Mississippi Midwifery Law Hoopla: Another Failure in Public Education?

By Gail M. Pfeifer, MA, RN, AJN news director


It seems even when doctors and nurses unite on an issue, there’s controversy. The Mississippi State Board of Medical Licensure and the Mississippi Board of Nursing (MBON) both support state bill No. 695, which would allow only certified nurse-midwives to practice midwifery in the state, according to the December 2009 issue of the state board’s magazine. Melinda Rush, executive director of MBON, wrote that there have been “incidences of death and harm to infants born in situations that were less than safe,” and urged nurses to support the bill.

I wonder though, if the board did its homework on educating the public about their concerns. One objector to the bill wrote a letter to Governor Barbour, asking him to veto the bill if it lands on his desk, because “midwives are more qualified than Drs

[sic] to deliver healthy low-risk babies.” And responses to an article on the topic in The Commercial Appeal indicate that consumers think the bill will entirely block women from having home births, literally pushing all deliveries into the hospital. Although the bill was amended to grandfather in professional non-nurse midwives with more than five years of experience, Birth Action Coalition is also urging Mississippi residents to oppose the bill, because it would “deny access” to the care of certified professional midwives.

Whether the bill finally passes or fails in the Mississippi Senate on Tuesday, it looks like both terminology and the value of nurse midwives needs clarification—and this is probably true in more places than Mississippi. My colleague Shawn Kennedy, AJN’s editorial director and interim editor-in-chief, brought up another point to consider when we discussed this issue: “I wonder why nurses are looking to limit the practice of lay midwives, unless there’s evidence about unsafe practice. Isn’t that what we rail against physicians for doing to us?”

AJN then asked Margaret Comerford Freda, professor of clinical obstetrics and gynecology and women’s health at Albert Einstein College of Medicine and Montefiore Medical Center, her opinion on the subject. In her e-mail response, Freda wrote: “I feel it would be going in the wrong direction to suggest that nurse midwives, most of whom have master’s degrees, could be replaced by individuals without the comprehensive knowledge base that nursing provides.”

Freda is also editor of MCN: The American Journal of Maternal Child Nursing. She added that midwifery education is “a very hot topic.” It sure looks that way. So, what do you think about the hoopla in Mississippi and the broader issue of midwifery regulation?

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2016-11-21T13:19:06+00:00 March 1st, 2010|Nursing|5 Comments

About the Author:

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

5 Comments

  1. Gail March 9, 2010 at 10:12 am

    If the only way to resolve the dilemma is to “grandfather” lay midwives into a licensure structure, then nurses would likely oversee them. If they do not need overseeing (which they may not) then why should any midwifery practice be regulated, and why do nurse midwives undergo such rigorous training? The MBON’s point, which some folks argued withe, is that nurses deliver safer care in this setting than lay midwives do. That said, most nurse midwives do not offer home births, but practice in the hospital, where emergency care is quickly available if mother or baby needs it. The criticism here is that we end up “medicalizing” what is a normal healthy process. According to an AP source I read today, it looks like this Mississippi HB 695 died in the Senate, so either the MBON did not make their point clearly enough, are not politically powerful enough in that state, or the public support for lay midwives ended up being very strong!

  2. Shawn March 4, 2010 at 9:21 am

    Gail, why should the BON oversee the practice of lay midwives anymore than they should oversee physician obstetrical practice or physicians should oversee nursing practice?

  3. Gail March 2, 2010 at 10:41 am

    I think stepping aside is not an option for nurses, as we are already somewhat invisible when it comes to policy change, and we need to become more influential. A recent survey pointed out that one reason for our lack of influence is that we do not speak with a unified nursing voice. It seems to me that “grandfathering in” very experienced safe practitioners in any area of nursing is a reasonable way to go (including standardizing our degree preparation). This approach in this particular situation in Mississippi raises several questions though: How do nurses assure that these lay midwife practitioners actually are performing at an acceptable level of safety without some kind of assessment process in place? Would the BON in any state be strong enough to insist on overseeing that process?

  4. angela March 1, 2010 at 9:04 pm

    Seth’s comment is true, yet doesn’t really answer the question of who’s more qualified. I think what we really need to decide is which fight we’re going to fight: reforming healthcare malpractice legislation so that providers can PROVIDE CARE without fear of litigation, or not allowing women to have any birth choices at all.

    The other option is stepping aside and allowing lay people to do our jobs for us.

  5. Seth McLaughlin March 1, 2010 at 5:04 pm

    Certified Professional Midwives have a long history of safe birthing practices for low risk pregnancies. Their approach is typically different than Certified Nurse Midwives. Most CNMs to not do homebirths, at least in my area. I’ve been told that they are legally allowed to do them, but cannot due to restrictive insurance rates for those who do. Limiting access to CPMs DOES limit access to safe home birth options. I support women having the freedom to choose for themselves where to deliver and which model of care to apply to their childbirth.

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