Exceutive Summary

This is a document created for a meeting with the Secretary of Kentucky's Cabinet for Health Services. The purpose of the meeting was to obtain support from the Cabinet for legal access to direct-entry midwives for women in Kentucky.

Goal:

The Kentucky Alliance for the Advancement of Midwifery is seeking support from the Cabinet for Public Health to amend 902 KAR 4:010 in order to allow for the licensure of Direct Entry Midwives based on the Certified Professional Midwife Credential.

Explanation of Need:

KRS 211.180 authorizes the Cabinet of Human Resources to regulate midwifery "including the issuance of permits to... women who practice midwifery."

In 1975, 902 KAR 4:010 ceased authorization of new permits to practice "lay midwifery."

Direct Entry "lay" Midwives were grandfathered out of legal practice with this regulation.

·Today, Direct Entry Midwives can be certified by the North American Registry of Midwives (NARM), founded in 1987. After completing this process, a midwife can use the title, Certified Professional Midwife. The NARM certification process has undergone a thorough jobs' analysis by an independent contractor, Schroeder Measurement Technologies, Clearwater, Florida. Due to the rigorous psychometric testing involved in this analysis, this process is now legally defensible. This certification process was not available when the most current "lay midwifery" regulations were drafted.

Certified Nurse Midwives practice virtually exclusively in hospitals. Nationally 95% of women birthing with the assistance of nurse midwives do so in a hospital.

·Both Kentucky schools of nurse midwifery provide exclusively hospital-based training.

·The overwhelming majority of planned home births are assisted by Direct Entry Midwives.

·The safety of planned homebirth, assisted by Certified Professional Midwives, is indisputable.

·The Certified Professional Midwife credential is the only credential available, in the United States, that validates out-of-hospital birth experience.

·Families who choose homebirth deserve legal access to qualified professionals.

·Licensing and promoting Direct Entry Midwives are "managed care friendly" without being "patient hostile".

Benefits of midwifery care include: reduced use of medical technology, such as cesarean section, epidural block, forcep delivery, vacuum extraction; decreased exposure of mother and baby to infections, which may be antibiotic-resistant; minimized disruption of the birth process, typically caused by moving the mother, strangers, and loss of autonomy; improved bonding, due to eliminating mother/baby separation and mother/father separation; in depth breastfeeding support; and reduced morbidity associated with technological interventions.

Direct Entry Midwives can practice legally in 33 states. More states are added each year.

·Other states have set precedent in licensing and promoting Direct Entry Midwives. Just last month, legislation was passed which allows Medicaid reimbursement for homebirths to Florida Licensed Midwives. Licensed Midwives includes both Certified Nurse Midwives and Direct Entry Midwives licensed by the State of Florida. Previously, Florida Licensed Midwives were eligible for Medicaid reimbursement in hospitals or birthing centers, but not in homes. This not only sets precedent for other states, but it also impacts reimbursement from managed care organizations.