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The role of midwives is in a state of flux


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Nurse-midwives perform many of the same tasks and responsibilities of a physician, and in recent years, the ability of nurse-midwives to operate independently has expanded. Nurse-midwives have been fighting for decades against state laws that require physician supervision for births, and the American College of Nurse-Midwives says that they’ve reached a “tipping point” nationally. Research shows that certified nurse-midwives have fewer cesarean deliveries and lower epidural rates than hospital physicians.

In California, nurse-midwives are facing resistance to a bill that would allow them to practice independently from a surprising source: physicians. All parties agree that certified nurse-midwives have the qualifications to practice without physician supervision, but the hospitals and doctors disagree on whether hospitals should be allowed to employ midwives directly. California has regulations in place that prohibit hospitals, or any corporation, to hire physicians directly. The restriction intends to prevent the “corporate practice of medicine.” The proposed bill under that would allow nurse-midwives to practice independently debate had a similar provision, but it was withdrawn to accommodate the California Hospital Association. The California Medical Association, representing California doctors, insists that the provision should be reinstated, and refuses to support the bill without it.

With the hospitals and doctors arguing this issue, certified nurse-midwives are caught in the middle. Licensed midwives have had the ability to practice without physician supervision since 2013, and nurse-midwives require more education than their counterparts. Nurse-midwives report that requiring physician supervision is a burden, as it often requires paying extra malpractice insurance and paying doctors for their time (even though the doctors are not required to be present under the current law). However, if the bill passes with the hiring restriction, it will be much harder for nurse-midwives to work in hospitals, forcing them into burdensome roundabout contracts.

In Alaska, midwives are also facing challenges, this time in the form of fees. Midwife certification fees are tripling, and midwives are concerned about the effect this will have on the profession. According to the CDC, Alaska has one of the highest out-of-hospital births in the country with approximately six percent of births taking place outside of hospitals. Midwives in the state are concerned that the fees will make it prohibitive to attract new people to the professions. Because of their low-intervention methods, many midwives are more affordable than hospitals, but the increased fees could jeopardize that. The licensing board reports that the increase is necessary to cover the increasing costs of running the board and reduce the board’s deficit.

So even though midwives have made significant progress, the profession still faces many regulatory hurdles.