The number of Idaho births attended by midwives is keeping pace with the state birth rate, continuing to increase while a legislative debate over a state licensing system continues.

According to statistics compiled by the Idaho Department of Health and Welfare, physicians attended 94 percent of the 24,185 births in the state in 2006. But certified nurse midwives - who graduate from an accredited nurse-midwifery program and pass a national certification exam - were present at 806. And "lay" direct-entry midwives, who can be certified by a North American midwife registry, were at 489.

Both numbers are higher than the previous year. But while totals for nurse midwives have varied over the past few years, lay midwives have gradually followed the birth rate since 2000, when they attended 267 births.

It's not just an Idaho trend. Michelle Bartlett, the Idaho Midwifery Council's vice president and legislative chairwoman, said she's seen nationwide growth for midwife-attended births, possibly due to rising costs for maternity care. On top of that, she said, it's easier for future parents to find information on midwives.

"Families are accessing the Internet for information, and many are seeking ways to avoid unnecessary interventions," Bartlett said via e-mail.

Jerome certified nurse midwife Connie Wolcott was much more optimistic about national trends. In her view, she said, midwifery is going through a revival after being suppressed in the 20th century. Growth in the industry, she said, is largely due to word-of-mouth.

"It's contagious," said Wolcott, affiliated with St. Benedicts Family Medical Center. "It's like you find this really great way to have a baby â€- and you tell your friends."

In Idaho, midwives haven't so much increased their numbers as spread out across the state. More than half of midwife-attended births in 2000 were from one of the state's seven health districts. In 2006, the totals were more evenly distributed across the districts, with two notable exceptions - including District 5 in south-central Idaho.

For whatever reason, midwives have had a hard time in the region, Wolcott said. While her workload has steadily gone up, direct-entry midwives haven't always been as lucky, she said. One who used to operate in Jerome moved to Utah, and others are scattered around the area but aren't always easy to find.

The current political climate may be one reason for that. A bill this summer would have allowed certified professional midwives - those direct-entries who meet national standards - to expand what they are allowed to do under state law, Bartlett said. Among other things, the bill would allow licensed midwives to use specific medications in certain situations - some, she said, required by law.

"All CPM's are trained in neonatal resuscitation but cannot legally carry oxygen to do resuscitation," Bartlett said. "We are required by law to apply an antibiotic eye ointment to the newborn's eyes but cannot legally obtain or carry this medication."

The bill's sponsors, including the council, pulled the bill after the Idaho Attorney General's office determined that some of its language was too ambiguous. They plan to submit it again, Bartlett said. But the Idaho Medical Association and other groups who oppose the bill often cite the medication requirement as one reason. And a board made up of representatives from the seven health districts drafted a resolution against voluntary licensing, citing concerns about lack of standardization and allowing direct-entry midwives to dispense medication.

Maggi Machala, community health director for the South Central Public Health District, said the district isn't opposed to midwives - "a wonderful resource." But the bill needed more work, she said, and has to be clearer as to what kind of training midwives are required to go through.

Home births attended by midwives are popular in other countries, Machala said. But the problem in the U.S. is that the country lacks the support network found elsewhere. In the Netherlands, for example, midwives keep mobile medical units in the area during a birth, ready to swoop in should things go wrong.

"Sometimes, it's a matter of minutes in order to save (babies') lives," Machala said.

Wolcott understands that. Sadly, she said, the licensing debate has pitted her profession against a group of people she considers a valuable part of the process.

"There's no one I'm happier to see when I'm having a difficult delivery," she said of physicians.

Nate Poppino may be reached at (208) 735-3237 or npoppino@magicvalley.com.