Jason Sandford
Jason Sandford is a reporter, writer, blogger and photographer interested in all things Asheville.
Here’s a hot topic — should midwives be licensed to practice in North Carolina? My thought is: yes, and I didn’t know they weren’t!
I haven’t really thought this through, though. What are the impacts? Will it put bad people out of business? Will it make it harder for people to do this work? How much will it cost?
Here’s a press release from the folks who favor licensing midwives. Discuss, and let me know if you think there should be more follow-up:
NC HO– — USE COMMITTEE RECOMMENDS LICENSING MIDWIVES
Legislation Would Let NC Join 24 Other States in Advancing Healthcare Options
RALEIGH, NC — The NC House Select Committee on Licensing Midwives released a report last week calling on the state to license and regulate Certified Professional Midwives (CPMs), who are trained as specialists in out-of-hospital maternity care. The Committee recommended that North Carolina join the growing number of states that have enacted laws to provide families who choose out-of-hospital delivery with access to highly-trained and legally-recognized maternity care providers.
“Each year, more North Carolina families choose out-of-hospital birth for religious, cultural, philosophical or financial reasons,” said Russ Fawcett, Legislative Chair for North Carolina Friends of Midwives. “CPMs also care for a disproportionate number of rural, low-income and uninsured families. All families deserve safe and affordable maternity care, and the midwives who provide it deserve legal recognition. We applaud the Committee for recommending a much-needed and long-overdue reform in current law and policy.”
Certified Nurse Midwives (CNMs), who practice primarily in hospital settings, are licensed in all 50 states. Currently, there are no laws in North Carolina to regulate CPMs, who deliver babies in private homes and freestanding birth centers. Studies show that low-risk women who plan home births under the care of CPMs have outcomes equal to low-risk women who deliver in the hospital, but with far fewer costly and preventable interventions. A study commissioned by the Washington legislature found that during the last five years alone, the state’s licensed midwives saved taxpayers and private insurers more than $10 million.
Rep. Ty Harrell serves on the Committee that is chaired by Rep. Bob England. “We’ve heard testimony from dozens of public health and policy experts. The facts are clear – it is time to license North Carolina’s midwives.”
“From both a cost and a safety standpoint, licensing midwives is an important public health issue,” said Henry Dorn, MD, a board certified OBGYN who practices in High Point. “The Certified Professional Midwife credential is the gold standard for midwives who specialize in out-of-hospital birth, and it is critical that we do all we can to ensure that women in our state have access to the safest care possible, including collaborative care with other providers when it becomes necessary.”
A positive recommendation from the House study committee paves the way for the full General Assembly to develop and enact legislation in the 2009 session that provides for the licensure and regulation CPMs.
North Carolina Friends of Midwives is a grassroots organization of midwifery advocates dedicated to promoting, supporting, and protecting midwifery in North Carolina. We advocate for the preservation of midwife-attended births, in accordance with the Midwives Model of Care™ including those at home and in freestanding birth centers.
North Carolina is a priority of The Big Push for Midwives Campaign a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care. Through its work with state-level advocates, the Big Push is helping to build a new model of U.S. maternity care built on expanding access to out-of-hospital maternity care and CPMs, who provide affordable, quality, community-based care that is proven to reduce costly and preventable interventions as well as the rate of low-birth weight and premature births.
The Big Push Campaign Manager Katie Prown says, “The demand for safe and less-costly maternity care has been steadily increasing in recent years, as more people realize that we can no longer afford a system that produces inferior results at premium costs.”
I cannot wait for CPMs to be licensed as autonomous providers in NC. I would like to see CNM’s be able to practice autonomously as well.
Still for home birth, there is no one like a CPM. I loved my safe CPM attended home birth and cannot imagine birthing anywhere else!
Home birth is a safe choice and one that should be fully supported in our state!!!
