Midwifery Legislation & Regulation The New Jersey Experience

Dawn Durain, CNM, MPHACNM Region II RepresentativeUPenn Midwifery Facultyduraind@nursing.upenn.edu

NJ Midwifery History

Immigrants Demonstration

projects (later birth centers also)

Pattern of Model legislation & regulation (for many types of providers)

Context of 1910 Statute

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).

“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

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

Until 1975…same law, new regulations….

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

CNM Appointments…

Maternal Child Health Consortium Perinatal Cooperatives

Regulatory & Advisory Bodies

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Introduction of CM in New York Restrictive/out of date CNM Scope of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

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

Change Process

CNM, CM, CPM loosely coalesced BOME Legal advice

Consultation with MANA & NARM Support Opposition

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

? “Support”

CM community CPM community

Variety of views on regulation Few CPMs in NJ at the time

CNM community Issue of the RN license

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

Other Opposition

MD Medical Society silent Individual MDs pro/con

CNMs who objected to loss of RN license criteria

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

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

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

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.+>>

Scope of Practice

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

Lesson learned

Coalition Lobbyist Expect RN opposition Professional body support Consumer support +/- Propose big – know what you are willing

to lose on

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