What a difference a word makes: midwifery, tocology, and legislation enhancement by obfuscation

In some Missourians the stubbornness of the Missouri mule shows up either in a posteriorly-painful bull-headedness or in a bee-like one-mindedness. The former type refuses to budge from a position. The latter works diligently to reach a goal. Both persevere despite setbacks.

This time, the bees got one over on the bulls.

In the late 1980s and early 1990s a war over the practice of midwifery in Missouri took off.

(There’s language content here, so stick with me.)

Midwives are women trained to provide prenatal care and to attend births. They are, in some places, considered old-fashioned and low-tech.

Now, midwives are legal in Missouri, but only if “they are nurse midwives and work in partnership with doctors,” according to the St. Louis Post-Dispatch. What midwives and their proponents would like in Missouri is broader rules about who can be licensed to be a midwife, who can train them, and what services they can provide.

They are opposed, however, by three powerful groups. Religious anti-abortion groups suggest more midwives might increase abortions. Doctors and hospitals fear midwives will dilute their trade with in-expertise and will cost them business. Insurance companies seem to worry that they might be required to pay for the midwifery services and they envision high-risk services costing them huge malpractice payouts.

These are no small forces allied against midwifery. Their members allude and imply that it is quackery, that it is primitive, that it is unwholesome or ungodly, and that it is life-threatening.

My reading in the months before the birth of our boy led me and my wife to believe none of these things are true, which is why when he was born we had a midwife at the hospital in New York City. She was exactly what we needed and we were glad to have her there.

In Missouri over more than 15 years, bill after bill has been proposed to lay down new, workable laws that would broaden the licensing and requirements for midwives. Each bill has been killed.

Then came Missouri bill HB818. Described by the Columbia Daily Tribune as a non-controversial bill to help low-income workers get private health insurance, it doesn’t contain the words “midwife” or “midwifery” at all. Instead, it contains this amendment inserted by Sen. John Loudon, R-Chesterfield, chairman of the Senate Small Business, Insurance and Industrial Relations Committee.

376.1753. Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organization for Competency Assurance (NOCA) may provide services as defined in 42 U.S.C. 1396 r-6(b)(4)(E)(ii)(I).

“Tocology” is a synonym for midwifery or obstetrics. So “tocological” means “related to or associated with midwifery or obstetrics.”

That unfamiliar word went right by midwifery opponents who read the bill, and, as the St. Louis Post-Dispatch wrote, “Most lawmakers learned Monday that they had unwittingly approved the measure. Even some supporters of looser regulations were livid.”

So how did that word get in the legislation?

Earlier in May, Anu Garg of the A Word A Day email list noticed the Missouri story and included this note in the top of his AWADmail issue 262—a weekly compilation of reader feedback.

Tocological trickery:
St. Louis Post-Dispatch
(If only they were reading AWAD. From the archives: tokology)

“Tokology” (another spelling) has in fact been featured twice, first on January 30, 2001, and most recently January 31, 2006.

Well, they were reading AWAD. This letter appeared in AWADMail 263 a week after Anu’s note. (That link does not contain the full text yet, so I’m quoting it from the AWADmail email here.)

My name is Sarah Greek, and I’m a homeschooled student in Mountain Grove, Missouri, who just graduated from high school. I’m a subscriber of AWAD and just read your latest email and its reference to “tocological trickery” with interest.

“If only they were reading AWAD”? We were. That’s how this happened!

I live in Missouri, and have been working with Senator Loudon and others on midwifery legislation all year. You might be interested to know that I discovered the word ‘tocological’ as a result of your daily emails. When we were working on midwifery legislation several weeks ago, I remembered the word and informed Senator Loudon. We inserted it into our amendment, resulting in the events that the news article which you referenced narrates.

The whole situation, especially the word tocology, has been all over the Missouri news this week. I spent the week in Jefferson City, and can personally attest to the fact that the word tocology has been in the mouths of nearly every politician all week. It’s become the latest inside joke in the Missouri Legislature. I’ve been called “a tocological pain”. 🙂

Thanks to AWAD, midwifery is well on its way to becoming legal in Missouri, and the whole state has added a new word to its vocabulary!”

Loudon was removed at least temporarily as the head of the committee.

The legislation still stands as of this writing.

The St. Louis Post-Dispatch describes the coalition that got it passed as bonnet-wearing Mennonite women, Birkenstock-clad social activists, and a lottery winner.

More: Riverfront Times, Fox 2 (KTVI) video.

Posted May 30, 2007

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