Cradling her 2-month-old son in her arm as she read her statement, Wendy Lefko of Northwest Washington told members of a City Council committee last week that the birth of her child had been "trouble-free, drug-free and speedy." Her son Morgan was delivered by a nurse-midwife instead of a doctor.
Lefko, who said she chose delivery by a nurse-midwife even though she always had had good experiences with doctors, spoke in support of the proposed D.C. Midwifery Practice Act. The legislation would allow women the option of using either nurse-midwives or physicians for pregnancy-related care. Lefko's son was born at George Washington University Medical Center.
One of the reasons Lefko said she favors nurse-midwives instead of physicians for normal deliveries such as hers was that they provide "continuous bedside attention" during labor, while doctors just "scoot in and out."
Lefko had the support of her obstetrician, Dr. Cheryl Gardner, who also addressed the committee. Gardner, a physician with the Group Health Association, said she believes nurse-midwives "do a better job than the average physician" during labor and in such areas as counseling, educating and "achieving rapport" with patients.
Although both the D.C. Medical Society and the American College of Obstetricians and Gynecologists have acknowledged that nurse-midwives should be permitted to exercise their profession, both organizations are opposed to language in the bill that they contend would establish independent practices for nurse-midwives.
Dr. John H. Niles, chairman of the obstetrics and gynecology section of the D.C. Medical Society, said the legislation as currently written does not provide for supervision by a physician, a complaint the bill's supporters deny.
Niles urged that the bill be rewritten to provide that nurse-midwives practice "under the supervision of a physician." Sally Thom of the American College of Nurse-Midwives (ACNM) called the suggestion "unduly restrictive."
Virginia Crandall, a certified nurse-midwife and a spokesman for the local ACNM chapter, added that at present nurse-midwives in the District are sometimes unable to practice their professions because they are not licensed.
Crandall said that although nurse- midwives "manage individual cases independently if the case is normal," they do not practice in a vacuum. She said they work within the structure of a health care system in a "team relationship" with a physician.
In a letter to the committee, Dr. Allan B. Weingold, professor and chairman of the department of obstetrics and gynecology at George Washington University School of Medicine, said he feared that the bill as written would lead to a "license for home delivery in D.C." and expressed concern that home deliveries might increase the infant mortality rate. George Washington University Hospital has the largest nurse-midwife service in the District.
In earlier testimony to the committee, Weingold said it is "essential" to license nurse-midwives but favored direct supervision by doctors.
After the two-hour hearing, some of the bill's supporters charged that physician opposition to the bill's language is economically motivated. They suggested that physicians are concerned with the prospect that nurse-midwives, who now function primarily as employes of physicians or hospitals, would receive direct reimbursement.
The nurse-midwifery bill, introduced in February by Council Member Polly Shackleton (D-Ward 4), was cosponsored by Council Member Betty Ann Kane (D-At Large) and Council Member Hilda H. M. Mason (Statehood-At Large). Mason told the gathering that she had been delivered by her great-grandmother, "who was a midwife."
More than 80 persons, including several infants and toddlers, attended the hearing, which was described as a "preliminary" step in the process toward passage of the bill. Shackleton and Kane, who are not committee members, pledged their support of the legislation. "If it does not get through in this session of the council , which is over in January," said Shackleton, who is seeking reelection, "I will introduce it again. You can be sure it will stay before the council until we get it passed."
Kane, a candidate for mayor, said she is "anxious to see the legislation move forward."
Committee Chairman Wilhelmina J. Rolark (D-Ward 8) postponed further discussion until this week, when she said remaining statements from the public would be heard.