If you’re in Massachusetts, please ask your state representative to urge House Speaker Robert DeLeo to bring an important midwifery bill to a vote. Text of the bill — House 4810: An Act Relative to Certified Professional Midwives and Enhancing the Practice of Nurse-Midwives – can be found here.
The bill was just released from the House Policy and Steering Committee and is now in Third Reading, chaired by Rep. Vincent Pedone of Worcester. The legislative session closes on Saturday, July 31. If it’s not voted on by then, the bill would die and have to be reintroduced in the next legislative session.
If you’re able to discuss the bill with your legislator or a staff member, please be aware that some legislators have misinformation about the midwifery bill’s content, especially regarding the items below. Here’s some background:
1. The Massachusetts Medical Society strongly objects to CNMs functioning without direct MD supervision, yet has articulated no sound basis for this objection. Nationally, ACOG already supports the elimination of direct supervision of CNMs by physicians, acknowledging that it is not required for safe practice, and 44 other states no longer have such requirements.
2. Some legislators incorrectly think that the bill would provide new prescription-writing privileges for nurse-midwives — this is not really the case. Nurse-midwives already have prescription-writing privileges but can now exercise these privileges only if an MD is technically providing supervision, which amounts merely to a review of sample prescriptions on a quarterly basis.
Because of hospital accrediting rules, this clause prevents CNMs from admitting patients in labor under the midwives’ own names; prevents CNMs from serving on hospital committees that determine maternity care policies; and bars them from control of their own practice environment. This undermines the ability of CNMs to provide the most effective care. (CNMs already have independent prescription authority in most other states, including New Mexico, New Hampshire, Washington, Arkansas and Oregon, and the District of Washington.)
3. Although the legislation has already been rewritten to accommodate concerns about the age at which a midwife could begin training (it was changed from 18 to 21), legislators are still being misled about this fact. There are, by the way, no such age requirements that we have been able to find in the Massachusetts statutes with respect to the education of nurses.
4. Another objection is that the bill does not require a midwife to carry malpractice insurance. In almost all states, malpractice insurance is not required by statute, and it would be unfair to single out one professional group in this regard. Some would argue that such a requirement would violate equal protection clauses.
Because the “risk pool” of homebirth midwives across the country is small, malpractice insurance has never been available for homebirth midwives, despite the concerted efforts of national and local organizations over several decades. Requiring CPMs to adhere to a standard that is impossible is another mechanism to restrain trade and prevent access to home birth midwives.
Childbearing women who want to be protected by malpractice insurance have the option of delivery in facilities, where such insurance coverage is required. Moreover, the Massachusetts legislature could follow a few other states in making disclosure of this absence of malpractice insurance coverage part of a required informed consent procedure. The malpractice insurance issue is not a credible objection to this bill.
Please share this news, and thanks for taking the time to take action on this important piece of legislation!