The Ordinary Doula Podcast
Welcome to The Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning. We help folks prepare for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
The Ordinary Doula Podcast
E91: Utah's Journey of Birth Laws with Guest Holly Richardson
Twenty years ago, having a baby at home in Utah could land your midwife in jail with felony charges. Today, Utah boasts the most flexible midwifery laws in the nation. What happened in between is a remarkable story of determination, political savvy, and grassroots organizing that forever changed how families experience birth in the state.
Holly Richardson, now known for her political commentary and radio show "Inside Sources" on KSL, joins us to share her firsthand account of the five-year legislative battle to legalize direct-entry midwifery in Utah. As one of the key architects of this movement, Holly reveals the challenges they faced, from powerful medical lobbies to threatening phone calls, and the creative strategies that ultimately led to success.
We explore how a small group of determined women navigated the legislative process despite being told they were fighting an impossible battle. Their persistence paid off in dramatic fashion when the bill passed by a single vote at 9 PM on the final day of the 2005 legislative session. This landmark legislation made Utah the only state with voluntary midwifery licensure and paved the way for birth centers to become legal options for families.
The conversation offers fascinating insights into how birth rights were secured through political activism. Holly shares amusing stories about their advocacy tactics, including flooding legislators with postcards announcing each home birth in their district and mobilizing hundreds of pink-clad supporters to fill committee rooms. These grassroots efforts transformed public perception of midwifery from fringe to mainstream.
For parents considering out-of-hospital birth today, Holly provides practical advice on selecting providers and understanding the licensing system. Whether you're interested in birth options, political activism, or how determined citizens can change laws against powerful opposition, this episode offers valuable lessons in persistence and the power of organized advocacy.
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
Speaker 2:Hello and welcome to the Ordinary Doula Podcast. I am your host, angie Rozier, and today we have with us a very special guest. Her name is Holly Richardson. She wears many, many hats. I'll kind of let her introduce herself, but the first hat I knew that she wore was my doula trainer some 23 years ago. Holly has, as I've watched her over the last several years, had her influence on so many different things, and she's an incredible woman. So, holly, will you introduce yourself a little bit, give us a little bit of background, and then we'll introduce our topic for the day.
Speaker 3:Sure it's. It's really varied right? So there's a lot of different things in my background. So doula and doula trainer was one of those. Also direct entry midwife, and that was one of the things that got me into politics, which led down a whole different path. I became a blogger. I had a blog called Holly on the Hill. I was going to say podcast, but they didn't even exist.
Speaker 2:Those weren't there back then, right they?
Speaker 3:were not. And then from there I started writing for the Salt Lake Tribune in Utah. I did opinion columns for four years and then I switched over to the Deseret News and I do opinion columns there, but more importantly, I do a daily newsletter called Utah Policy. So it really is about politics. So here you know, a long time later I'm really involved in politics, which when I was your doula trainer I did not. I mean you could have told me that and I'm like well, I ever like no way will that happen?
Speaker 3:Right so, and even even more outlandish is, I ended up getting a PhD in political science.
Speaker 2:Like what the freak you went down a big rabbit hole that you love rabbit hole right.
Speaker 3:So my first degree, my first academic degree, was as a nurse, and then I got two degrees in communication and finished it off with a degree in political science. Anyway, now I'm co-host of a radio show on KSL news radio. It's every morning from 9 to noon. It's called Inside Sources and it's really fun. It's something different. I've only been doing it for a few months and just really really love it. I have a chance to talk to lots of really fun people.
Speaker 2:Very cool. I love to listen to that. I try to catch you whenever I can, so you're doing a great job, thank you. So today, our topic. This is something as I've gone to a couple births throughout the year with home birth midwives, some of whom were in the industry 20 years ago got chatting and realized that 20 years ago something pretty incredible happened in the state of Utah around home birth and home birth midwives, and Holly had a front row seat to that, so I kind of wanted to chat with her about that. I actually wanted to host a party or a celebration or just shout it from the rooftops, because I think it's very important to.
