Bills have been introduced in both chambers of the Mississippi Legislature to expand the scope of practice for nurse midwives.
House Bill 418 and Senate Bill 2553 would allow certified nurse midwives to practice independently as advanced practice registered nurses without needing a written collaborative agreement with a physician. A midwife is a healthcare professional who treats women during pregnancy and childbirth. Many midwives also provide care for newborns.
In Mississippi, certified nurse midwives are only allowed to work within the boundaries of their expertise if they have collaborated with a practicing physician. This has prompted a federal lawsuit against the Mississippi State Board of Medical Licensure by the American College of Nurse-Midwives. The lawsuit aims to prove that a collaborative agreement is unnecessary, given that nurse midwives are thoroughly trained before getting to the practicing stage of their careers.
The plaintiffs in the lawsuit also argue that few Mississippi physicians are willing to collaborate with midwives, adding that those who are willing often do so with a hefty fee attached. The Federal Trade Commission has even weighed in, contending that Mississippi’s law requiring forced collaborative agreements is unfair.
“The only context in which certified nurse midwives can possibly work is under the thumb of a physician,” said Republican Rep. Dan Eubanks, who authored HB 418. “And we’ve got to change that in order to end the maternal crisis before it worsens. That will only happen when we exempt them from the collaborative practice agreement law.”
Expanding the practice ability of certified nurse midwives, according to Eubanks, is especially necessary due to the state’s staggering infant and maternal mortality rates, along with limited access to health specialists in rural areas. With physicians typically choosing to practice in metropolitan regions, rural counties are oftentimes left with limited access to care.
“In Rankin County, for every 10,000 women of childbearing age, there are 14.6 physicians compared with only four physicians in DeSoto County, my district,” Eubanks said.
Getty Israel is the founder and CEO of Sisters in Birth, a nonprofit dedicated to improving birth outcomes through prenatal, birth, and postpartum care. She argues nurse midwives can fill a void in the state’s most rural areas, but not without a new law on the books.
“The bottom line is the collaborative practice agreement is the leading obstacle to substantively addressing Mississippi’s maternity crisis, including the 53 counties that have no obstetrical providers or hospitals, forcing women to drive up to 90 minutes one way for access to care,” she said.
Annually, mothers in Mississippi experience some of the nation’s highest rates of cesarean deliveries, preterm births, low birth weight babies, and maternal and infant deaths. Eubanks and Israel argue that one of the leading causes of maternal and infant health outcomes is the scarce number of providers and maternity care facilities.
Mississippi ranks 50th in the number of midwives and obstetrical physicians per capita, and more than half of the state’s 82 counties lack obstetrical physicians, nurse midwives, and hospitals. The state does not have any freestanding birth centers.
With these figures in mind, Eubanks and Israel believe a start to providing more care is by ridding of the collaborative practice agreement. While supporters of it argue it provides safety, standardization, and protects patients from unqualified providers, critics like Eubanks and Israel assert that it does not improve patient health outcomes or patient safety and discourages people from becoming midwives.
The result of the current law, according to them, is denying mothers the opportunity to select their preferred provider type, increasing medical costs, and a lack of new maternal health initiatives.
“Removing this unnecessary law, which is not based on evidence, would not only improve women’s overall health but also substantially reduce medical costs associated with preterm births and cesarean deliveries among the Medicaid and state and school employees populations, which are paid for with our tax dollars,” Israel said.
HB 418 and SB 2553, authored by Democratic Sen. Hillman Frazier, have been referred to their respective chambers’ public health committees.