Thursday, April 18, 2013

Disaster in the Making: Senate Bill 292

Last week Senator Green introduced a new bill in the Senate, SB 292.  It looks much like last year's HB 5070, and its sister bill SB 1310, all of which propose to license CPMs in the State of MI.  

In summary, this bill is a disaster in the making. 

According to Kate Mazzara, CPM and President for the Michigan Midwives Association:

     “The purpose of licensure is to protect the public's safety by providing a mechanism 
      for consumers to verify that their midwives have appropriate training, proficiency 
      and accountability, as determined by the state,” said Kate Mazzara, president of the 
      Michigan Midwives Association.  "Licensed health care providers are subject to 
      oversight by state boards that are responsible for determining standards of practice 
      as well as hearing consumer grievances and carrying out disciplinary measures 
      when necessary.” ~ Quoted from recent LSJ Article

All sounds good right?  "Appropriate Training ~ Proficiency ~ Accountability ~ Oversight ~ and Standards of Practice"... so what's the problem?  Isn't this precisely what Safer Midwifery for Michigan is all about? 

The problem is that Ms. Mazzara's statement is a carefully crafted PR move, with absolutely no meaning or intention behind it.  Anyone who takes the time to read this bill will see glaring discrepancies between what she claims to support, and what is actually being proposed in this bill.  It's almost as if the small number of midwives supporting this bill are counting on the fact that the public won't read it for themselves. 

Well, we did read it, and in a nutshell here is what this bill proposes for MI families: 

  • A body of licensed midwives whose minimum standard for education is a high school diploma or a GED, hold a CPM certification, and pass the NARM exam.  
    • Just a reminder here that the minimum standard for education in every other first world country is 3-5 years of UNIVERSITY education.  The educational standards for CPMs in the US would not qualify them to be employable in any other first world country.  Is this "appropriate training and proficiency?"  Not by anyone's standards but their own.   This level of educational training is no where near a university level education, in fact there is literally NO university level training required whatsoever to earn a "CPM" credential. 

  • Midwives who carry prescription medications and administer IV fluids with NO MEDICAL TRAINING or even so much as a course in Pharmacology.  
    • No, they don't want to bother with jumping through the hoops of earning prescriptive authority, instead they propose to work under the prescriptive authority of other "health care providers".   Other "health care providers" is purposefully defined as Physicians, Nurse Midwives, or any other licensed, registered, or authorized health care professional. 
    • The bill further states:
                        "The department shall not promulgate any rules that limit the  
                         authority of a midwife to administer prescription drugs or 
                         medication or prohibit the administration of medication." 

  • A strategically biased board of "midwifery" that consists of 5 midwives and 2 members of the public.   
    • Note that this bill also defines "midwifery" as being completely separate from Nurse Midwifery.  Therefore, there are no Nurse Midwives that will participate on this board, no physicians, no balance.  It's a sneaky little way to avoid accountability by protecting the sisterhood, just as is done now with "peer review".  
  •  A "board" that promises to promulgate rules about regulating, limiting, prohibiting, the tasks, acts, or functions of midwives, yet in the same bill states:   
                          "The department shall NOT promulgate any rules under this 
                          section that limit or restrict the scope of practice of midwifery 
                          as established under this article." 
    • In other words, there will be no risking out criteria, no defined scope of practice that ensures families will be properly assessed and appropriately limited to low-risk births.  The bill specifically states that no one can limit a midwife's scope of practice except for themselves.  
  • Collaborative care will be determined by the "board" with the "appropriate health care providers".  
    • So an unbalanced board will determine when, if ever, a client would need to consult with a "health care provider."  For example, a woman with a breech presenting baby might be referred to a local chiropractor in lieu of consulting with an actual OBGYN.  (Yep, that happened.)  We all know that high risk birth is considered, "just a variation of normal" anyway.  
Licensing alone will not improve the safety of out-of-hospital birth Time and time again, experts have said that the factors that contribute to the safety of home birth (or OOH birth) are:
          a) Highly educated care providers (In the US that means a CNM or a CM)

          b) Clear screening guidelines and risking out criteria that ensure homebirth is an 
               option for only low-risk women
          c) Truly collaborative care between midwives and medical personnel

ACOG has issued a statement on Planned Homebirth explaining the critical factors in achieving favorable outcomes:

     "Importantly, women should be informed that the appropriate selection of candidates 
      for home birth; the availability of a certified nurse–midwife, certified midwife, or 
      physician practicing within an integrated and regulated health system; ready access 
      to consultation; and assurance of safe and timely transport to nearby hospitals are  
      critical to reducing perinatal mortality rates and achieving favorable home birth 

Licensing CPMs wouldn't come close to meeting educational standards for "highly educated care providers", and dangerous bills like SB 292 work intentionally against appropriately defining a scope of practice as being for low-risk pregnancies in the OOH sector.   The notion that this bill is about accountability, proficiency, oversight, or safety is an absolute lie.   

