Nurse-Midwives at Jordan Hospital Applaud New Legislation

Last week, Gov. Deval Patrick signed legislation authorizes nurse-midwives to issue written prescriptions and order and interpret tests and therapeutics, expanding access to nurse-midwifery care for more women in the Commonwealth.

At , nurse-midwives are celebrating the law changes, which provides them with more autonomy to provide care, according to certified nurse-midwife Agnes Densmore.

“I am proud to sign this bill that recognizes the growing trend of nurse-midwifery in Massachusetts by giving women more flexibility in choosing their health care, while maintaining the safest practices,” said Governor Patrick on signing the bill last week.

The Department of Public Health will be charged with registering nurse-midwives to issue prescriptions. DPH will work jointly with the Board of Registration in Nursing and the Board of Registration in Medicine to authorize controlled substances for which nurse-midwives may be certified.

"The practice of nurse-midwifery is based on the 'normalcy' of well woman care of pregnant and non-pregnant women," Densmore said. "Because we take care of 'well' women and not sick women, a great deal of the care we provide can be and should be delivered independently, i.e. it is rather redundant to require a physician to be hovering over our shoulders and making sure we "do things right". We Nurse-Midwives have been educated, trained and certified so that we can function independently.

"The new law removes 'supervisory' language of physician to midwife, but retains the mandate for a 'clinical relationship' to exist between physician and CNM," Densmore continued. "We absolutely would continue  the  excellent clinical relationship that we have with our colleague physicians."

This piece of legislation represents at least 15 years of hard work and lobbying efforts., Densmore said. The legislation will eliminate the requirement of nurse-midwives to practice as part of a team that includes a licensing physician with admitting privileges. Instead, nurse-midwives will be required to practice within a health care system and have clinical relationships with obstetrician-gynecologists that will provide consultation and referral.

Massachusetts has been one of a handful of states that has not kept step with the times in acknowledging the ability of nurse-midwives to function independently, Densmore said.

"This law removes legislative constraints that make physicians have to review and co-sign the work of CNMs. Such constraints create redundancy and inefficiency in the delivery of health care here in Massachusetts," Densmore added.

"For instance, the bulk of prescriptions written by nurse-midwives are for prenatal vitamins and birth control pills. These are simple and straight forward prescriptions that the law formerly required the (doctor) to review on a regular basis. Likewise, when we give care in the office or hospital, the physicians are required to 'supervise' even though we have long demonstrated competence and the ability to conduct that care independently. Physicians at Jordan Hospital right now have to cosign every order and note that CNMs write. This is an onersome task for already overworked physicians," Densmore said.

The passing of this law does not mean that there is an immediate change. Nursing regulations and hospital by-laws need to be re-written to reflect the new law.

"What this means in this day and age of health care coverage concerns is that with CNMs able to practice more independently, there are more 'hands on deck' to deliver safe affordable care to women. Many states came to that conclusion earlier when there were not enough obstetricians to give care to women," Densmore said.

Finally, the legislation authorizes nurse-midwives to order and interpret tests and therapeutics in accordance with applicable regulations and requires that nurse-midwifery care be consistent with the standards of care established by the American College of Nurse-Midwifes.