You may be wondering how the law impacts Midwifery and how Midwives may practice, especially in New York State…. The NYS Professional Midwifery Practice Act (PMPA), passed in 1992, established criteria for licensure of all midwives and created the NYS Board of Midwifery. NYS is the first state in which nurse-midwives and direct-entry midwives are regulated by the same legislation and the same Board using the same designation – Licensed Midwife (LM). That said, this law and the regulations developed from it were enacted before the CPM credential was fully developed and has not embraced it as a direct route to licensure. CPMs can get licensed in NYS, but they need to demonstrate their credentials to the Board and must take the AMCB exam (used to certify CNMs & CMs). Even so several CPMs have done so (including a Chair of the Board). All midwives licensed in NYS must have a bachelor’s degree (in any subject) and attend an accredited midwifery school. It is possible to use the apprenticeship route to become a CPM, but to become licensed in NYS the CPM must be supplemented with further study. Furthermore, the law allows LMs to provide well-woman care, but the CPM does not currently certify that training. LMs must also have some training in pharmacology, but the NYS Education Department has developed a 3 hour course for that. While CNMs, CMs, and CPMs could get licensed in NY, the primary barrier to independent midwifery and access to licensed midwives for homebirth was a requirement that all LMs have a written practice agreement (WPA) with a physician or hospital with obstetric privileges. This caused access to licensed midwives for homebirth to be limited in particular areas of the state. The Board had no control over this requirement; as it was written into the law and only the state Legislature could change it. So thats what midwifery supporters worked toward. They supported the Midwifery Modernization Act (MMA) passed in 2010 that removed the WPA requirement. This was a huge win for midwifery and home birth advocates that illustrated the power of strong consumer advocacy in state legislatures.1 The Midwifery Modernization Act passed in New York in 2010. This act followed the lead of other states, and eliminated the previously required written practice agreement (WPA) between midwives and physicians. While the idea of the WPA may have seemed like it would inspire collaboration between midwives and physicians, in fact, this was not the case. Although many doctors were willing to collaborate with midwives, they were unwilling or unable to sign these agreements. Therefore, although midwives are trained as independent health care professionals, this requirement in the law prohibited them from being able to practice independently. The WPA represented an enormous barrier to practice for midwives all over NYS. Midwives collaborate, as necessary, with many different types of physicians (e.g. obstetricians, endocrinologists, pediatricians) with whom they have collegial relations. They very rarely have written collaborative agreements with these physicians – they simply refer their clients to see the doctors. This system works quite well without the requirement of a written agreement. Importantly, when midwives cannot practice, women and families are denied access to care. The WPA limited access to midwifery care for many women in communities across NYS, and often in underserved areas where this type of care is sorely needed.2 1. cfmidwifery.org/states/states.aspx?ST=NY 2. upstatenyhbmidwives/new-york-midwives/midwifery-modernization-act/
Posted on: Sat, 11 Oct 2014 00:24:12 +0000
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