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!

As an Our Bodies, Our Blog reader, you know that the specific interests of women and health are intricately connected to broader issues of social change. For just this reason, OBOS has been a proud, longtime member of Community Works, a cooperative fundraising effort involving more than 30 Massachussetts social justice organizations.

Community Works is currently offering a special incentive that I wanted to share with our Massachusetts friends. You might be able to directly support OBOS’s work without even making a donation yourself.

Community Works receives donations largely through the convenience of payroll deductions at 52 private, public and nonprofit employers in the greater Boston area, representing more than120,000 employees. Such payroll deduction contributions to Community Works help to support the work of member organizations such as OBOS.

Any member group that enlists a new workplace that will offer Community Works as one of its employee charitable giving options will receive half of the proceeds of the first year’s campaign. So if you help OBOS enlist a new employer, you will help raise valuable funds for OBOS in the coming year.

The set-up is simple: Visit the Community Works website to see where campaigns are already underway. Then contact your friends in workplaces that don’t already offer Community Works as a charitable option. If you know anyone who can help bring Community Works to their workplace, please email me: judy (at) bwhbc (dot) org

If we are successful in securing the workplace you suggest, OBOS co-founders (myself included) will send inscribed copies of any of OBOS’s books to the person or institution of your choice.

This is a wonderful opportunity for those of you who value what OBOS does to provide concrete support to both our organization and the other social change groups that are part of Community Works. Whether working to address environmental justice, sexual assault, youth and community violence or health care access, each Community Works member operates within a framework of equality, justice and peace.

Remember, it takes a village and more to sustain the work of public interest organizations like ours. Take a look at the current employer partner list and let us know who’s missing. Your help with this effort is much appreciated!

Judy Norsigian is executive director of Our Bodies Ourselves.

It is with heavy heart that so many of us receive the news of Sen. Ted Kennedy’s death. Although I have been anticipating this moment for weeks now, the reality is still such a shock.

I know that for so many women’s health activists, Kennedy’s passing will only strengthen our resolve to continue his valiant fight for meaningful health care reform. I have started writing letters to several more liberal Republicans, beseeching them to honor his memory by breaking ranks with the Republican Party and its current efforts to eliminate the public health insurance option from any bill coming out of Congress.

As a tribute to this tireless advocate for the millions who had no political power, each of us can think of one gesture we can carry out in the coming weeks.

In 2002, I testified before the Senate HELP Committee on the topic of somatic cell nuclear transfer (which involves creating cloned human embryos to serve as a source of embryonic stem cells for scientific research; it poses health risks for women who provide eggs for such research). Kennedy, who was co-chairing that particular HELP Committee hearing, was ever so gracious, even though I knew he did not agree with the position of Our Bodies Ourselves at that time.

And when my late husband, Irving Kenneth Zola, died in 1994, shortly after he was appointed to the National Council on Disability, Kennedy’s remarks at a special memorial service for Irv in Washington, D.C., brought tears to everyone’s eyes. His compassion, tenacity and commitment to the needs of all remain an inspiration to me both personally and professionally.

We will miss you terribly, Ted, and we will all fight even harder for the causes you championed for more decades than some of us have even been alive.

Judy Norsigian is executive director of Our Bodies Ourselves.

Dr. George Tiller’s murder offers us all an opportunity to reflect upon and honor the work of so many women’s health care professionals who continue to offer abortion services despite ongoing threats to themselves and their families.

That such a kind and dedicated human being could be attacked and killed like this sends all of us reeling once again. How is it that those who purport to care about life can spew forth the kind of hateful rhetoric that foments destructive passions in already unstable individuals like Dr. Tiller’s attacker?

I think about a few physicians I know who have had to walk around their communities wearing bullet-proof vests. Even though there has not been a shooting like this one in some years, they are well aware of the recent increase of harassment and violent incidents related to abortion clinics in this country.

Terrorist behavior like this is designed to deter other women’s health care practitioners from providing abortion services. And it is precisely because of this that we must all be outspoken in our support of all physicians willing to provide such services — and of the women who seek these services.

Widespread community resolve and solidarity will be key to our ability to restore a civil society in which such acts of violence will not be met with so many cheers by those who would use any means to stop women from having abortions. We now need to find more ways to honor and support women’s health providers like Dr. Tiller.

This week I re-read the moving speech of Dr. Garson Romalis, an obstetrician-gynecologist in Vancouver, British Columbia, who was attacked twice (in 1994 and again in 2000). He spoke last January at a University of Toronto Law School symposium marking the 20th anniversary of R. vs. Morgentaler about why he continued to provide abortions despite two attempts upon his life. It is a speech I think that all of us need to read again.

His courage, commitment and resolve will help inspire many of us to keep working toward a world in which women are respected and supported in their times of need. One concrete action we can all take is to support the George Tiller Memorial Fund, established by the National Network of Abortion Funds to provide assistance to the same women Dr. Tiller served, or any of a number of groups now working to preserve women’s access to comprehensive reproductive health services. Here’s more info (pdf) about the fund.

- Judy Norsigian, Our Bodies Ourselves Executive Director

by Judy Norsigian
Our Bodies Ourselves executive director

Last year, the American Association of Birth Centers (AABC) filed a petition with the federal Centers for Medicare and Medicaid Services (CMS) to intervene in a hearing regarding CMS’ disallowance of Medicaid payment for a birth center.

According to AABC:

The federal Medicaid law lists the types of providers and services that are eligible for payment. Hospitals, clinics, nurse-midwives are listed, but birth centers are not. Until recently, some states paid birth center charges above and beyond the midwife’s professional fee, but did so based upon an interpretation of the Medicaid law.

However, as a result of the judge’s recent ruling:

CMS top officials … have a new interpretation, which leaves out birth centers, and no longer accept the former interpretation.  This means that if the birth center is to get paid for the facility, the birth center must to be added to the Act as a distinct category of provider, like hospitals or clinics.  And, the ONLY WAY this can be done is by passing a bill through Congress to amend the Medicaid law.

Birth centers have an outstanding record of providing safe, women-centered births and all women should have access to them, regardless of their income status. In addition, the ruling could easily lead to denial of other insurance payments to birthing centers, as other payers often follow the lead of CMS.

Our Bodies Ourselves believes that CMS must be directed to cover birthing centers, and we ask our supporters to take the following steps:

• Sign this petition in support of Medicaid funding to birth centers. (And tell your friends and colleagues to do so as well!) We need to collect 10,000 signatures in the next week or so.
• Contact your senators and representative to support a new bill to be introduced by Rep. Susan Davis (D- CA). This bill will include birth centers as eligible providers for Medicaid payment.

The AABC  has additional background information on the issue, as well as a letter for physicians to sign. You can keep up with the progress of the campaign on the AABC’s Facebook page.