In regards to the *licensing* of paramedics, what I mean is this: yes, we’re allowed to practice legally. However, we’re not considered "licensed", but rather "certified" or "credentialed" by the state. RNs are "licensed" by the state. Being "licensed" vs. "credentialed" or "certified" is an issue of money/pay. RNs make more money than paramedics simply because they are given the title of being "licensed" even though paramedics are allowed to do TONS of things/procedures/give meds/etc. without a doctor ordering them to or standing over them every second. Now, I love nurses and the work they do, but think the pay discrepancy is riduculous. But until the NC Board of Nursing gets off their high horse, I guess that’s they way it will remain…
It’s safe, it’s personal, it would save a lot of money! The health care crisis in this country is out of control and it’s all because we believe interventions and medications solve all our problems when that is so far from the truth. Go back to family, have babies at home, participate in the miracle of birth and it will make the world a better place. Legalize home birth.
As a home birthing mother of one, I can attest to the difficulty CPMs and women face in finding each other in NC. With freestanding birthing centers closing down because of high malpractice costs, and hospital costs and unnecessary interventions blowing out the ceiling, home birth was not only an economic decision for me, but also a safety one.
I fully support midwives being licensed in NC. However, I think something needs to be said about the base issue. A license is permission to do something that would otherwise be illegal. No CPM should be required to be licensed by doing a service that is needed to maintain the autonomy of a woman and her family. Same idea with the right to drive – legally, it’s been proven that it’s a right, not a privilege for persons to move freely in a personal vehicle; however, the government realized long ago there was money to be made from requiring permission, and so it’s been accepted by the public that licensure should be required. I’ll take my CPM for my next homebirth licensed or not, so long as she’s trained and certified.
I just heard that WLOS will air a segment on their 5:00 program today (Wed, 1/14) about this issue and have interviewed New Dawn Midwifery. I would like to clarify that Certified Nurse Midwives are legal to attend births at home and in the hospital in NC under physician supervision. Unfortunately, there are only 3 CNM practices in NC offering home birth care. WNC does have the bulk of legal providers currently attending women at home: 1 CNM group practice (New Dawn), 1 individual CNM, and 1 MD. There is only 1 CNM in the entire remainder of the state attending home births. This is simply not enough to meet the demands of women choosing home birth in NC.
This recommendation for licensure applies to the professional non-nurse midwives (currently 15 in NC) who have achieved the Certified Professional Midwife credential. They are the only health providers required to train in out of hospital maternity care. Certified Nurse Midwives are Registered Nurses who obtain a post graduate degree in Midwifery and are trained in hospital settings. Some obtain out of hospital experience on their own, but it is not required for their credential. Both are wonderful and have a place in our system.
As for EMTs, I agree, they are an invaluable part of our health system and should be recognized as such. Forgive me, as I am surely not as educated on that situation as I am on birth attendants, but EMTs are practicing legally aren’t they? The difference to me is that the EMT may go to work and do his or her job without threat of prosecution. A non-nurse midwife (or a nurse midwife without a physician’s supervision) is currently considered practicing medicine without a license and could be prosecuted. The fact that they are practicing midwifery rather than medicine seems to irrelevant to the medical associations.
Every field of healthcare has their own disparity of appreciation, or the lack thereof. The paramedic has my sympathies.
The Certified Professional Midwife route provided me the opportunity to have 7 children at home, sweetly, and safely. Every women should have this choice. To legalize the CPM opens the doorway for better communication between healthcare providers. During my pregnancy had I ever needed care beyond herbal remedies, and nutritional support, I would have been in a tight spot. These doors need to be open!!
As an Asheville mother of two who is currently enrolled in the National College of Midwifery working towards CPM certification, I can attest to the rigors of the education and hands-on experience that are encountered along the way. My biggest challenge as continue through this process is the question of whether or not I will be able to remain in North Carolina (Asheville specifically) once I am recognized and licensed by N.A.R.M. Yes, I will be able to legally practice in more states than not; however, this is my home, this is my community and I am dedicated to remaining and serving the families of our unique and progressive community. It would clearly be a disservice to the women/families of our state if the legislators in Raleigh continue to make it impossible for birthing families to have safe, legal access to home birth care providers. Simply, home birth is legal in North Carolina and it is an insult to those making that choice to not have access to trained, certified attendants. Liberate Labor-Mandate Midwives!
If a CPM wishes to be licensed, she should be allowed. Women giving birth in NC ought to be able to give birth where they feel the most comfortable, and with whom they prefer–legally.
