A judge Wednesday rejected a request for a temporary order allowing midwives to help women who have previously had Caesarean sections give birth at home.
In a lawsuit, five women had also asked Pulaski County Circuit Judge Chris Piazza to stop the Department of Health from enforcing a rule requiring midwives' clients to submit to examinations to assess their risk of complications during labor and delivery.
At a hearing Wednesday, Piazza said that to grant the requests, he would have to find that the women's lawsuit challenging the Board of Health's rules is likely to succeed.
"I don't see that in this case," he said. He added that such a temporary order lifting the restrictions "might cause harm to an unborn child."
"The Department of Health has a duty, whether it's right or wrong, they have a duty to try to protect both the mother and child," he said.
The women argue that the rules limit their options because many doctors will not deliver babies vaginally for women who have had Caesarean sections in the past, and some hospitals have policies against such births.
One of the plaintiffs, Belinda Baxley of Paragould, testified that her two previous Caesarean sections have prevented her from being able to hire a midwife to deliver her third child, due in December.
Because no obstetricians in the area are accepting new patients who are on Medicaid, she said she has been receiving prenatal care at a clinic in Jonesboro where she sees a different doctor each time she visits.
One doctor is willing to attempt to deliver her baby vaginally, but there's no guarantee that doctor will be working at the hospital on the day she gives birth, she said.
"It just depends on who I get," she said.
She said her previous Caesarean sections have caused her to be depressed and left her with adhesions -- scar tissue that attaches to organs in her abdomen.
"It takes a long time to come back from where you can actually function like a normal person again," she said.
William Greenfield, the medical director for the Health Department's family health services, said women who have had Caesarean sections are 22 times more likely to suffer uterine ruptures during vaginal births.
Although the overall risk of a rupture is still less than 1 percent, it can have "catastrophic" consequences for the mother and baby, he said.
The American College of Obstetricians and Gynecologists in a November 2017 bulletin recommended against home births for women with previous Caesarean sections because of the "unpredictability of complications requiring emergency care."
Vaginal birth after a Caesarean section, or VBAC, "is a good thing, but VBAC at home is not," Greenfield said.
Bentonville attorney Kesha Chiappinelli, who is representing the plaintiffs, said obstetricians are against home births in general because they deliver babies only in hospitals.
Women who are barred from hiring licensed midwives may end up hiring unlicensed midwives or giving birth at home without assistance, putting them at greater risk, she argued.
"It drives midwifery underground," she said.
She said she doesn't plan to appeal Piazza's ruling.
The lawsuit claims that the state's regulations violate women's rights to refuse medical treatment and choose their providers.
It also contends that the Board of Health exceeded its authority in enacting the rules and failed to follow the Administrative Procedure Act when it revised them in January.
In the filing Tuesday, attorneys for the state asked Piazza to dismiss the case, arguing that four of the plaintiffs aren't affected by the rules because they aren't pregnant.
The attorneys also said the Health Board followed the law in revising the rules and that the U.S. Constitution doesn't guarantee the right to see a particular health care provider.
Piazza hadn't ruled on the dismissal request as of Wednesday.
Metro on 10/25/2018