Licensing Certified Professional Midwives

Statement on the proposed Massachusetts bill supporting the licensing of certified professional midwives
by Jo-Anna Rorie and Judy Norsigian
October 26, 2017

As strong advocates for home birth and midwifery for more than 40 years,* we are discouraged to see how much misinformation about the current MA midwifery bill (S.1206/H.1189 “An Act Relative to Out-of-Hospital Birth Access and Safety”) is appearing on the internet by those opposed to this bill.

We urge those consumers who are being encouraged to contact their legislators to express their opposition to this bill to read more about why this bill is overall an important step forward right now. 

In particular, we see this bill as advancing both social and racial justice, finally creating a path to Medicaid reimbursement for home birth midwifery services that so many women have sought over the years. Without this bill, many women will continue to be denied access to home birth midwives.

The bill represents a good compromise involving some challenging issues and has the support of many consumer groups that have looked at other states’ experiences with licensing and regulating CPMs. Attached below is the letter that 8 consumer groups (some national) are soon sending to members of the MA Legislature.

Most homebirth midwives in Massachusetts do support licensure, but some midwives are posting misinformation about this legislation, claiming that this bill would constrain access and that it contains excessively onerous educational requirements that would mean some midwives with many years of experience would not be able to achieve licensure.  These statements are not really accurate, as the bill includes a clear and reasonable avenue for midwives who were certified before current accreditation standards were available. Any midwife can apply for a Bridge Certificate, which requires fifty qualifying continuing education units, through the North American Registry of Midwives, the national certifying organization. The completion of the process will qualify a midwife for licensing.  Thirty hours of CEUs are already required for CPM re-certification, and since these 30 hours can count towards the Bridge Certificate, it is only another 20 hours that will be required. (This additional cost is likely not prohibitive for most midwives and achieves the goal of being in alignment with the educational standards set by the International Congress of Midwives.)  

We urge consumers to learn more about the bill’s history and the intentions of those in organizations such as Our Bodies Ourselves and the Bay State Birth Coalition before jumping to the conclusion that this is a bill that they should oppose.

Sincerely,

Judy Norsigian, home birth mother and co-founder of Our Bodies Ourselves

Jo-Anna Rorie, CNM and former faculty member at the Boston University School of Public Health

* For more than 45 years, Our Bodies Ourselves (OBOS) has been a major advocate for midwifery AND home birth in this state and across the country. Jo-Anna Rorie was part of that effort and has championed the right of low-income women to access out-of-hospital care.

Starting with the fight to LEGALIZE midwifery in MA (we were one of the LAST states to legalize any form of midwifery – including CNMs practicing in hospitals), we have worked several decades at the forefront of positive consumer/midwifery collaboration to advance a constructive agenda.

LETTER FROM CONSUMER GROUPS TO MEMBERS OF THE MASS LEGISLATURE IN SUPPORT OF THIS BILL (Oct 2017):

We are writing to you now in strong support of HB1189/SB1206, An Act Relative to Out-of-Hospital Birth Access and Safety (sponsored by Rep. Kay Khan and Sen. Anne Gobi). In previous legislative sessions this was identified as a licensure and regulation bill for Certified Professional Midwives (CPMs), but as you can see below, it is primarily a bill that would increase consumer protections for families in Massachusetts seeking out-of-hospital maternity care.

As you know, this legislation would require all midwives in Massachusetts who are practicing in out-of-hospital settings to become Certified Professional Midwives (CPMs) and would create a multidisciplinary Board of Midwifery to establish state licensing requirements for CPMs and to provide regulatory oversight of the profession.

At present, the Commonwealth regulates only Certified Nurse Midwives (CNMs). There is no state oversight of the midwives who provide out-of-hospital care to approximately 650 women and their families across the state each calendar year, a number that is growing. A recent CDC report indicates there was a 31% increase in home births in Massachusetts from 2004 to 2012, consistent with nationwide trends.1

Thirty-two states currently regulate the provision of out-of-hospital maternity care by requiring midwives who practice in out-of-hospital settings to meet national educational and credentialing standards as CPMs. Legislation is currently pending in 10 more states. Currently, Massachusetts and Connecticut are the ONLY New England states that do not require midwives who practice in out-of-hospital settings to become licensed as CPMs.

