An Arkansas homebirth midwife is facing disciplinary action.
An Arkansas homebirth midwife is facing disciplinary action for honoring the wishes of her client to decline a vaginal exam during pregnancy.

Many pregnant women seeking to minimize medical interventions during pregnancy turn to home births. With the hope that they will be able to make informed choices surrounding their pregnancy and childbirth, some women look to the care of midwives. Midwives are often able to provide a holistic level of care that is sometimes lacking in the medical industry.

One midwife in Arkansas is under fire for refusing to drop one of her pregnant clients who declined a vaginal exam. Mary Alexander, a lay midwife, asserts that she would not abandon a client, especially one making an informed decision by refusing an exam that is medically unnecessary.

In October 2017, the Arkansas Health Department began requiring vaginal exams as part of the pregnancy health assessments. According to the Health Department, the exams are meant to identify whether the mother has any medical conditions that would make giving birth at home dangerous. The regulations prohibit a licensed lay midwife from delivering a baby unless the mother "passes" two vaginal assessments, one at the beginning of pregnancy and one at 36 weeks.

Related: What's the Big Deal With Vaginal Exams, Anyway?

According to William Greenfield, medical director for the Health Department's family health services, the protocol was developed by a panel of nurse practitioners to ensure that there was a standard of practice throughout the state. Greenfield says that 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.

According to reports, nurse midwife, Mary Alexander, delivered a client's baby in November, one month after vaginal exams became mandatory. Alexander also happens to be the chairman of Arkansas' Midwifery Advisory Board.

Alexander's client, Molly Butler, underwent her initial risk assessment, but declined the vaginal exam at her second assessment, as she did not feel it was necessary as the baby's position was already determined. She testified that it was her decision alone to decline the vaginal exam.

"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.

Related: Mom and Dad Duo Give Birth Their Way: Unassisted at Home

Alexander was disciplined for her actions, and that decision was recently upheld by a three-member committee of the state Board of Health. She is required to complete a plan for improvement and to ensure that her next five clients receive the vaginal exams. The committee's decision will go to the full Board of Health on July 26th.

Many midwives and women argue that the invasive exam is not only unnecessary, but can lead to other complications such as infection or accidental premature rupture of membranes.

"We don't think that these vaginal exams are necessary," Alexander said. "They don't give information that would declare the woman high risk for home delivery or not."

While some women are getting the exams against their better judgment, others are refusing them all together. As a result, some women are choosing to have unassisted births at home. Deborah Phillips, a North Little Rock midwife and member of the midwife advisory board, told Arkansas online that three of her clients ended up giving birth at home, without her assistance, after she was forced to drop them as clients because they refused the vaginal exam.

Licensed lay midwives, also referred to as Certified Professional Midwives (CPM's), are trained in prenatal care, labor and delivery, and postpartum care. As of 2015, 27 CPMs were practicing in Arkansas.