January 27, 2014

Bill Regulating Certified Professional Midwives Needs a Push

Once again, a bill that would license and regulate certified professional midwives, or CPMs, has been introduced in the Massachusetts legislature. And it’s time for the Commonwealth to join the 28 other states in this country that already have adopted such regulation.

CPMs are educated to develop hands-on expertise in the home or birth center setting. Maternity care professionals with many decades of experience as well as prominent consumer organizations are supporting this bill because they believe it will increase the safety of home birth for families choosing this option.

Among these professionals writing to the legislature are pediatricians, obstetricians, midwives and academic researchers. Below are excerpts from some of their letters:

Martha Richardson, MD, practicing obstetrician in the Boston area for 33 years: “Home birth is an option in some states and in many countries including some where the overall birth outcomes are better than in the U.S. Bringing home birth under public surveillance in Massachusetts is unlikely to worsen outcomes and could help us address our lack of reliable information.”

Robyn Churchill, former director of midwifery at Mt. Auburn Hospital: “I am a Certified Nurse Midwife with over 20 years of clinical and research experience in maternal health care. I…am now at the Harvard School of Public Health, working on a large trial of the WHO Safe Childbirth Checklist in India … My experience and research has shown that safe childbirth can occur in many settings, within a well-coordinated system, with regulation and oversight of providers.”

Lisa Paine, a certified nurse-midwife and DrPH long involved at the national level with policy development to improve health education and regulation: “For nearly 30 years I have been involved in a variety of clinical, academic and administrative roles related to maternity care, midwifery and public health … My policy and advocacy experiences are numerous and have led to several publications and testimonies, including undertakings directly relevant to my support of this legislation … these fully support House Bill 2008/Senate Bill 1081.”

In its testimony opposing this legislation, the Mass Medical Society (MMS) makes several incorrect statements. For example, it asserted that “CPMs have not adopted a set of criteria based on generally accepted medical evidence or public safety for patients who may be appropriate candidates for home birth, relying instead on the decision of the individual midwife and patient.”

This is not true. Although CPMs respect a women’s right to informed consent in childbirth (as all health professionals should do), the CPM profession, through the National Association of Certified Professional Midwives, has clearly defined professional guidelines and standards. Also, many state midwifery organizations have developed extensive practice guidelines because licensure laws were passed in their states.

One good example is New Mexico, where CPMs are regulated and licensed by the Department of Health. Extensive clinical guidelines have been developed by the state midwifery association and are enforced by the New Mexico state licensing and disciplinary authority. House Bill 2008/Senate Bill 1081 would allow Massachusetts to place similar guidelines on CPM practice here.

No state adopting the regulation and oversight of CPMs has reversed its policy. Some states — Texas, Colorado, and California, for example — have more recently reaffirmed these earlier legislative decisions.

CPMs are specifically educated to develop hands-on expertise in the home or birth center setting.  The CPM credential is overseen and certified by the same national organization that validates the CNM credential for nurse-midwives.

The Massachusetts Medical Society also states: “The curriculum, clinical skills training, and experiences of CPMs have not been approved by any authority recognized in certifying knowledge and skills associated with the practice of obstetrics, including the American Board of Obstetrics and Gynecology, the American Midwifery Certification Board (AMCB), and the American Board of Family Medicine.”

These three entities do not engage in the approval of curricula for other professionals in their fields, so this comment is not actually relevant.

The Committee on Public Health should report this bill out favorably, so it can advance to the next step in the legislative process, and eventually be released to the floor for a vote and enable the state to oversee this growing health profession. 

Failure to license CPMs will make the several hundred home births that occur in Massachusetts every year less safe by failing to create an integrated maternal health care system with enhanced collaboration among all care providers. This bill would affirm that all Massachusetts maternal health care providers are committed to practicing with state oversight and public accountability.

Please make your voice heard by contacting your legislator and by signing a petition in support of the Massachusetts Midwifery Bill, sponsored by the Massachusetts Midwives Alliance and the Massachusetts Friends of Midwives.

This article was originally posted at Cognoscenti, WBUR Boston’s ideas and opinions section, and is re-posted with permission.


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