Your State Affiliates at Work: Increasing Access to Midwifery Care Nationwide

Affiliate leaders are already busy in the Year of the Nurse and the Midwife with efforts to increase access to midwifery care nationwide. ACNM will continue to support our affiliates for the 2020 state legislative sessions as they continue working toward dismantling some of the barriers, including implementation of full practice authority in several states where certified nurse-midwives (CNMs) and certified midwives (CMs) have some form of restriction on the ability to practice to the top of their training and education. The goal is to eliminate formal and arbitrary agreements and continue the collaborative work our members do every day with their physician colleagues.

We encourage our affiliates to find areas of common ground and work with other stakeholders to find solutions to address the rise in maternal deaths and severe maternal morbidity. ACNM is working to expand the number of states and facilities participating in the Alliance for Innovation on Maternal Health (AIM) quality improvement initiative as well as working to establish maternal levels of care designations in states. CNMs and CMs are committed to quality and a CNM sits on nearly every perinatal quality collaborative at the state level. Other state-level issues ACNM is focused on include expanding prescriptive authority of medication assisted treatment to CNMs in states where our members are not able to prescribe. The opioid crisis continues to erode families and CNMs are now eligible to apply for a DATA-waiver once they’ve taken the required 24 hours of training thanks to the passage of the SUPPORT Act in Congress last year.

ACNM is also committed to enacting and supporting state legislative efforts that seek to eliminate racism and racial bias in the midwifery profession and race-based disparities throughout the health care continuum. We support passage of state and federal legislation requiring Implicit Bias Training as a continuing education requirement for medical professionals and efforts to ensure pregnant black women receive equal treatment with similar training for those involved in perinatal care. We are also focused on establishing reimbursement equity within the Medicaid program, as there are 15 states where CNMs are reimbursed below the physician fee schedule for doing the same work. ACNM is also supportive of expanding Medicaid coverage to one-year postpartum and inclusion of mental health benefits. To help address the shortage of preceptors to assist midwifery students, we are interested in helping our affiliates pass legislation establishing tax incentives for preceptors.

Your state affiliates are hard at work!

• In California, though they did not advance another attempt to remove the licensure requirement for physician supervision in the current legislative session, the Health Policy Committee of the California Nurse-Midwives Association has been busy building coalitions to pass implicit bias maternity care provider training legislation and partnering with the Pacific Business Group on Health and the California Health Care Foundation to build the strongest case possible for removing barriers to midwifery care and fostering a robust midwifery workforce.
• The Pennsylvania affiliate held the first ever weekend-long conference entitled, “Midwifery Forward” in 2019, with plans to repeat the successful meeting in 2020 bringing healthcare providers and other stakeholders together to learn about the power of the midwifery model of care. This event includes a lobby day this year to educate lawmakers on the impact of greater access to midwives. Pennsylvania ACNM leaders have been meeting with leaders from Pennsylvania ACOG to discuss efforts to achieve full practice authority and recognition of the CM credential.
• Florida’s affiliate has been involved in an APRN coalition for years and they have never been closer to success in their quest to remove physician supervision as a practice requirement. While they face strong resistance from organized medicine, they are organized, savvy and joined in their coalition by powerful allies in AARP and the National Council on State Boards of Nursing. Most recently a new coalition called Floridians Unite for Healthcare, has emerged, bringing APRNs together with business, health care, political action groups and others to strive for passage of House Bill 607. These efforts have resulted in traction for this bill in the Florida House and on making headway in the Florida Senate.
• In North Carolina, the SAVE Act is alive and well despite an ongoing stalemate over Medicaid expansion in the deeply divided General Assembly. The affiliate is part of an APRN coalition and has garnered the support of the state March of Dimes chapter on the heels of the national March of Dimes statement in support of efforts to increase access to midwifery care to improve maternal and infant health outcomes. The affiliate has a political action committee which functions to support favorable lawmakers’ campaigns for re-election and has made great inroads with other policy makers. The North Carolina Institute of Medicine recently recommended full practice authority for CNMs as part of a number of systemic recommendations in the Perinatal System of Care task force report. This task force included consumers, insurers, public health officials, physicians, nurses, and several affiliate members who represented the midwifery perspective.

There are dedicated midwife volunteers working with experts in health policy and legislation all across the country. Without you, we could not keep moving midwifery forward. Next time we will talk about what’s happening in Kansas, Wisconsin, Massachusetts, Virginia, and Georgia. If you want more information about how to get involved or if you need help in your state’s efforts to increase access to midwifery care, please contact ACNM’s State Government Affairs Consultant Suzanne Wertman at swertman@acnm.org.