Fighting the Antiquated Image of Midwifery

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<p>Nurse midwives came to the General Assembly to show their support for Senate Bill 695, legislation that would remove what they called “unnecessary” physician supervisory requirements.

By Hyun Namkoong

For many people, a midwife is someone who delivers babies in a rustic log cabin filled with mysterious herbal concoctions – which is why Suzanne Wertman hopes to change the image of midwives in North Carolina.

Maureen Darcy (red jacket), former member of the N.C. Joint Midwifery Board, came to the legislature in 2014 to advocate for loosening rules governing midwifery practice. Certified nurse midwives have returned this year to petition lawmakers to revise their practice to function more autonomously. Photo credit: Rose Hoban

“Ninety-nine percent of nurse-midwives practice in a health system. They’re in a health department, medical office or hospitals,” she said.

Wertman, president of the North Carolina Affiliate of the American College of Nurse-Midwives, came out to the General Assembly Wednesday to advocate for the loosening of supervisory requirements that limit the way certified nurse-midwives practice in the 31 counties in North Carolina that don’t have maternal care. She estimated that there are around 300 CNMs in North Carolina.

CNMs are licensed health care providers with prescribing power in all 50 states. Under federal law, they are considered primary care providers.

Wertman said state legislation on nurse-midwives was last ratified in 1981, and that since then the standards for training and educating them have improved substantially.

She said Senate Bill 695 would update regulations for nurse-midwifery in the state. SB 695 defines four primary components of what CNMs can do. A broad scope of what they can do under the proposed law includes diagnosis, treatment, prescribing power, interpreting diagnostic studies and consulting with other health care providers. The bill passed its first reading in the Senate and was referred to the committee on health care on March 30.

CNMs are currently required by the state Board of Nursing to have a physician act as a supervisor.

“Basically, that supervision is a signature on a piece of paper,” Wertman said. “They’re certainly not with us in the delivery room. In my case, my supervising physician isn’t even in the same town.”

Maureen Darcy, executive director of the Women’s Birth and Wellness Center in Chapel Hill, explained that CNMs employed by a hospital or a practice don’t have to pay physicians to “supervise.”

“We are a 501(c)(3) [nonprofit organization]. We actually pay our physician [five figures] to be our backup,” Darcy said. She declined to disclose the exact amount of that five-figure total.

Wertman believes that CNMs can help address the health care provider shortage in the rural pockets of North Carolina. She stressed that CMNs know what they can and cannot do.

“We know our limits, we know our scope of practice; we’re not asking for that to be changed. But we’re asking for that restriction that doesn’t serve anybody to be lifted so that we can go to those 31 counties and practice,” Wertman said.

She said she feels “really optimistic” that SB 695 will pass this year.

“I feel like the time is right. We are being recognized for our contribution and for what we can offer,” Wertman said, smiling.