Speaker 2:I mean, a lot of people don't know this story right, this is going to be new to them. But to realize what we have here in Utah the accessibility to options and choices for families of Utah and how they birth, where they birth came from 20 years ago. A lot of it, and I don't know that everyone knows that, so I just want to do a shout out for that. And during that 20 years, I did spend five years living in North Carolina, where the birth laws are incredibly different and how that impacted practice and families there. So, coming back to Utah, even more grateful for the options that we have here. So, holly, if you can tell us this story like, what was going on, what was different before 2004, 2005? And what was different after?
Speaker 3:So it's really funny to look back, because what the norm is now right, you just mentioned, it's kind of normal that we have options and we realize that we do. But in 2000, I had just I had actually just certified as a certified professional midwife, which is a national certification, and there was a midwife in the state of Utah who was arrested and charged with practicing medicine without a license and I, I mean, I felt like her actions were totally appropriate, they were certainly within the scope of her training and her skillset. But what we realized as a midwifery community is that the laws what we were told about the laws in the state of Utah were not actually accurate, so they were partially accurate. So parents had the right to choose, and parents 20 years ago could choose to deliver their babies wherever they wanted. However, if you were not so that's not illegal Parents were doing nothing illegal. Parents were not doing anything illegal.
Speaker 3:But if you were the provider, then you were practicing medicine without a license, which is a third degree felony, not good right. Without a license which is a third degree felony, not good Right they could pursue anything from diet that you diagnosed a pregnancy, you prescribed a specific treatment. So then you diagnosed, prescribed and treated. You just have three counts right there, right? So yeah, using, just anyway. There was a lot, and so, as we looked into the law, we realized that we did not understand completely how the law would apply until this midwife was arrested.
Speaker 2:So it kind of took that catalyst to take a good look it really did.
Speaker 3:Yeah, it really did. And then there was a. There was a kind of a cohort of us that were willing to be on the Hill and talking to legislators. This was a group effort, there's no question. This process took us five legislative sessions, so beginning with the legislative session in 2001. So one, two, three, four and five. So four calendar years, but five legislative sessions to pass a bill that legalized direct entry midwifery in the state of Utah. That legalized direct entry midwifery in the state of Utah. And I look back now with some amusement in some ways, because I remember it being really hard. It was really hard.
Speaker 2:And now- Because you didn't know the system.
Speaker 3:Yeah, partially. So one of the things that happened when we said, hey, we're going to go change this law, we had people say you do not want to know what you're doing. You're going up against one of the most powerful lobbies in the state of Utah, the medical association, and and you're never going to be successful. And they were right on two out of the three counts right. So we did not know what we were doing. We were going up against a powerful lobby and, and it took us a while but we were successful. And it's one of the things now where, at the time, it's like we have a 45 day legislative session in Utah. So if you are not done by the last week of March, you have to wait until January.
Speaker 2:Starts over, yeah.
Speaker 3:And I remember like just crying more than once when our bill died and we're like oh, we gotta wait another year.
Speaker 2:Does that mean you start over or do you start where you left off?
Speaker 3:There's some of both, right, so your relationships carry over. But there's elections every two years for representatives, every four years for senators, so you may have to reestablish new ones, rewrite the bill for sure, right? You had to be able to say, okay, what are your concerns? How do we address your concerns, those types of things. So the fourth year, so in 2004,. We were able to get it through the House, but it was killed on the Senate side by people we thought were our allies, and that was really disappointing.
Speaker 3:Oh that's hard. And then we had to wait another whole year Right, and it did not pass. It was one of the very first bills released in the session. It did not pass until 9 pm the last day of the legislative session.
Speaker 2:Wow.
Speaker 3:Wow so, and it only passed by one vote, wow. I mean it was close, it was close, Very close Very very close, and and what's interesting since then is it has just become the norm, right.
Speaker 2:Does it ever get contested along the way Like do we ever revisit?
