MAINE: Midwives licensing bill rejected; dispensing of some drugs OK’d

From the Bangor News:

After significant debate and a strong lobbying effort by Maine physicians, lawmakers on Friday derailed a proposal to license “lay” midwives, voting instead to authorize them to purchase, possess and administer a short list of prescription drugs often needed during a home birth.

This really is baffling to me. The Maine Medical Association “successfully” thwarted efforts to create a system wherein Certified Professional Midwives would have to verify their training and credentialing with the North American Registry of Midwives to obtain a license to practice midwifery and provide home birth services but gave them the freedom to administer drugs like lidocaine, oxygen, pitocin, methergine, and presumably misoprostol to control bleeding. The logic escapes me. How do they know these midwives unworthy of licenses due to their inferior education (tongue in cheek my friends) are trained to use them? And why would any midwife in Maine push for a license now that the MMA has allowed them to practice freely without a license and with the freedom to stop a hemorrhage or repair a tear using drugs that another state would charge as practicing medicine without a license?  I hope the MMA will come to their senses and work with the midwives to design a licensing process for Certified Professional Midwives in Maine.

In any event, congratulations to the families of Maine, the MMA has just made home birth a bit safer for you in that your Certified Professional Midwife will no longer fear carrying the medications that will make birth safe for you and your baby.

The rest of the article is after the jump.

The new law, sponsored by Rep. Nancy Smith, D-Monmouth, applies to certified professional midwives, as they prefer to be called, who specialize in delivering infants at home with a minimum of intervention in the natural process.

Certified professional midwives achieve certification by taking a standardized national exam, but preparation for the test ranges from graduation from a formal training program to a portfolio of documented observations and deliveries without formal education. Their services may include prenatal care, delivery and postpartum care, and newborn care.

By contrast, nurse-midwives — registered nurses with additional credentials — typically practice in a hospital or birthing center under the supervision of a doctor.

There are 26 certified professional midwives practicing in Maine. Midwife Ellie Daniels, who has practiced in Belfast for 29 years and has delivered about 850 babies, said Friday that 23 states have created a licensing program for midwives, including Vermont, New Hampshire and Massachusetts.

“There is a national wave of licensing certified professional midwives,” she said. Licensing confers many professional benefits, she said, including enabling midwives to order imaging tests and blood work, increasing public awareness of their practice, and improving communication with other professionals.

According to Daniels, a 2000 study determined that births attended at home are as safe as hospital births, but rates of Caesarean deliveries are much higher for women who choose to deliver in the hospital.

“We’ve spent years proving that we are a low-cost, low-intervention way to give birth,” Daniels said. “America’s health care system is a mess; we’re 43rd in the world in term of infant mortality rates, behind Cuba. We want to be part of the solution, but we can’t even sit at the table with the other health care professionals.”

The licensing bill has been a hot issue for the Maine Medical Association since it first appeared on the legislative agenda more a year ago, according to MMA Executive Vice President Gordon Smith. While midwives have been delivering babies for many years, he said, their lack of formal education increases the likelihood of potentially serious complications for mother and baby.

“We don’t think that in 2008 home births are generally a good idea,” he said.

Licensing certified midwives, Smith said, would allow them “to hold themselves out as professionals. … They would be confused with nurse midwives.” While the association has no goal of outlawing the practice of home births, he said many doctors resist being put in the position of handling high-risk emergency transfers when a home birth goes wrong.

Smith said he hoped to set up opportunities in coming months for midwives to meet and interact professionally with doctors and other professionals, with an eye to improving communications and patient well-being.

The medical association drafted the committee amendment that won all-but-final legislative approval on Friday. The measure makes it legal for midwives to have access to certain medications, most of which they manage to obtain anyway. They include oxygen, Vitamin K to control bleeding, drugs that induce labor, antibiotic eye drops for newborns and numbing agents to reduce discomfort when repairing tears after delivery.

Daniels said midwives always carry the medications anyway, getting them from colleagues who work in other states or from “friendly doctors” who support the work midwives do.

“I get my oxygen from a welding supply [company],” she said.

While the authority to get medications through more legitimate routes is a step in the right direction, she said, Maine lawmakers can expect to see the midwife licensing issue before them again before too long.

April 14, 2008 | Filed Under Home Birth, Midwives/Midwifery, Politics 

Comments

2 Responses to “MAINE: Midwives licensing bill rejected; dispensing of some drugs OK’d”

  1. Heather Emerick on September 18th, 2009 3:43 am

    a Canadian medical study proved home birth to be as safe, if not safer than a hospital birth with a CNM.Sometimes you have to look at the facts, and not the hospitals financial agenda.

  2. Meg on June 2nd, 2010 6:28 am

    I am not sure that licensure is actually good for midwifery; are not the licensing boards made up of the very people who have a vested interest in preserving high-intervention, medicalized births and a high cesarean rate, and suppressing drug-free, natural birth at home?

    Limiting midwives to practice only at the pleasure of the medicalized birthing industry reduces, rather than enhances, birth choice.

    I would be interested in finding out what the effects of State Licensure have had on homebirths, in various states, and who sits on that Licensing Board in each case. So long as the Board is not affiliated with Obstetricians whose vested interest is to stamp out home births, and indeed vaginal births of any sort, I could see it being beneficial.

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