There is no doubt that our options in MI are limited, and that licensing is part of a bigger picture that can potentially offer safer options, but it MUST be done responsibly, including all of the factors that impact safety.  Handing out a license to those who haven't earned them according to educational & safety standards, will undoubtedly cause more harm than good.  Women in MI deserve to have safe, reliable options, and this bill will not provide them with that. 

Please read the bill for yourself and contact your Senator and State Representative immediately to share your concerns for the safety and well being of mothers and babies in MI.  

* Tell them that people with a high school diploma, & no medical or university level training, have NO business administering drugs or IVs, let alone delivering babies.  

* Let them know you value options surrounding birth, but that MI women deserve for those options to be safe and reliable...this bill won't get them there.

What would improve the safety of OOH birth?  
  • Licensing only the most educated to serve as midwives, those with a university level education 
  • A clearly defined scope of practice and risking out protocols that ensure only low-risk births are taken on outside the hospital
  • Appropriate transfer of care and Collaborative Care guidelines 
  • A balanced board of midwifery, including a majority of highly educated midwives, doctors, and citizens

Check out this link for more reading about Educational Standards for Midwives Around the World.  

(Part II in the 3 part series on Education of Midwives Around the world, coming on Monday.) 


  1. The Certified Professional Midwife credential, issued by NARM, is accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence (ICE, formerly NOCA). The mission of ICE is to promote excellence in credentialing for practitioners in all occupations and professions. The NCCA accredits many healthcare credentials, including the Certified Nurse-Midwife. NCCA encourages their accredited certification programs to have an education evaluation process so candidates who have been educated outside of established pathways may have their qualifications evaluated for credentialing. The NARM Portfolio Evaluation Process (PEP) meets this recommendation. The CPM is the only NCCA-accredited midwifery credential that includes a requirement for out-of-hospital experience.

    The main purpose of a certification program is to establish entry-level knowledge, skills, and abilities necessary to practice competently. A Certified Professional Midwife’s (CPM) competency is established through training, education and supervised clinical experience, followed by successful completion of a skills assessment and written exam. The goal is to increase public safety by setting standards for midwives who practice “The Midwives Model of Care” predominately in out-of-hospital settings.

    The first step in the certification process is an evaluation of the applicant’s education and clinical training according to the standards set by the Portfolio Evaluation Process. All certification candidates must demonstrate the essential competencies identified by the NARM Job Analysis, either through completion of the Portfolio Evaluation Process or through a route determined by NARM as equivalent. All candidates, regardless of educational route, must complete the second step, which is the NARM Written Examination. The NARM Written Examination is designed to assure mastery of the didactic material that is necessary for clinical competence.

    As of January 2012, the CPM certification had been issued to over 2000 midwives. All twenty-six states that recognize direct-entry midwives practicing in predominately out-of-hospital settings use the NARM Written Examination or the CPM credential as the basis for legal recognition. Midwives in eight other states are working on laws to license midwives using the CPM credential.

    As hospital care costs escalate and home or birth center births increase, the Certified Professional Midwife is the credential that consumers choose when they are seeking an out-of-hospital birth. The CPM practices the Midwives Model of Care and preserves multiple routes of entry into the profession of midwifery. The Certified Professional Midwife (CPM) continues to offer traditional, natural, non-interventive births with good outcomes and state-of-the-art professional skills

  2. This comment is regurgitated blather directly lifted from NARM's website. Obviously, we do not agree with NARM's concept of accountability and certification. It is simply not enough to ensure competency and quality of midwifery practices.

    We also disagree that CPMs offer care that has similar outcomes to hospital-based birth. The cost savings comes with the increased risk of injury and death. Though our healthcare system may have obscenely high costs, trading off these costs at increased risks to life and health is not acceptable.