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Law constrains state's midwives(Omaha World-Herald (NE) (KRT) Via Thomson Dialog NewsEdge) Nov. 19--Nebraska has no independent midwife birth centers, and that will continue to be the case, even though one was built this year in Norfolk. Until that birth center's owner and certified nurse-midwife, Gail Consoli, procures a partnership with a physician, the doors will stay closed. "So it's a big, wonderful, empty place," Consoli said. She and Nebraska Friends of Midwives held an open house at the birth center over the weekend to draw attention to the issue. The organization hopes to change state law so that the partnership requirement may be lifted and the center can open. In Nebraska, a certified nurse-midwife must have a "collaborative practice agreement" with a physician. In the written agreement, the midwife is to consult with and refer complex cases to that physician. In contrast, certified nurse-midwives in Iowa may function without a formal partnership. That does not mean that birth centers in Iowa have it easy. "Politically, they're very hard to open," said Carey Ann Ryan, clinical director of Almost Home Birth Center in Des Moines. "And they are even harder to keep open." Consoli still works as a midwife at Norfolk's Faith Regional Health Services and collaborates with Dr. Keith Vrbicky. Consoli said Vrbicky had told her he would serve in that role if she built an independent birth center. She said she and her husband took out a 20-year loan for the $1.3 million center, which was finished in May. But last December, she said, Vrbicky said he would not sign on with her at the birth center. Vrbicky said last week that he told Consoli he would partner with her if several conditions were met, including that his malpractice insurance would cover him for the birth center. As it turned out, he said, it would not. Consoli said her malpractice insurance would cover Vrbicky's participation in the birth center. Consoli said she has tried without success to find another physician for her center, which has three birthing rooms. Certified nurse-midwives generally are registered nurses with bachelor's degrees and additional training and education in midwifery. Midwives believe that births should be as natural as possible, with minimal use of drugs. They educate their clients in the pregnancy, birth and post-partum processes. Their practice is typically limited to low-risk pregnancies. Nebraska has 23 active certified nurse-midwives. Iowa lists 80. Rebecca Wingebach gave birth to her son at home 1 1/2 years ago when she lived in Fremont, Calif. Two midwives assisted her. After moving to Omaha, she learned that a home birth with a midwife's assistance was not allowed under state law. She said that during her first pregnancy, an obstetrician rushed through appointments with her in 10 minutes. Midwives sometimes spent an hour discussing her pregnancy. Wingebach, now pregnant with her second child, plans to deliver in a Topeka, Kan., birth center. The 28-year-old wants to have her baby in a place where she doesn't have to defend choosing natural childbirth with minimal drugs and intervention. The birth center is far more homelike, with a kitchen, a children's playroom and a family area that looks like a living room. "I think my baby deserves better than a hospital birth as long as we're both healthy," she said. Most midwives work in hospitals or physicians' clinics. Bridget Wieczorek, director of the University of Nebraska Medical Center nurse-midwives, said her institution has five certified nurse-midwives who delivered a total of 435 babies last year. They do not need to have a physician in the room during the delivery, she said. But it is good to have agreements with UNMC physicians, she said, for times when Caesarian sections, forceps and vacuum-assisted vaginal deliveries are required. Midwives generally aren't allowed to use those techniques and tools. The Nebraska Hospital Association said certified nurse-midwives "fill a critical role in the health care delivery system." But eliminating the physician agreement would be contradictory to midwifery, which "calls for collaboration in all cases that fall outside of a certified nurse midwife's scope of practice," the association said. Kate Bauer, executive director of the American Association of Birth Centers, said about 185 such facilities operate in the United States, up from 132 in 1994. More than 200 existed in the mid-1980s, she said, but some closed because they could not get malpractice insurance. Joanna King, of the Maryland-based American College of Nurse-Midwives, said it is not rare for states to require midwives to have a collaborative agreement with a physician. But such formal requirements generally are unnecessary, she said. Because midwives are trained only to handle normal births, they must have some kind of relationship with physicians anyway when complications arise, King said. Only two birth centers exist in Iowa -- Almost Home Birth Center in Des Moines, and New Beginnings Birth Center in Corydon. Ryan said her center in Des Moines opened in November 2003. A Des Moines hospital fought it, she said. She had to convince a state board that her one-bed center would fill a need. Upon opening the center, Ryan found that some insurance companies wouldn't cover certain birth center charges, even though the centers charge about 60 percent less than hospitals, she said. Ryan said she has no written agreement with a physician who serves as a partner. To whom does she refer patients when a case is not normal? "I've got the phone book." World-Herald researcher Jeanne Hauser contributed to this report. To see more of the Omaha World-Herald, or to subscribe to the newspaper, go to http://www.omaha.com. 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