Midwifery Legislation: The New York Experience

1. Midwifery Legislation:The New York Experience Patricia Burkhardt, DrPH, LM

2. 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.

3. 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.

4. 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.

5. Midwifery Law (con�t) 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.

6. 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.

7. 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.

8. 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.

9. Requirements for a professional license (con�t) 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

10. 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.

11. 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.

12. 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.

13. What we didn�t 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

14. Lessons Learned Find the most effective sponsors Talk to the opposition Maintain contact with supporters Don�t become complacent Figure out compromises early Decide on the give-aways and the holding points Keep your eye on the prize New law doesn�t change old laws

15. NYSALM Barriers to Practice Committee Written Practice Agreement Effects on the midwives Effects on the women History Strategies Address more than WPA issue

16. Amendments to current law � elements being considered Remove WPA Expand definition of midwife Reinforce out-of-hospital birth BOM membership

17. 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

18. Resources NYS Office of the Professions