This bill would:

  • Require licensed CPMs to have obtained an accredited education by 2020, or a bridge thereto. This meets the educational standards of the International Confederation of Midwives and complies with the U.S. Midwifery Education, Regulation and Association (MERA) statement endorsed by the American Congress of Obstetricians and Gynecologists in April 2016.
  • Establish a Board of Registration in Midwifery under the Department of Public Health, which will issue all CPM licenses and have regulatory oversight for all Massachusetts-licensed CPMs.
  • Give consumers choosing out-of-hospital maternity care more security in knowing that their provider is regulated by the state and as such is integrated into the broader health care system.
  • Expand opportunities for third-party reimbursement, thus making this option available to low-income women now denied this choice because of their financial situation. For example, licensure is a prerequisite for Medicaid coverage: “medical care, or any other type of remedial care recognized under State law, furnished by licensed practitioners within the scope of their practice as defined by State law.” 2 In addition, we know of many women who use private-pay coverage who could not get reimbursement because their home birth provider was not licensed by the state.
  • Create a more integrated health care system by improving communication among caregivers (for example, it will not be legally problematic for hospitals to have formal transfer protocols once this bill becomes law).

We are aware that some detractors of this bill may have sent you misinformation. Thus, to ensure that you have easy access to citations and information that rebut this misinformation, we are enclosing a memo from Emily Anesta of the Bay State Birth Coalition. As a current supporter of the bill, you should find this memo useful in discussions with your colleagues.

All of the organizations listed below hope that you will increase your advocacy for this bill, so that it can pass in this legislative session. CPMs are the only primary maternity care providers in the United States who are required to undergo specialized clinical training in the provision of out-of-hospital maternity care.

The CPM credential is accredited by the National Commission for Certifying Agencies (NCCA), the same agency that accredits the certification for nurse practitioners and nurse midwives. In addition, this bill would require that CPM education be accredited by the Midwifery Education Accreditation Council, which is an accrediting body approved by the U.S. Department of Education. There are approximately 2,000 CPMs in the United States, with a growth trend of 10% per annum.

In addition, CPMs have proven results while utilizing less costly interventions. In 2007, an independently conducted cost-benefit analysis commissioned by the Washington State Department of Health (DOH) indicated that the state saved more than $473,000 biennially in Medicaid expenditures due to the lower c-section rates associated with licensed midwifery care. 3

While this bill does not mandate insurance reimbursement for CPMs, many states have seen subsequent increases in public and private insurance coverage after licensure. According to the 2013 Listening to Mothers survey, a fourth of mothers would like to consider a home birth in the future; however, insurance coverage was the leading factor in choice of a maternity care provider. 4,5

In summary, this bill helps ensure accountability and a consistently high standard of practice for all out-of-hospital midwives in Massachusetts. At the same time, it will improve the ability of families across the Commonwealth to make safer choices about the type and location of their maternity care. Please let us know if we can support your advocacy of this bill in any way.

Sincerely,

Amnesty International USA
Mary Ann Ashton, president, League of Women Voters of Massachusetts
Krina Patel, Women’s Bar Association of Massachusetts
Emily Anesta, Coordinator, Bay State Birth Coalition
Carol Rose, executive director, ACLU MA
Julie Childers, executive director, Our Bodies Ourselves
Sasha Goodfriend and Ellie Adair, co-presidents, Mass NOW
Horace Small, Executive Director, Union of Minority Neighborhoods

Sources

  1. MacDorman MF, Mathews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990–2012. NCHS data brief, no 144. Hyattsville, MD: National Center for Health Statistics. 2014. (data table referenced in caption of Figure 3) (http://www.cdc.gov/nchs/data/databriefs/db144.htm)
  2. Social Security Laws Sec. 1905. [42 U.S.C. 1396d] (6) (https://www.ssa.gov/OP_Home/ssact/title19/1905.htm)
  3. “Midwifery Licensure and Discipline Program in Washington State: Economic Costs & Benefts.” An independent report conducted by Health Management Associates for the Washington State Department of Health, October, 2007 (http://www.washingtonmidwives.org/assets/Midwifery_Cost_Study_10-31-07.pdf)
  4. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to Mothers III: Pregnancy and Birth. New York: Childbirth Connection, May 2013. (http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf)
  5. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to Mothers III: New Mothers Speak Out. New York: Childbirth Connection, June 2013. (http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_NMSO.pdf)