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South Dakota Nurse Midwife Lobbies To Change Law


Certified Nurse Midwives bring midwifery care in South Dakota into the 21st Century with House Bill 1267. Although Certified Nurse Midwives have been licensed and practicing for over 25 years in South Dakota, CNMs are not growing in numbers in our state. Part of this is likely due to the fact that in order for a nurse midwife to practice in South Dakota, she must have a written collaborative agreement with a physician. That agreement takes form in a written contract that is enforced by the State Board of Nursing as well as the State Board of Medical Examiners. South Dakota’s Nurse midwives are on a mission to change this statute and have submitted a bill to the House of Representatives. Sponsored by (R) Rep. Tom Brunner, the bill proposes that CNMs be allowed to practice in accordance with their board certifying organization, the American College of Nurse Midwives.

The American College of Nurse Midwifery defines nurse midwifery as an independent practice. As of November of 2006, 30 states have removed the requirement for written collaborative agreements and many more have legislative action in progress. South Dakota has been slow to move on the concept and House Bill 1267 will hopefully change that. House Bill 1267 was initiated by members of the South Dakota Chapter of the American College of Nurse Midwives. In 2006, one member, Jeanne Prentice, attempted to obtain a waiver from the state to provide care to women who were having unassisted home births. The state denied the waiver stating they did not have the authority to provide a wavier. The requirement for the collaborative agreement is in South Dakota Statute.

Prentice has a clinic in Beulah, Wyoming where she provides care for women who choose to birth outside of the hospital setting. “Having a baby at the clinic is not the same as a homebirth, but we make it as homelike as possible” says Prentice. Beulah is just 10 miles across the South Dakota border. In Wyoming, Certified Nurse Midwives do not have the restrictive requirements of a collaborative agreement. In 2005, there were 42 unassisted homebirths in South Dakota.

Across the nation, there are over 5,500 Certified Nurse Midwives practicing in a variety of settings including hospitals, birthing centers and homes. Entry into the College of Midwives requires a state license as an RN and graduate education in Nurse Midwifery. In South Dakota there are 14 Nurse Midwives licensed but not all are able to practice due to the collaborative agreement restrictions.

Certified Nurse Midwives are known for their low intervention in the birth process leading to outstanding outcomes with fewer cesarean sections, less trauma to mother and babies, higher apgar scores. They focus on care of normal pregnancies but work in high risk settings as well.

Most of South Dakota’s Native American population receive Nurse Midwifery care at facilities like Pine Ridge, Rosebud and Native Women’s Health Clinic in Rapid City. Three nurse midwives from the Rapid City clinic deliver mother’s at Rapid City Regional Hospital. Federal law does not require Certified Nurse Midwives to have a collaborative agreement.

American College of Nurse Midwives - Position Statement on Collaborative Agreements

Requirements for Signed Collaborative Agreements between Physicians and Certified Nurse-Midwives (CNMs) or Certified Midwives (CMs)

The American College of Nurse-Midwives (ACNM) strongly supports the principle of collaboration in the delivery of healthcare services, as evidenced by the Standards for the Practice of Midwifery, the ACNM Position Statement on Collaborative Management in Midwifery Practice, and the Joint Statement of Practice Relations between Obstetrician - Gynecologists and Certified Nurse-Midwives/Certified Midwives. However, the ACNM opposes requirements for signed collaborative agreements between physicians and certified nurse-midwives (CNMs) or certified midwives (CMs) as a condition for licensure, reimbursement, clinical privileging and hospital credentialing, or prescriptive authority.

It is the ACNM position that safe, quality health care can best be provided to women and their infants when policy makers develop laws and regulations that permit CNMs and CMs to provide independent midwifery care within their scope of practice while fostering consultation, collaborative management, or seamless referral and transfer of care when indicated. ACNM opposes requirements for signed collaborative agreements with physicians as a condition for licensure, reimbursement, clinical privileging and hospital credentialing, or prescriptive authority as such requirements, in practice, interfere with effective coordination of care.

- Requirements for a signed collaborative agreement do not guarantee the effective communication between midwives and physicians that is so critical to successful collaboration:

 They do not assure physician availability when needed
 There is no evidence that they increase the safety or quality of patient care
 In certain circumstances, such as the aftermath of a natural or declared disaster, such requirements have hampered the ability of CNMs/CMs to provide critically necessary emergency relief services
 Collaborative agreements signed by individual physicians wrongly imply that CNMs/CMs need the supervision of those individuals in all situations. Based on this misconception:

o Professional liability companies have used signed agreements with their implied requirements for supervision as the rationale for raising physician premiums citing increased risk related to such unneeded supervision
o CNMs/CMs may be restricted from exercising their full scope of practice or from receiving hospital credentials, clinical privileges, or third party reimbursement for services that fall within the scope of their training and licensure

 Requirements for signed collaborative agreements can create an unfair economic disadvantage for CNMs/CMs:

o They have been used to limit the number of midwives who can practice collaboratively with any one physician, effectively barring CNMs/CMs from practice in some cases or restricting the ratio of CNMs/CMs to physicians
o They allow potential economic competitors to dictate whether or not midwives can practice in a community
o They restrict access to care and choice of provider for women. This is of particular concern in underserved areas.

The Standards for the Practice of Midwifery state that midwifery care is based upon knowledge, skills, and judgment which are reflected in written practice guidelines that are mutually agreed upon, and specifically mandates that those guidelines define the parameters for consultation, collaboration, and referral. The Standards do not require signed collaborative agreements with physicians. Policies that create confusion about the designation of responsibility are to be avoided, especially given the current malpractice climate. It is critical that laws and regulations facilitate effective relationships between health care professionals, creating systems whereby midwives and physicians can communicate openly and practice collaboratively while continuing to provide quality care that falls within each individual’s professional scope of practice.

* Certified nurse-midwives are registered nurses who have graduated from a midwifery education program accredited by the ACNM Division of Accreditation and have passed a national certification examination administered by the American Midwifery Certification Board, Inc. (AMCB), formerly the American College of Nurse-Midwives Certification Council, Inc. (ACC).

* Certified midwives are graduates of an ACNM Division of Accreditation accredited, university affiliated midwifery education program, have successfully completed the same science requirements and AMCB national certification examination as certified nurse-midwives and adhere to the same professional standards as certified nurse-midwives.

Source: ACNM Board of Directors
Date: March, 2006


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