Midwifery Legislation: The New York Experience

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Midwifery LegislationThe New York Experience

• Patricia Burkhardt, DrPH, LM

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Result of 10 years of lobbying

• The practice of the profession of midwifery is
  defined as the management of normal pregnancies,
  child birth and postpartum care as well as
  primary preventive reproductive health care of
  essentially healthy women as specified in the
  written practice agreement, and shall include
  newborn evaluation, resuscitation and referral
  for infants.

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Written Practice Agreement

• Midwifery shall be practiced in accordance with a
  written agreement between the midwife and
• a licensed physician who is board certified as an
  obstetrician-gynecologist by a national
  certifying body or
• a licensed physician who practices obstetrics and
  has obstetric privileges at a general hospital
  (licensed under article twenty-eight of the
  public health law) or
• a hospital (licensed under article twenty-eight
  of the public health law) that provides
  obstetrics through a licensed physician having
  obstetrical privileges at such institution.

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What the Practice Agreement Supposedly Covers

• The written agreement shall provide for physician
  consultation, collaboration, referral and
  emergency medical obstetrical coverage, and shall
  include written guidelines and protocols. The
  written agreement shall provide guidelines for
  the identification of pregnancies that are not
  considered normal and address the procedures to
  be followed. The written agreement shall also
  provide a mechanism for dispute resolution and
  shall provide that the judgment of the
  appropriate physician shall prevail as to whether
  the pregnancy, childbirth or postpartum care is
  normal and whether the woman is essentially
  healthy in the event the practice protocols do
  not provide otherwise.

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Midwifery Law (cont)

• A licensed midwife shall have the authority, as
  necessary, and limited to the practice of
  midwifery, and subject to limitations in the
  written agreement, to prescribe and administer
  drugs, immunizing agents, diagnostic tests and
  devices, and to order laboratory tests, as
  established by the board in accordance with the
  commissioner's regulations. A midwife shall
  obtain a certificate from the department upon
  successfully completing a program including a
  pharmacology component, or its equivalent, as
  established by the commissioner's regulations
  prior to prescribing under this section.

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State board of midwifery

• The state board of midwifery shall be appointed
  by the board of regents on recommendation of the
  commissioner for the purpose of assisting the
  board of regents on matters of professional
  licensing and professional conduct in accordance
  with section sixty-five hundred eight of this
  title. The board shall be composed of thirteen
  individuals. Initial appointments to the board
  shall be such that the terms shall be staggered.
  However, no members shall serve more than two
  terms.

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Composition of the BOM

• Seven members of the board shall be persons
  licensed or exempt under this section.
• One member of the board shall be an educator of
  midwifery.
• Two members of the board shall be individuals who
  are licensed physicians who are also certified as
  obstetrician/gynecologists by a national
  certifying body.
• One member of the board shall be an individual
  licensed as a physician who practices family
  medicine including obstetrics.
• One member of the board shall be an individual
  licensed as a physician who practices pediatrics.
  
• One member of the board shall be an individual
  not possessing either licensure or training in
  medicine, midwifery, pharmacology or nursing and
  shall represent the public at large.

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Requirements for a professional license

• Application file an application with the
  department.
• Education satisfactorily
• complete educational preparation (degree or
  diploma granting) for the practice of nursing,
  followed by or concurrently with educational
  preparation for the practice of midwifery in
  accordance with the commissioner's regulations,
  or
• submit evidence of license or certification, the
  educational preparation for which is determined
  by the department to be equivalent to the
  foregoing, from any state or country,
  satisfactory to the department and in accordance
  with the commissioner's regulations, or
• complete a program determined by the department
  to be equivalent to the foregoing and in
  accordance with the commissioner's regulations.

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Requirements for a professional license (cont)

• Examination pass an examination satisfactory to
  the department and in accordance with the
  commissioner's regulations.
• Age be at least twenty-one years of age.
• Character be of good moral character as
  determined by the department.
• Citizenship or immigration status be a United
  States citizen or an alien lawfully admitted for
  permanent residence in the United States.
• Fee pay a fee

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Prior nurse-midwifery certification

• Any individual who is certified as a
  nurse-midwife pursuant to section twenty-five
  hundred sixty of the public health law before
  June first, nineteen hundred ninety-six, shall be
  deemed to be licensed as a midwife under this
  article provided that each such certified
  nurse-midwife shall, prior to that date, submit
  evidence of such certification to the department
  together with the appropriate fee required by
  subdivision seven of section sixty-nine hundred
  fifty-five of this article. Any individual
  certified as a nurse-midwife pursuant to section
  twenty-five hundred sixty of the public health
  law (i) may practice under that section until it
  is repealed, but (ii) shall not practice pursuant
  to this article until after receiving approval
  from the commissioner and submitting the fee
  required by subdivision seven of section
  sixty-nine hundred fifty-five of this article.

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Exempt persons

• Nothing in this article shall be construed to
  affect, prevent or in any manner expand or limit
  any duty or responsibility of a licensed
  physician from practicing midwifery or affect or
  prevent a medical student or midwifery student in
  clinical practice under the supervision of a
  licensed physician or board certified
  obstetrician/gynecologist or licensed midwife
  practicing pursuant to the provisions of section
  twenty-five hundred sixty of the public health
  law in pursuance of an educational program
  registered by the department from engaging in
  such practice.

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Limited permit.

• A limited permit to practice midwifery may be
  granted for a period not to exceed twelve months
  to an individual who has to the satisfaction of
  the department met all the requirements of
  section sixty-nine hundred fifty-five of this
  article, but has not yet passed the examination
  required by subdivision three of such section.
• A limited permit shall entitle the holder to
  practice midwifery only under the direct
  supervision of a licensed physician who is
  authorized under section sixty-nine hundred
  fifty-one of this article or a licensed midwife.

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What we didnt consider

• Those doing midwifery in NYS at the time - to
  take into account what was best for the women
  rather than just profession
• Did not understand that with a law, violation
  became a felony rather than a misdemeanor

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Lessons Learned

• Find the most effective sponsors
• Talk to the opposition
• Maintain contact with supporters
• Dont become complacent
• Figure out compromises early
• Decide on the give-aways and the holding points
• Keep your eye on the prize
• New law doesnt change old laws

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NYSALM Barriers to Practice Committee

• Written Practice Agreement
• Effects on the midwives
• Effects on the women
• History
• Strategies
• Address more than WPA issue

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Amendments to current law elements being
considered

• Remove WPA
• Expand definition of midwife
• Reinforce out-of-hospital birth
• BOM membership

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Best Advice

• Be unified in your beliefs and goals
• Maintain a vision while being pragmatic
• Support one another
• Be greatly passionate but not too patient
• Advocate for the women through the profession

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Resources

• NYS Office of the Professions