Midwives' bill is necessary and appropriate

Rep. Nancy E. Smith, D-Monmouth,
Kennebec Journal - Morning Sentinel

4/29/2008

During the 123rd Legislative session, I was actively involved in shepherding dozens of bills through the legislative process. I voted on literally hundreds more. I never imagined that the bill I sponsored in 2007 originally intended to license Certified Professional Midwives, or CPMs, would require explanation so soon after adjournment. This is one law for which I am confident the legislative process worked and the outcome was appropriate.
The Joint Standing Legislative Committee on Business, Research, and Economic Development (or the BRED committee) of which I am House chairman, has jurisdiction over the Department of Professional & Financial Regulation, which oversees the licensure of 40 occupations, from accountants to veterinarians and medical professionals such as podiatrists, physicians, radiologic technicians and dental hygienists.

The midwifery bill was presented to the BRED committee during the spring of 2007. We held a public hearing and work session, weighing testimony for and against the concept of licensure for CPMs.

The decision was made to request a review from the Department, to report back to the committee during the 2008 legislative session. One of the primary questions addressed in the review, which takes months to complete, is whether licensure is needed in order to protect public safety and welfare. The report concluded that there was no need to license CPMs because there were no demonstrated safety issues.

With this information, the committee members were unanimous in determining that CPMs should have a clear process to acquire the five medications cited as important for the best outcome possible for home births. The committee was split over whether licensing was necessary in order to monitor CPMs if the following are needed: local anesthetics, oxygen, vitamin K, oxytocin in small quantities to stop uterine bleeding and treatment known as "prophylaxis" to protect newborn eyes.

During floor debates in the full Legislature, the committee's report -- the one that did not recommend licensure for CPMs -- successfully passed in the House and Senate, with strong bipartisan votes in each chamber. This committee report, developed with assistance from the Maine Medical Association, included development of a plan for the state to monitor CPMs and report back to the BRED committee. It is important to note that the Maine Medical Association opposed licensure of CPMs because they do not endorse home births as a legitimate choice for families, and they felt that licensing would appear a state endorsement of this practice. They were not opposed to allowing CPMs to administer these specific medications.

Gov. John Baldacci, in reviewing the issue prior to signing the bill, added additional steps of oversight for the department, including a report back to his office in 2009.

I believe the result is good policy for Maine. I have been concerned by rather odd statements made by opponents to the bill recently, and would like to address those here.

First, The CPM certification is federally accredited by the National Commission on Certifying Agencies (NCCA), the same agency that accredits the Certified Nurse Midwife credential, among many others. The CPM credential provides assurance of a consistent level of training for midwives from all routes of entry -- either through an accredited midwifery school or through a portfolio evaluation process.

Secondly, the 26 CPMs in Maine are the only maternal care providers specifically and intensively trained in out-of-hospital birth. All CPMs must pass a rigorous written exam administered by the North American Registry of Midwives. The test specifications state that a CPM must demonstrate knowledge of the benefits and risks, as well as appropriate administration, of several medications, including the five that since the passage of the bill CPMs will be authorized to administer.

Finally, the legislation does not allow CPMs to prescribe medication to a patient, but to possess and obtain five specific items. This is a key difference, in that the medications are used only as needed by the midwife during the birthing experience.

There are two prevailing facts that are the basis for my perspective on this legislation. First, planned home births are happening in Maine -- not a large number, perhaps 100 a year, but it is a choice being made by some families. Second, when the Department of Professional and Financial Regulation reviewed the issue of licensing CPMs, the determination was made that there were no safety issues to require licensing this profession in order to protect the public.

The legislation, as signed by Gov. Baldacci, is a success.

Rep. Nancy E. Smith, D-Monmouth, is a farmer and forester in her third term in the House, where she is co-chairman of the Business, Research and Economic Development Committee.

Source: http://morningsentinel.mainetoday.com/view/columns/5011589.html