Speaker 3:They did right at the beginning. Yeah, so our opponents contested right at the beginning, and by contest I mean they wanted to propose different laws. There was one like I don't think anybody did it the next year, but the second year after we passed it there was a bill that wouldn't have completely eliminated the law, but what it did was imply so many restrictions like you literally would have. Like, I don't know, maybe 5% of pregnant women would fit into that category, being able to risk out right, Right.
Speaker 3:So if you had ever had a baby before 37 weeks, if you ever had a baby after 40 weeks, if you'd ever have a baby bigger than eight pounds or smaller than six pounds, I mean it was so narrow that it was like this is ridiculous.
Speaker 3:And so after that we actually did have a rules committee for a while. That was established and set up and I was part of that. We had at least one physician now I can't remember at least one certified nurse midwife, we had two. I think we had three direct entry midwives actually on the committee and we came up with rules and those are the ones that are still basically in place, and what that did is one provide some parameters for these licensed direct entry midwives, but it also provided an additional level of things that you could do as an LDEM, because you had taken a pharmacology class and you had a physician that you worked with to create, you know, some kind of a list of things that they felt comfortable with you administering. There were also other rules about like when we transport those types of things.
Speaker 3:So we are the only state in the nation that has a voluntary licensure program. It's very unique. It can be confusing and that's one of the arguments I continue to hear is that's confusing because I thought they were licensed. Yes, some of the midwives in the state are licensed, but not all the midwives.
Speaker 2:So they are. They can be, they're allowed to be, but they don't have to be.
Speaker 3:That is correct.
Speaker 2:So that's pretty flexible.
Speaker 3:That's very flexible. But you're now legal as a direct wife to practice in the state of Utah, right, so you don't have to worry that you're going to go to jail, right, doing a birth, yeah, right, so yeah, so I recall I was a baby doula at the time.
Speaker 2:I remember going to a couple meetings. I didn't know what was going on, I felt overwhelmed. But I remember something about there was concessions given like twins versus V backs and like more people are going to be facing a V back at home than multiples, probably, and so things like that. And it sounds like this rules committee had the voices of everybody at the table. Right, everyone had a voice.
Speaker 3:Yes, and the rules committee came about after the law actually passed. So yeah, there are some things in the law that were kind of put in place. But yeah, you're correct about that. We wanted to be able to give as much flexibility as possible for as many situations as possible. But the twins thing is actually a rule and it's in the actual legislation, so it's in the rules for licensed direct entry midwives. So there are there. There's just like a variety of things Like if you're a licensed direct entry midwife in the state of Utah, you could administer Pitocin for a hemorrhage. If you are not licensed, you do not have the legal authority to do that. Everyone has the ability to carry oxygen, because even our detractors are like well, if you're going to do it, you should probably have oxygen.
Speaker 2:Right, let's be smart about it.
Speaker 3:So, yeah, yeah, so there were some of those things like that and it was, you know. From there we got the license, direct entry midwife act with rules put in place, so now we have a licensure. We also got birth centers, yes, legalized and licensed. And I will say that was suzanne smith.
Speaker 3:That was really her work, and one of the things that happened is it just came out as an offshoot, I think, of this work that we did with midwifery, because she started reading the law and she's she was like this law literally makes it impossible for anyone to have a birth center technically legal on the books, but so many restrictions, it was impossible. And so we had an ally Um, it was Senator Deidre Henderson at the time. She's governor for the state and she, like she had her interns scouring meeting minutes, listening to recordings, and she was like they were open in their disdain for birth centers and people who practice there and they're basically like we're going to prevent them from doing this. But we were able to press forward, especially Suzanne, and so now we have the ability to have legally licensed birth centers in the state of Utah as well.
Speaker 2:Which there are so many right Like there's. There's a plethora of birth centers available from all along the Wasatch Front and so many home birth midwives which people have a lot of choices.
Speaker 3:So, wow, yeah, and isn't that interesting, right, that that it's midwives which people have a lot of choices? So, wow, yeah, and isn't that interesting, right, that that it's it's been normalized. And you know, when I started this journey, I would say 25 well, I mean more than that before. When I started practicing, but the the legal journey 25 years ago, people largely were unfamiliar with midwives, right? So we would have legislators who asked us things like well, how do you do a C-section at home? Like, well, we do C-sections at home? Wow, right, and they just didn't know.
