Midwifery Legislation Regulation The New Jersey Experience

1. Midwifery Legislation & Regulation The New Jersey Experience Dawn Durain, CNM, MPHACNM Region II Representative UPenn Midwifery Faculty duraind@nursing.upenn.edu

3. NJ Midwifery History Immigrants Demonstration projects (later birth centers also) Pattern of Model legislation & regulation (for many types of providers)

4. Context of 1910 Statute

5. 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).

6. “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/maternity.htm

7. …and then one day, the  midwives disappeared...

8. Until 1975…same law,  new regulations….

9. 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

10. CNM Appointments… Maternal Child Health Consortium Perinatal Cooperatives Regulatory & Advisory Bodies

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 Identified Issues RX Authority for CNMs (law passed 1993) Introduction of CM in New York Restrictive/out of date CNM Scope of Practice ‘non’ CNMs requesting licensure Lack of a written exam Lack of regulatory recognition

12. 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

13. Change Process CNM, CM, CPM loosely coalesced BOME Legal advice Consultation with MANA & NARM Support Opposition

14. 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

15. ? “Support” CM community CPM community Variety of views on regulation Few CPMs in NJ at the time CNM community Issue of the RN license

16. 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

17. Other Opposition MD Medical Society silent Individual MDs pro/con CNMs who objected to loss of RN license criteria

18. 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

19. 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

20. 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

21. 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.+>>

22. Scope of Practice CNM/CM – Gyn, Primary Care CNM – RX authority

23. Lesson learned Coalition Lobbyist Expect RN opposition Professional body support Consumer support +/- Propose big – know what you are willing to lose on

24. 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