A Victory for Certified Nurse-Midwives!
By Angelita Nixon, APRN, CNM
The passage of HB 4334 in March 2016 pleases Certified Nurse-Midwives (CNMs) due to its repeal of Chapter 30, Article 15. Article 15 contained the outdated section of code that regulated CNM licensure and prescriptive authority. With the incorporation of CNMs as Advanced Practice Registered Nurses (APRNs) in 2012 by definition in Article 7, Article 15 became obsolete. Since 1973, Article 15 had entitled CNMs to licensure in WV, but also required a collaborative relationship with a licensed physician.
A dictionary definition of “collaborate” includes working jointly on an activity. In professional terms, collaboration includes much more than working jointly – it is a non-heirarchical system of mutually respectful communication, across care settings and among providers, generally centered around the needs of the patient. Regulatory requirements for collaboration do not foster interprofessional communication or improve patient care, but were probably intended to assure that appropriate professional collaboration would occur. In practice such requirements have come to serve as formalities, wrongly implying oversight. While clinical guidelines for prescribing practices are mutually-developed, in many cases the activities that satisfy collaborative requirements consist of making a list of drug references and conducting chart reviews. When HB 4334 goes into effect, CNMs will finally achieve full practice authority by eliminating the requirement of any collaborative relationship with physicians.
HB 4334 also allows CNMs (as APRNs) to apply for prescriptive authority without the further requirement of a written collaborative agreement, after 3 years of prescriptive authority in a duly-documented collaborative relationship.
Each of the four APRN roles (as well as many other allied health roles), emerged during health care professional shortages. Registered nurses who showed capability, interest, and commitment in attaining advanced skills were educated to take on additional responsibilities in their settings. State regulation of midwifery first appeared in West Virginia state code in 1925. The Department of Health developed training for midwives by 1938. In 1973, qualification of CNMs as defined by the American College of Nurse-Midwives (ACNM) became part of WV state code – to upgrade midwifery to federal standards, thus making the state eligible for federal funding for certain programs of maternity care. After 1973 there were no further changes in the midwifery law, until the APRN licensure regulation was enacted in 2012.
Today CNMs practice in hospital, private office, clinic, health center, administration, freestanding birth center, and home health settings. In 2013 there were 67 CNMs licensed in West Virginia, not all of whom attended births. CNMs have met the Joint Commission (formerly JCAHO) definition of Licensed Independent Professionals (LIPs) in 42 states since 2006, according to ACNM publications.
The West Virginia Perinatal Partnership conducted a “Key Informant Survey” of maternity providers in 2012, and found that 36 West Virginia birth facilities have closed since 1976. Thirty-one of the 55 WV counties (more than half) had no birth facilities; sixteen WV counties had no prenatal care and no birth facilities. A large portion of WV is not within a 30-minute drive time of any birth facility. A smaller but significant portion of WV is not within a 30-minute drive time of any prenatal care facility.
The 2012 report issued by the WV Perinatal Partnership found that the total number of practicing licensed maternity providers who attended births (OB-GYN physicians, family practice physicians, and CNMs) showed a modest decrease in 2010, after a substantial rise in the years between 1991 and 2006.
Results of West Virginia Perinatal Partnership Birth Attendant Studies (2012):
1991 2006 2010
OB-GYN Physicians 115 145 150
Family Practice Physicians 40 19 10
Certified Nurse-Midwives (CNMs) 8 41 35
Total licensed birth attendants 163 205 195
For more information about the initiative to improve women’s health and maternity care by re-introducing nurse-midwives and nurse-midwifery care, please visit www.OurMomentOfTruth.com. ACNM also maintains a number of standard-setting documents, position statements, white papers, and issue briefs pertaining to the practice of midwifery in the U.S. All ACNM position statements can be accessed at www.midwife.org.