Speaker 2:A lot of education had to take place.
Speaker 3:Yeah, lots for a lot of them. So now we have things like Call the Midwife right, which is a really great realistic show. I think that normalized that and we have people who've discussed it more. And now, when I think that normalized that and we have people who've discussed it more, and now when I say, you know, I've been a midwife, they're like oh, that's really cool.
Speaker 2:It's like what is that? Yeah, yeah, interesting. So it has become more normalized and I know Utah has a higher home birth or out of hospital birth rate than many other states, which is kind of interesting, but these partially. I mean we have an interesting family dynamic here as well, but the laws are friendly to it as well.
Speaker 3:Yeah, the laws are friendly to it and we're as far as I'm aware, there are no rumblings of any kind of legislation aimed at doulas. But look, even lawmakers know what doulas are now, and there have been, in fact there've been several lawmakers championing doulas getting paid through Medicaid.
Speaker 3:Medicaid yes, yeah because there are plenty of studies now that show how helpful doulas are in decreasing the complication rate, which, at the bottom line, if you're a politician, a legislator, you're looking at how do I best spend taxpayer money? It's a lot better investment to spend on a doula.
Speaker 2:Yeah, absolutely that can bring down your obviously cesarean NICU, all those things right, All those things yeah. Wow that that brings a whole nother podcast episode to mind, Because that and that some states are like I work with a group that's working on that across the country, and some states are reimbursing $3,500 Medicaid, which is pretty incredible.
Speaker 2:Yeah, that's pretty incredible so hopefully we're making headway there and so just doing a little research. Like Alabama, nebraska, north Carolina remain, and illegal may be the not quite correct term, but they're just not allowed. They won't allow licensure, so same thing that Utah used to have, I suppose, right.
Speaker 3:Yeah, and I would say so. I think when we passed our law it was there was kind of a little flurry of states passing laws right around that time the early two thousands, and I think we were state number 26. So we were just the tipping point, to be over halfway. But there were some that were then and I think still are now very, very hostile to midwives, right, and it's like some of the stuff that we heard. We were called baby killers.
Speaker 3:We heard a lobbyist who still works on the Hill I still see him every year who said that if the state approved this, they would also have to set aside money for body bags because we would be burying people in our backyards. I mean there's stuff like that where it's like oh my gosh, right, we had at my house this is back in the day when we used to have a home phone. My kids would answer the phone and people would yell at them and tell them their mom was going to go to jail. I mean just, I mean people were not excited about this opportunity and now, um, again, it's become normalized, and that was one of the things that even our detractor said is, once you pass this, this becomes normal, this becomes what government says is okay and you don't want to go down that road. They were right about that first part. It has become normalized, yeah, yeah.
Speaker 2:And then a good way and a lot of ways, but also, because it is a pretty broad stroke licensed, unlicensed people have to be cautious, right, those who are practicing as midwives, licensed or not, and those who are choosing. So what advice do you have for families who are selecting out of hospital birth, because we have a lot of options? What advice might you have for those looking at birth centers or midwives out of hospital?
Speaker 3:I think you need to be really clear about asking whether they're licensed or not. And I will say this one of the more recent pieces of legislation and I'm going to think it's maybe I can't remember in relation to the pandemic, so in the last five years I think there's been a new law that says every single midwife, no matter what kind of midwife you are, has to have informed consent, and on that consent document you must specify what your training is and whether you're licensed or not in the state of Utah. And so so for parents, your best question to ask them is are you licensed in the state of Utah? What's your training? What's your background? What do you do in cases of emergency?
