Midwifery Legislation

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Midwifery Legislation Regulation The New
Jersey Experience

• Dawn Durain, CNM, MPHACNM Region II
  Representative
• UPenn Midwifery Faculty
• duraind_at_nursing.upenn.edu

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NJ Midwifery History

• Immigrants
• Demonstration projects (later birth centers also)
• Pattern of Model legislation regulation (for
  many types of providers)

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Context of 1910 Statute
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1910 Statue ... 2007 still in effect

• A person is "regarded as practicing midwifery"
  under New Jersey's statute if he or she "attends
  a woman in childbirth as a midwife, or advertises
  as such."
• Old Regs - Persons wishing to practice midwifery
  in New Jersey first must obtain a midwifery
  license from the state board of medical
  examiners. Candidates for a license must pass an
  examination designed "to test the scientific and
  practical fitness of candidates to practice
  midwifery, and must complete an application
  evidencing, that they are of good moral
  character, and that they have "received a
  certificate or diploma from a legally
  incorporated school of midwifery, or maternity
  hospital, in good standing, after at least 1800
  hours' instruction within a period of not less
  than nine months."
• Candidates also must get a physician registered
  in the State of New Jersey to indorse their
  application ( of good moral character).

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• Midwives delivered babies at home, and New
  Jersey was at the forefront of the licensing and
  training of midwives. In 1914 there were 712
  practicing midwives in the state. In 1919 forty
  percent of all births in New Jersey were attended
  by midwives.
  www.scc.rutgers.edu/.../Period_4/materni
  ty.htm

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and then one day, the
midwives disappeared...
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Until 1975same law,
new regulations.
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NJ Board of Medical Examiners

• CNM appointed to BOME
• Twelve physicians, one podiatrist, three public
  members, a certified nurse midwife, a licensed
  physician assistant, a bioanalytical laboratory
  director, the Commissioner of Health or his
  designee and a government liaison member -- all
  gubernatorial appointees -- serve on the Board.
• CNM Liaison Committee formed 3 CNMs, One MD

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CNM Appointments

• Maternal Child Health Consortium
• Perinatal Cooperatives
• Regulatory Advisory Bodies

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Identified Issues

• RX Authority for CNMs (law passed 1993)
• Introduction of CM in New York
• Restrictive/out of date CNM Scope of Practice
• non CNMs requesting licensure
• Lack of a written exam
• Lack of regulatory recognition

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BOME Legal Opinion

• Request to ACNM Chapter to create an exam
• Request to Liaison Committee to write exam
• Discussion on Committee to include CM and CPMs in
  regulation
• Joint Decision to rewrite/update/expand
  Regulations

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Change Process

• CNM, CM, CPM loosely coalesced
• BOME Legal advice
• Consultation with MANA NARM
• Support
• Opposition

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Coalition of Support

• CNMs CMs....and ultimately CPMs
• CNM/CM CPM bridged by homebirth CNMs
• CNM/CMs long term pre-existing goal of Board of
  Midwifery
• CNM Chapter - lobbyist

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? Support

• CM community
• CPM community
• Variety of views on regulation
• Few CPMs in NJ at the time
• CNM community
• Issue of the RN license

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Opposition - NJSNA

• For the past year, the Board of Medical Examiners
  (BOME) has been working on new regulations for
  nurse midwives which, if implemented, would, for
  the first time, authorize the practice of
  non-nurse midwives in New Jersey. For nearly one
  hundred years, since the passage of the 1910
  statute governing midwifery practice in this
  state, the only midwives licensed to practice
  here have been nationally certified nurse
  midwives and all NJ regulations currently in
  effect for midwifery relate only to certified
  nurse midwives. NJSNA's knowledge about these
  in-the-works regulations is all second hand since
  no one, outside of the BOME has seen them and
  will not, until they are published in the NJ
  Register.
• NJSNA finds it ironic that at the same time the
  BOME has proposed regulations which would
  strictly limit the practice of certified
  registered nurse anesthetists (CRNAs) in
  ambulatory care, and forbid the provision of
  Botox by anyone but a physician, they would
  consider reversing the use of professional nurses
  in the practice of midwifery.
• NJSNA strongly supports the practice of midwifery
  in New Jersey but maintains that those providing
  this care should continue to be registered
  professional nurses who are certified nurse
  midwives.
• Please contact your legislator and let him know
  how you feel about this. (remains on NJSNA
  website with 2006 date0

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Other Opposition

• MD
• Medical Society silent
• Individual MDs pro/con
• CNMs who objected to loss of RN license criteria

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NJSNA Action

• Legislative sponsorship of law limiting the
  practice of midwifery to a person holding an RN
  license.
• Proposed while regulations were in public comment
  process

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Coalition Reaction

• Lobbied Chair of Senate Health Committee
• Lobbied identified sponsor in the Assembly
• Bill died in Committee
• NJSNA threatened to re-introduce it every session
  not done to date

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Outcome - Regulatory Change 2002/3

• Recognition of CNM, CM and CPM
• Proof that the applicant is 18 years old or older
• An official transcript from a midwifery program,
  accredited by the American College of Nurse
  Midwives (ACNM) or the Midwifery Education
  Accreditation Council (MEAC), or their successors
• A notarized copy of Certification from either
  ACNM, ACC, NARM, or their successors
• Scope of practice issues updated

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Midwifery Liaison Committee to BOME Reconfigured

• The Midwifery Liaison Committee shall consist of
  eight members who shall serve as consultants to
  the Board and who shall be appointed by the
  Board. The Committee shall include at least one
  certified nurse midwife, at least one certified
  professional midwife, at least one certified
  midwife, and two other midwives, all of whom
  shall hold licensure from the Board. The
  Committee shall also include one certified nurse
  midwife who is a member of the Board and two
  physicians, one of whom shall be a member of the
  Board of Medical Examiners and one of whom shall
  be Board-certified by either the American Board
  of Obstetrics and Gynecology, the American
  Osteopathic Board of Obstetrics and Gynecology or
  any other certification organization with
  comparable standards.gtgt

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Scope of Practice

• CNM/CM Gyn, Primary Care
• CNM RX authority

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Lesson learned

• Coalition
• Lobbyist
• Expect RN opposition
• Professional body support
• Consumer support /-
• Propose big know what you are willing to lose
  on

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Future Plans

• ?Open statute CM RX Authority
• Elimination of signed MD agreement happening at
  regulatory level
• Create Board of Midwifery
• current biannual fee 270 (610 MD)
• 175 license application

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