Midwives Fight Back: The First-of-Its-Kind Legal Move to Save SC Birth Choice
- Sandy Glenn, LM MBC
- 3 hours ago
- 4 min read
The recent legal battle between South Carolina midwives and the Department of Public Health (DPH) has taken a significant turn. Following a contentious session in the South Carolina Administrative Law Court (SCALC), the Ethics, Competency, and Performance Committee (ECPC) has officially moved to intervene.
This case, which began as a trial against an individual midwife, has evolved into a high-stakes defense of midwifery autonomy and regulatory due process. At the heart of the conflict is a push by the DPH to impose hospital-based standards on out-of-hospital births—specifically regarding fetal monitoring.
The Role of the ECPC: Demanding Regulatory Compliance
The ECPC has stepped forward as the representative organization for midwifery in the state to address what it describes as a critical procedural failure. During testimony at the SCALC, the committee highlighted that the midwife in question was denied an internal peer review process, which is a mandatory regulation in South Carolina.
Why Procedural Integrity Matters:
Exhaustion of Remedies: State protocol dictates that all internal professional processes and reviews must be exhausted before DPH or government agencies can send citations to the Administrative Law Court.
Expertise in Oversight: Moving forward, the ECPC is seeking to have the case remanded back to the DPH for a "Best Practice Review." This would ensure the case is evaluated by professionals with clinical birth experience, rather than a single ALC judge who may lack the specialized background required to judge midwifery care.
Preserving Legal Claims: The intervention motion was accompanied by an Amicus Curiae brief describing the DPH’s failures and the ongoing conflict between ACOG standards and Sound Midwifery Practice (SMP). These filings are designed to preserve the ECPC’s claim on the outcome and allow for future filings if the court reaches a non-desirable decision.
Understanding the Conflict: ACOG vs. Sound Midwifery Practice
The DPH’s current position is that midwives must adhere strictly to the American College of Obstetricians and Gynecologists (ACOG) standards. However, midwives argue that Sound Midwifery Practice (SMP) provides a more appropriate framework for out-of-hospital births.
A primary point of contention is the DPH’s claim that there is no reliable way to assess fetal well-being without Continuous Fetal Monitoring (CFM). This assertion directly challenges long-standing midwifery practices:
Feature | ACOG Standards (Hospital-Based) | Sound Midwifery Practice (Community-Based) |
Monitoring | Emphasizes continuous electronic fetal monitoring. | Utilizes intermittent auscultation (listening at intervals). |
Environment | Designed for high-intervention hospital settings. | Tailored to natural, low-intervention environments. |
Mobility | Often limits mother's movement due to equipment. | Encourages mobility to aid labor progress. |
Why Continuous Fetal Monitoring is Controversial
While CFM is standard in many hospitals, it is not without risks. Research indicates that continuous monitoring in low-risk pregnancies can lead to:
Increased Interventions: Higher rates of cesarean sections and instrumental deliveries.
False Positives: Alarms that may not indicate a real problem, leading to unnecessary stress.
Reduced Patient Choice: Restricting the birthing person's ability to move or use water for pain management.
The Impact on Midwives and Families
If the DPH’s position prevails, it could set a dangerous precedent where midwives are judged by standards designed for surgeons rather than the specialized care they are trained to provide. This pressure could force midwives out of practice, significantly reducing access to birth choices for South Carolina families—especially in rural or underserved areas.
How You Can Support Midwifery Rights
The outcome of this intervention will shape the future of birth choice in our state. To help protect the profession and ensure your voice is heard, please take the following steps:
Advocate for Peer Review: Support the ECPC's demand that midwives be evaluated by those with actual clinical birth experience, ensuring fair and knowledgeable oversight.
Stay Informed: Follow updates on the ECPC’s filings and the progress of the SCALC hearing to stay current on legal developments (Follow Palmetto Association of Licensed Midwives, Join the private group Consumers Unite for SC Midwives.
Contact Your Representatives: Send a respectful email to your local state representatives and the South Carolina Attorney General. Let them know you value diverse, safe birth options and the preservation of Sound Midwifery Practice.
Target Key Committees: Direct outreach is especially vital for the following committees overseeing healthcare and regulatory efficiency:
Senate Medical Affairs Committee: Contact Chairman Danny Verdin to urge support for midwifery autonomy.
House Government Efficiency and Legislative Oversight Committee: Reach out to Chairman Jeff Johnson regarding the DPH’s failure to follow mandatory peer-review protocols.
The ECPC’s intervention is a stand for the integrity of the profession. It is a demand that the law be followed and that midwifery expertise be respected.
Potential Email Template: Support for Midwifery Rights and Regulatory Oversight
TO:
SC Attorney General Alan Wilson: awilson@scag.gov , infor@scag.gov
Find your STATE Senator and State Representative here: https://www.scstatehouse.gov/legislatorssearch.php
Email the full Senate Medical Affairs Committee: https://www.scstatehouse.gov/email.php?T=C&C=S2000000900
Email the full House Government Efficiency and Legislative Oversight Committee: https://www.scstatehouse.gov/email.php?T=C&C=H2000000235
Subject: URGENT: Support for Midwifery Rights and Regulatory Oversight
Dear [Representative/Senator/Attorney General Last Name],
I am writing to you as a constituent and a supporter of midwifery care to urge your immediate intervention regarding the Department of Public Health’s (DPH) recent actions against South Carolina midwives.
The DPH is currently attempting to impose hospital-based standards (ACOG) on community-based births, bypassing mandatory peer-review protocols. This overreach threatens the autonomy of the midwifery profession and severely limits safe birth choices for families across our state.
I respectfully request that you intervene on behalf of midwives and consumers to ensure:
1. The DPH follows established state regulations requiring internal peer review by those with actual clinical birth experience.
2. Protection for Sound Midwifery Practice (SMP) as a valid and safe framework for out-of-hospital births.
3. Oversight into the DPH’s current regulatory practices to prevent the elimination of diverse birthing options in South Carolina.
The outcome of the current SCALC proceedings will shape the future of birth choice in our state. We need lawmakers and the Attorney General to stand up for regulatory due process and the rights of families to choose their care providers.
Thank you for your time and for your commitment to the health and rights of South Carolinians.
Sincerely,
[Your Name]
[Your Address/District]