Speaker 3:Right, and the the concerns that I still hear rumblings on the Hill about is this people are just not sure. They heard midwife, they know licensure is available, they thought their midwife was licensed, right? So you can ask those types of questions. Absolutely would ask those what do you do in case of emergency? How do you solve, you know, how do you handle a hemorrhage? Are you licensed to carry Pitocin to stop a hemorrhage? What's your plan if we need to be transported to the hospital? But really you can ask just point blank are you licensed and where's your informed consent form?
Speaker 2:Yeah, and licensed that was through the NARM, correct? Is that kind of what?
Speaker 3:we're looking for.
Speaker 2:CPMs.
Speaker 3:Well, yes, for the state of Utah, you have to be to be licensed in the state of Utah, and that that's a really good point actually. So you want to know what type of licensure? So I guess, clarify the question are you licensed in the state of Utah as a licensed direct entry midwife? Because you can get a certification, that's the certified professional midwife, the CPM, right Without being licensed in the state of Utah. So you can do the one but not the other. But in Utah, to be a licensed direct entry midwife, you have to do both and there's a couple of additional steps that you have to take. You have to have the CPM. So they didn't want to reinvent the wheel. You do the CPM, the national exam, those things, but you also have to do a pharmacology class, you've got to do a fetal heart rate monitoring class, you've got to pass a background check and there's some CEUs that you have to do on an ongoing basis. So there is a difference and that's a very good question and thanks for asking that.
Speaker 2:Yeah, okay, and that's how I kind of looked up. It was like CPR is involved, obviously, record keeping, getting consent, like you had said, and it also comes in, as you had mentioned before, like transfers, when transfers happen, utah has become much more friendly to a transfer situation, correct, there's a lot of collaboration that's happened with that, which is helpful to everyone, right? Yeah?
Speaker 3:Yeah, and one of the things that happened during the birth center discussion is well, you have to have an agreement with the hospital, but that was part of the impossible paradox.
Speaker 2:I remember that.
Speaker 3:Not a single hospital that would say I will put in writing that I will take any patient that you transfer, but because of federal law affecting emergencies. So it's the EMTALA law, it's emergencies and labor right. Because of that, they will take anybody who comes in right. So typically people will transfer to the closest hospital.
Speaker 2:Right, just proximity, yeah, very cool, interesting Cool. Yeah, I know in North Carolina we had people going to South Carolina, virginia. Some of our midwives, long time midwives, have been in jail before and transfers like kind of dangerous, like they had to drop and go, like they couldn't share information because it's pretty hostile to that. So, gosh, I learned a whole big piece of gratitude for what we have.
Speaker 3:It used to be that way in Utah a lot of people or they would go in and they would say well, this is my sister, we're really. That's like the fourth one you've transported here.
Speaker 3:You have a lot of sisters, yeah Right, and I remember there were midwives who would. They were based in Utah, but because it was not legal, we were in this whole process. They would drive up to Wyoming and like an RV and they would do prenatal care and stuff up there in Wyoming, across the border, because it was already legal in the state of Wyoming, right, there's those types of things that actually make it less safe for parents having babies, and so now I think, yeah, utah does have a lot of really great options for parents.
Speaker 2:Yeah, so making it legal in this manner makes it more safe for everyone. I think so Very cool, I agree. Very cool, holly. Anything else you want to leave with us? And again my shout out from the rooftops is gratitude to those who did the work so many years ago and for those of us who have benefited from that. I've had two home births myself since then, been to dozens and dozens as a doula, but, but yeah, any parting thoughts with us for where we're at?
Speaker 3:I wanted to share you.
Speaker 3:I wanted to share a couple of funny stories, okay, so so we knew that we needed to get lawmakers attention and we we knew that there were people who were in opposition to our bill who were getting their attention, and so one of the marketing campaigns that we did was to send a postcard every time a baby was born and we added a couple layers of informed consent right, the midwife had to consent, the parent had to consent, but basically it was just a generic postcard and it was addressed to the lawmaker for that area, or the two right, a representative and a senator, and it said congratulations, a new constituent was just born in your district.
