A state Board of Health committee on Thursday recommended upholding disciplinary action against a Little Rock midwife whose client refused a vaginal exam during an assessment by the state Department of Health.
After an almost four-hour hearing in Little Rock, the committee unanimously agreed with the department that, by delivering her client's baby in November, Mary Alexander violated a requirement that her clients receive two assessments meant to determine whether a home delivery is safe.
The Health Department began requiring vaginal exams in October as part of the assessments it performs at county health units.
Alexander, who is chairman of the state's Midwifery Advisory Board, argued that the exams are unnecessary. She accused the department of retaliating against her after she complained about the difficulties the requirement was causing for midwives and their clients.
"We still haven't solved that issue," Alexander said. "I don't think it's fair to punish me over trying to make the best of this case without help from the women's health section" of the department.
The committee, made up of board members Susan Jones of Marion, Phillip Gilmore of Crossett and Robbie Thomas Knight of Little Rock, also recommended upholding the department's plan of improvement for Alexander, which includes ensuring her next five clients receive complete risk assessments.
The committee's recommendation will go to the full Board of Health, which meets July 26.
State regulations bar a licensed lay midwife from delivering a baby unless the mother has passed two assessments: one shortly after the midwife begins providing care and the other at or near the 36th week of pregnancy.
The assessments are meant to determine whether the mother has any medical conditions that would make a home birth dangerous or require consultation with a doctor.
In the past, women could sometimes decline the vaginal exam but still complete the assessment at a Health Department unit. That isn't the case now.
William Greenfield, the medical director for the Health Department's family health services, has said the protocol was developed by a panel of department nurse practitioners to ensure standard practice across different health units around the state.
The vaginal exam allows the nurse to assess whether the woman's pelvis is large enough for a vaginal delivery, to spot genetic conditions that could pose risks for such a delivery and to look for infections that could be passed on to the baby, he said.
State regulations don't require the risk assessments to be done at the department. But midwives say few clinicians outside the department will perform such assessments for women who plan to give birth at home.
Under new regulations that take effect June 1, midwives will be able to make a judgment about a risk assessment's findings, even if the Health Department considers it to be incomplete because of the woman's refusal to submit to the vaginal exam, said Namvar Zohoori, the department's chief science officer.
But Alexander said the department told her it will rule on whether a midwife's decision to accept a risk assessment was appropriate on a "case-by-case basis."
"It should be, any woman who declines this vaginal exam should be able to continue care with a midwife if she understands what she's giving up," Alexander said.
Alexander's client, Molly Butler of Little Rock, said she underwent her initial risk assessment at a private clinic, but was told she wouldn't be able to return unless she went to the clinic for all her prenatal care.
When she went to the Faulkner County Health Unit for her second assessment, she said the nurse practitioner there told her the vaginal exam was needed to check the position of the baby, even though the nurse had already checked that by touching Butler's stomach.
Butler said she considers herself and her husband, both chiropractors, to be "very knowledgeable people when it comes to health and the human body," adding that she is also "a very modest person."
"If I as a mother don't think that something is necessary, and don't want it done to my body or to my child, then I feel like that's my right to say that I don't want something," Butler said.
Metro on 05/11/2018