I’ve had two homebirths so far, and the quality of care I received for those pregnancies/births far exceeded the care I had with a doctor in a hospital for my previous births. Unless there is a pressing reason for me to be hospitalized the next time, I’ll never have anything but a homebirth.
Yes, they should be able to get licensed! Is this a free country or not? If a woman wants the choice to birth her baby at home instead of the hospital, then she should have LEGAL support around her, someone who will know how to respond should a situation escalate into high risk delivery. Standard, low risk pregnancies are not illnesses that need to be "taken care of" in a hospital setting!
Its about time people start waking up and respecting women/family rights in birthing, aswell as the very importance, sincere care and benefits hard working midwives bring us especially with regards to homebirthing.
I believe with the right regulations, safety measures and resources homebirthing is very safe and wonderful to make available. By oppressing homebirth and midwives- makes it a situation similar to abortions. Homebirths will still continue (no matter what) to take place "unground". By not helping the respected attendants (midwives, doctors, nurses, doulas, ect) and families make homebirthing (which will always take place) less safe in the aspect its harder to deal with any issues that could arise or be dangerous, with fear of being caught.
Birthing is a sacred right and choice for families, its not a "medical problem". Sure things can go wrong, but I believe with the right resources, training, support, regulations, and safety measures, homebirthing is no less safe than birthing in a hospital.
Paramedics are allowed to work legally in this state; non-nurse midwives risk jail to serve the needs of their clients. CPM licensure is vitally needed in NC.
If they license midwives, then they need to license paramedics. Actually, give paramedics their due and push to license them FIRST.
They need to be licensed and recognized as a safe standard of care for pregnant and postpartum women. We women should be able to choose where, and with whom we birth our children.
I am a mother of 3 who has given birth with OBs in a hospital, and at home with midwives here in NC. The experiences were vastly different, and my level of care was actually better from the midwives.
My total out of pocket cost with insurance for my second birth was almost $7000, this included my hospital bills and labs and doctors visits. My home birth was less than 3000. With that lesser price, I actually had more labor monitoring, more comfort, and more support than I did in a hospital. My midwives were at my home for somewhere around 10 hours, at the hospital I saw the doctor for less that 5 minutes of my labor, and only had a nurse for about 30. In MY circumstance, my baby and I were safer with an attended home birth.
By not allowing these women to be licensed we are forcing an "underground" illegal movement that women don’t have access to, making it impossible to find a midwife to attend your birth; this means there are women who feel forced to have children unattended because of the lack of available care for homebirth. This in turn creates dangerous circumstances.
So we need to stand up and protect women, and their rights. Let’s legalize and recognize midwives!
So, am I understanding this correctly? Women who choose to birth at home are accompanied by midwives practicing illegally?? LEGALIZE MIDWIFERY!
The reasons to license Certified Professional Midwives are compelling. It is important that we provide the families of NC who choose to birth out of the hospital with qualified, legal attendants. With licensure comes increased accountability, improved access, and easier transitions of care to other providers or facilities if necessary. And doesn’t the state owe it to the consumers who are practicing their right to informed consent to honor that choice? CPMs are nationally accredited and the only provider required to have out of hospital experience, yet they are considered practicing medicine without a license. Cost to the state will be minimal since the CPM credential is issued by a national organization. There is opposition from the medical physicians’ trade associations alleging home birth is too risky, but the research says otherwise. As a former health care administrator, I can tell you that the medical model of birth is designed to manage the natural process both in limiting liability and in optimizing profits. Because while birth is normal, it is not always predicable. What women who choose a midwifery model of care find, is that midwives are generally more patient centered and willing to work with labor and birth naturally. I believe that we owe it to every woman, family and baby in NC to uphold the rights to informed consent; whether the choice is to birth in the home with a midwife or in the hospital with a medical doctor or Certified Nurse Midwife.
Licensed, recognized, and reimbursed.
Yes they should. The countries in which midwifery is the standard for prenatal care and birth practices have better statistical outcomes for mothers and infants. As more families become aware of the facts, the demand for midwives will continue to increase. Expanding licensure means more choices and better access for a greater number of families.