Speaker 3:Right, with a home birth midwife Clever. So there were so many going out that I had a like boxes that I had a senator come up to me one time and say I will not vote for your bill If you don't stop sending me those. You proved your point. And he he was only he was joking, mostly joking because he was a supporter, he was an early supporter, but it was so funny he was like just totally overwhelmed.
Speaker 2:Wow, that helps them see the numbers right, like it did right Real time. Nobody in my district has a home birth, right, so that was them. See the numbers right, like it did right Real time.
Speaker 3:Nobody in my district has a home birth right, so that was one of the ways to make that visible.
Speaker 2:And then also the opposers. I imagine when we look at numbers, they and say to hospital transfers you're going to see a fraction and not the best fraction, right? So the glimpse you're getting is not sure not the shining part yeah, sure.
Speaker 3:So eight, what eight? And ten stay home, right? Yeah, maybe 20 transfer. So so that was one thing. And then the other thing is we had done we adopted bright pink and that was my favorite color at the time, so I probably had some influence there. It was really fun, but we did m m's that. So for moms and midwives and opportunity, we had to hand out something with a statement or an invitation. It would be moms and midwives for whatever. So we get down to the end on the last session and we had all these moms and we ended up recruiting as many people as we could find. I swear we ended up with like 425 people, volunteers, some of them grandma and grandpas, some of them, you know, never going to have a baby in their life, some of them actively breastfeeding or pregnant, whatever. We just all these people and they all wore these stickers and then we just flooded the committee rooms and every legislator. When you look out there, you can see a sea of people who are there to support that bill. Right, that's powerful and impactful.
Speaker 2:So and that bright pink probably stood out pretty good.
Speaker 3:The bright pink stood out and that's one of the reasons you do it right. It's like, well, I can tell what group you're with, right and, and I think again, having those having enough people who cared, even if you yourself were not going to have a home birth, having enough people who cared, even if you yourself were not going to have a home birth. And in fact, we had people who would say I'm still in my childbearing years. I would never choose that option, but I think people should have that ability to choose Right.
Speaker 3:We we ended up with so many volunteers, right, if it were just a few of us saying, hey, you know, do this, we would never have been successful. But because we were able to mobilize, um, this volunteer army, we really had that. And you know, like I said, now it's, it was really successful, but it was now I look back and say, well, that was fun, but at the time it was not fun.
Speaker 2:No, and I didn't realize how long it took like how many years of effort and nobody was paying you to do this right.
Speaker 3:No, it was money out of our pockets, yep.
Speaker 2:Absolutely so. That's incredible work and I know I remember people at the time. But main players, and are you able to share with us yourself you talked about Suzanne Smith any other main players that we can be grateful for?
Speaker 3:I think Johnston was the other one, yeah, yeah, yeah, absolutely Legislative. So there were like I think that was kind of the core group, the three of us, but everybody played a part right. So the doulas in the state, the midwives in the state, we had just a variety and we had again some. Even within our own community it was split, so some were supportive and some were not. Some called us midwives, some were you know that's right.
Speaker 3:Yeah yeah, yeah, I remember that there's lots of tension there. But, um, for, for a lot of people I think it was their preference was to kind of keep their heads down, and I understand that right.
Speaker 2:Stay off the radar right.
Speaker 3:Yeah, especially because the way it kicked off was an arrest with a felony charge. Right, they would have preferred that we not shake the tree. Um but we did and and I'm and I'm really happy we did, and 20 years later I'm still shaking the tree.
Speaker 2:So yes, you are. You found new trees to shake to, new trees, lots of trees out there, wow, cool. Well, holly, thank you so much for giving us a glimpse of the work, because I just I love where we are and I want to appreciate those who've come before, whose shoulders we stand on in this awesome work that we're doing, so appreciate you Thanks for having me.
Speaker 3:I really appreciate it.
Speaker 2:Glad to have you here. Thanks for being with us. We'll wrap up our podcast episode today and, as always, please go out and make a human connection with someone someone you know, someone you don't. Human connection is important. Thanks for being here. We'll see you next time.
Speaker 1:Thank you for listening to the Ordinary Doula podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth. Thank you.