gives families more options and freedom in birth methods, but the Missouri State Medical Association said that the provision "needlessly puts at risk the health of mothers and their babies" [press releases].
Missouri law prohibits physicians from aiding or encouraging an unlicensed person to practice medicine, and such actions can lead to the revocation of a physician's license by the state Board of Registration for the Healing Arts [official website]. Practicing midwifery in Missouri was previously a class-C felony that could be punished by up to seven years in prison, but the ruling allows all certified midwives to legally practice in the state. Certified Nurse Midwives, who have training in both nursing and midwifery, can be licensed in all states but usually must practice in association with a physician. Direct-entry midwives [state legal comparison chart] do not have to have formal training and usually do not have to practice in association with a physician, but they are prohibited in 10 states and not legally regulated in four others. AP has more. The St. Louis Post-Dispatch has local coverage.