Midwifery across different states in the US
In the US, women have the choice of giving birth at home, in hospitals, or at birth centers. During pregnancy and delivery, these women receive care from several different healthcare professionals. The education, training, and licensure requirements for these professionals differ. It is prudent to remember that state regulations, policies, education, and training of healthcare professionals can have a profound effect on the birth experience.
According to available statistics, around 98% of women give birth in hospitals while just under 1% give birth at home and around 0.5% give birth at birth centers. The US has a high rate of cesarean births, infant mortality, and maternal mortality. Besides the infant mortality rate, the other rates have increased, possibly because these women may not have access to the right care during and after pregnancy. Many healthcare experts believe that midwives aid in the normal birth process and minimize unwanted medical interventions. As a result, they play a crucial role in improving maternal and infant health.
Midwifery in the US
Midwifery has been increasing in popularity in recent years, with more women opting for this form of care during their pregnancy and childbirth.
Midwives are trained professionals who provide comprehensive care to pregnant women, including prenatal care, labor support, and postpartum care. They are skilled in providing a range of services, including counseling, education, and support during childbirth.
Midwifery is regulated at the state level in the US, meaning that each state has its own laws, regulations, and licensure requirements for midwives. This can make it challenging for midwives to practice across state lines or for women to access midwifery care if they live in a state with restrictive regulations. Some states, such as California, have more liberal laws and regulations while others, like Texas, have more restrictive ones.
Midwifery in Texas
In Texas, midwifery is a regulated profession, and midwives must have a license to practice legally. The Texas Department of Licensing and Regulation (TDLR) oversees the regulation of midwifery in the state.
To become a licensed midwife in Texas, an individual must complete a midwifery education program accredited by the Midwifery Education Accreditation Council (MEAC) and pass the North American Registry of Midwives (NARM) certification exam. If they already have a bachelor’s degree in nursing and are passionate about caring for women before, during, and after birth, they should consider midwifery programs in Texas. Baylor University, through the Louise Herrington School of Nursing, offers online DNP-Nurse-Midwifery. Attaining this degree is beneficial, as a DNP degree will soon be the norm for jobs available to advanced practice registered nurses. This degree is designed to help nurses prepare for leadership roles in a career that they are passionate about and can keep up with the ever-evolving healthcare system in Texas and the rest of the country.
In addition to these requirements, midwives in Texas must adhere to specific practice guidelines. These guidelines mandate that midwives can only attend low-risk births. That means midwives in the state cannot be with pregnant women who have pregnancy-related complications or pre-existing health conditions, such as high blood pressure, that pose a risk during childbirth. Furthermore, Texas requires that midwives provide clients with informed consent and informed refusal. In other words, they must provide clients with all the necessary information about their care and obtain their consent before any medical procedures are performed.
Midwifery in other states
While midwifery is regulated in Texas, the situation is different in other states across the US. In some states, midwifery is an unregulated profession, meaning that individuals can practice midwifery without a license or any formal training. In other states, this profession is regulated but the requirements for licensure and scope of practice vary significantly.
Certified professional midwives (CPMs), who receive special training to deliver babies outside hospitals, are regulated with licensure in 35 states and Washington DC. Missouri is the only state in the US that legalized CPMs through state statutes. In other states, pregnant mothers who want to give birth at home require a certified nurse midwife (CNM). A CNM is an advanced practice nurse, who has a master’s or doctorate-level training in midwifery.
For example, in California, midwifery is regulated, and midwives are licensed by the Medical Board of California. However, the requirements for licensure are different from those in Texas. To become a licensed midwife in California, an individual must complete an education program accredited by the MEAC or a program that meets the California-specific education requirements. Furthermore, they must pass the NARM certification exam and complete a specified number of clinical hours.
In New York, midwifery is also a regulated profession. However, midwives are licensed by the New York State Education Department. To become a licensed midwife in New York, an individual must complete a master’s or higher midwifery education program that is registered with the state as well as pass the NARM certification exam.
Scope of practice
The scope of practice for midwives also varies across states. As mentioned, in some states, midwives are allowed to provide care for women with high-risk pregnancies, and in others, they can attend to low-risk births only. Furthermore, in some states, midwives can administer medication while in others, they cannot.
In Texas, midwives are only allowed to attend low-risk births and they cannot administer medication or perform surgical interventions. The state requires that midwives must work under the supervision of a licensed physician and should have a written practice agreement with a physician that outlines their scope of practice and specific protocols for transferring care in the event of complications during childbirth.
Midwives in California are allowed to attend both low-risk and high-risk births. They can administer medication and perform certain surgical procedures, like episiotomies. However, midwives in the state must have a written transfer agreement with a physician that outlines the specific protocols for transferring care in the event of complications during childbirth.
Those who want to work as a midwife in New York can attend both low-risk and high-risk births. They can also administer medication and perform certain surgical procedures. However, they need a written collaborative agreement with a licensed physician. The specific requirements for the agreement vary based on the practice setting.
While midwives play an important role in ensuring maternal and infant health, the number of trained, qualified, and licensed midwives in the US is low. Even though the Affordable Care Act covers the cost of midwives through Medicare, it is challenging to find a professional and licensed midwife. Furthermore, due to the lack of consistent regulation across the different states, there is a difference in training and licensure requirements as well as scope of practice. However, things are gradually changing and once these challenges are addressed, it will create a more consistent and supportive regulatory and practice environment for midwives in the US.
