Lawmakers move toward plan to license midwives

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Capital News Service
LANSING — Pregnant Michigan women might soon have another state-recognized labor and delivery option.
More than a year after the House approved licensing midwives, a similar bill is before the Senate.
Supporters say this is a consumer rights issue that improves access to pregnancy care and paves the way for Medicaid reimbursement.
Critics say the education requirements don’t compare with certified nurse midwives and obstetricians and gynecologists. They also say the bill should be clearer about when and how women should be sent to doctors and hospitals.
“I’m satisfied it was adequate,” said Sen. Mike Shirkey, R-Clarklake, the chair of the Senate Health Policy Committtee. He supports the bill because it gives parents more options.
Sponsorr Sen. Ed McBroom, R-Vulcan, did not return calls for comment.
Linda Johnson, a certified nurse midwife in Temperance, has kept a list of Michigan babies who  died due to what she believes was midwife error. She sent that list to representatives and senators, telling them the babies were the reason she opposed the bill.
“I would imagine there’s also a list of babies that have died in the hospital,” said Jessica English, a childbirth educator who owns Birth Kalamazoo and supports the bill. Birth come with risks, whether it’s at home or in the hospital, she said.
Ultimately, it’s up to families to decide, English said. She’s known   women who would rather give birth unassisted if they can’t find a qualified home birth specialist than give birth in a hospital.
Johnson once performed homebirth deliveries, but says she quit about a year ago. More women were asking her to take risks, she said. When she told them no, they found midwives who gave them what they wanted.
“I just got tired of fighting it,” she said. Johnson now works out of hospitals only.
There are at least four types of midwives. The two most important distinctions are between certified nurse midwives and certified professional midwives.
Certified nurse midwives are registered professional nurses with graduate degrees in nurse-midwifery. They are already certified by the state and are capable of caring for women through their lifecycles.
Certified professional midwives train in birth issues only and do not have a path to licensing in Michigan. Students can enter midwifery training programs with just a high school diploma.
Schooling costs for nurse midwives and certified professional midwives are comparable, said Ida Darragh, executive director of the North American Registry of Midwives, which sets education standards for certified professional midwives and administers a qualifying test for trained midwives.
“We’re excited about the bill,” Darragh said.
One of the best things about the legislation is that it leaves a lot of details of what midwives can, can’t and should do to the midwifery board that will be created if the bill passes, Darragh said.
But that’s what people who are opposed to the legislation don’t like about the bill.
One sticking point: what happens when things go wrong during a home delivery and a woman needs to be transferred to the hospital?
The bill should establish rules and possibly reference national standards for hospital transfers, said Amy Zaagman, executive director of the Michigan Council for Maternal and Child Health.
When women are transferred during delivery, they’re in a state of crisis, she said.
“It’s very unlikely that the woman will arrive with any information about her prenatal care and progression of labor . . . the hospital gets a woman in crisis condition with little to no information about her current needs,” Zaagman said.
The board will set the parameters for which cases a midwife can take and what should happen if labor complications arise, Darragh said.
Parameters aren’t normally done in statute, Darragh said. “The regulations do that.”
It’s better not to put parameters in statute because regulations can change faster as technology evolves, she said. And that’s the way most professions are licensed.
The legislation calls for doctors, nurse midwives, certified professional midwives and consumers of midwifery care to be on the board, but the individuals who will serve on the board haven’t been picked.
“I’m not sure what consensus will be reached by that board,” said Dr. Jody Jones, chair of the Michigan section of the American Congress of Obstetricians and Gynecologists. It would be better to handle it upfront, said Jones, who practices in Canton.
But licensing midwives is the first step to setting the right parameters, advocates say.
The state certifies hairdressers and massage therapists and dog groomers, English said.
“It seems like a complete no-brainer to me that if anybody should be certified, it should be home birth specialists,” she said.
And there are economic reasons to license midwives as well, English said.
No licensure means no Medicaid reimbursement for certified professional midwife services, she said.
Since 2010, home births in Michigan have been climbing, according to  the Department of Health and Human Services. There were 1,293 home births in 2015, the last year for which there is data.

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