Allow non-nurse midwives to practice in Delaware without collaborative agreements

This petition is endorsed by and in conjunction with the Delaware Friends of Midwives.

Access to midwives in Delaware is severely limited. Maternity care is in crisis. Maternal mortality and infant mortality rates are unacceptably high and rising according to Amnesty International. A recent report found that 50 nations rank better than the United States in terms of maternal mortality, yet the US spends twice as much on maternity care. Nations with better maternal and infant mortality rates employ midwives as their primary maternity care providers.

A recent study has found that the rate of Cesarean deliveries has risen to 34% of all live births, despite the World Health Organizations recommendation of 5-15%. Amnesty International reports, “New analysis shows that the states reporting higher than average cesarean rates (over 33% of births) had a 21% higher risk of maternal mortality than states with cesarean rates less than 33%.” A 2005 study found that 3.7% of homebirths attended by Certified Professional Midwifes (CPMs) resulted in cesarean deliveries.

CPMs are trained and credentialed to offer expert care to women for pregnancy, birth and the postpartum period. They provide affordable care that is prevention oriented with particular attention to education and support for the mother. CPM care is proven to be safe and improve breastfeeding success rates. CPMs earn the only nationally recognized midwife certification that requires out-of-hospital birth training. They practice autonomously and consult with other health care providers as needed.

However, they are currently not able to obtain licensing in the state of Delaware. In order to be licensed in Delaware, CPMs must be able to establish "a collaborative agreement with a Delaware licensed physician with obstetrical hospital privileges." However, this is not possible as malpractice insurances will not cover CPMs or homebirths. This barrier means that no doctor in Delaware is able to work directly with non-nurse midwifes, and consequently, making it impossible for CPMs to obtain a license for the state of Delaware.

Licensing CPMs will increase access to midwives for families who choose to birth in any location they choose. As noted, CPMs can help to drastically reduce cesarean rates and maternal mortality.

We therefore ask that the Delaware legislators seek to improve maternity care in Delaware by changing the current Non-Nurse Midwifery regulations to allow CPMs to practice in our state. Our citizens deserve the best start to life possible, and we cannot give them that if we do not allow them access to the best maternity care.

RESOURCES:
• Johnson & Daviss, BMJ 2005, Outcomes of planned homebirths with certified professional midwives: large prospective study in North America, http://www.bmj.com/content/330/7505/1416
• Amnesty International, 2011, Deadly Delivery: The maternal health care crisis in the USA, http://www.amnestyusa.org/sites/default/files/deadlydeliveryoneyear.pdf
• Welsh, Today.com, 2011, C-Section rates hits all-time high, study finds, http://www.today.com/id/43807114/site/todayshow/ns/today-today_health/t/c-section-rates-hit-all-time-high-study-finds/#.UPlhgWfiWCo
• Delaware Code Title 16, 4106 Practice of Non-Nurse Midwifery, Section 4.3, http://regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Family%20Health%20Services/4106.shtml
• Hearing Held for Karen Webster: The case for medicine or midwifery continues in Delaware, 2013, http://www.mommatraumablog.com/1/post/2013/01/hearing-held-for-karen-webster-the-case-for-medicine-or-midwifery-continues-in-delaware.html