After several years of working the halls in Frankfort, Kentucky midwives finally scored a legislative win with the passage of Senate Bill 84 (SB84) which establishes a state license for certified professional midwives (CPMs).
Gov. Matt Bevin signed the legislation after the House passed the bill 96-1, ending an eight-year effort by the Kentucky Home Birth Coalition and a longer 44-year effort to recognize midwives as a state-recognized medical provider after Kentucky stopped issuing permits in 1975.
Stamping Ground’s Elizabeth Regan, who serves as the president of the Kentucky chapter of the National Association of Certified Professional Midwives, helped lead the effort and was elated to see the bill finally pass.
“There’s been several attempts in the last 44 years to pass this bill; the latest push was eight years in the making,” she said. “There is still a long way to go to establish the regulations and the licensing process. We look forward to making home births more accessible and it is badly needed.”
Regan said the legislation creates the CPM Advisory Council under the Board of Nursing and creates regulations and guidelines on earning certification. Regan said that process could take about a year. Currently midwives can be licensed but not credentialed.
“But passage allows midwives to be recognized as an official medical provider and can collaborate with nurse practitioners and other medical professionals,” she said.
Regan said there are about 20 CPMs serving Kentucky, but not all live in the state. Annually, about 700 babies are born at home in Kentucky for a rate of 1.2 percent, which is above the national average.
“There are folks who want to give birth at home and want access to midwives,” said Mary Kathryn Delodder with the Kentucky Home Birth Coalition. “When I wanted to give birth at home eight years ago, it’s not as simple as going to Google and finding a midwife. You are not always sure of their background and credentials. An expectant mother should not have to find a midwife that way.”
CPMs specialize in providing care to healthy women experiencing low-risk pregnancies and do not provide services for people who have health circumstances that should be managed in a hospital and do not replace a pediatrician, according to the Coalition.
Regan said several groups have opposed such legislation over the past few years, including the Kentucky Hospital Association and the Kentucky Medical Association. Legislation passed the Senate in 2018, but was held up in the House by pension reform. Both Regan and Delodder credited Sen. Damon Thayer and Rep. Phillip Pratt for their support.
“We just believe women and families should make our choice and be informed about what the choice is we are making,” she said.
According to the Coalition, SB84 does the following:
— Establishes the Advisory Council be made up of one ex officio member from the Board of Nursing, three certified professional midwives, two APRN-designated certified nurse-midwives, two obstetricians licensed in Kentucky, one practicing neonatal health care provider licensed in Kentucky and one member of the general public;
— It also requires completion of birth certificate paperwork, newborn testing and annual reporting requirements consistent with requirements of other health care providers;
— Allows for open communication with healthcare practitioners, obstetricians and pediatricians and provide safety for midwives to openly identify themselves to caregivers to provide medical records should a transfer of care be needed;
— Allows CPMs to order medical tests necessary to confirm that home birth is a safe option, and establish a specific list of critical safer medications that CPMs may obtain and administer (but not prescribe), such as medication to manage sudden postpartum hemorrhage;
— Allows CPMs to attend vaginal births after cesarean section, births of multiple or breech babies with documented informed consent.
Regan said to be licensed there is several years of training and college, typically done by the Midwife College of Utah, and she knows of several students that have expressed interest in completing the requirements.
They also said midwives can be very helpful in meeting the healthcare needs of expectant mothers in areas of Kentucky currently underserved by obstetricians and hospitals.
“It definitely could improve access to maternal and prenatal care to low access areas,” Regan said.
“There are places in Kentucky that it takes two hours to drive to a hospital that delivers babies,” added Delodder. “There are 76 counties with no obstetrician.”
However, using a midwife is not for everyone.
“If a woman is not a good candidate for a home birth, we will refer on to a hospital,” Delodder said. “It isn’t right for everyone, but we want it to be a safe, licensed option.”
Steve McClain can be reached at firstname.lastname@example.org.