Expanding Options in Maryland: The Birth Options Preservation Act by Amy Polk, Communications Director, Birth Options Alliance The Problem The closures of two popular midwifery practices in Montgomery County, Maryland in the spring of 2007 – the Maternity Center in Bethesda and Takoma Midwives in Takoma Park – compelled many to ask: "What is causing these excellent practices to close?" and "What is keeping alternatives, such as independent home birth practices, from opening up to take their place?" Among many factors is the requirement of certified nurse midwives (CNMs) to have a written collaborative agreement (WCA) signed by Maryland physician and approved by the State Board of Nursing. While many Maryland physicians, most notably obstetricians (OBs), welcome the opportunity to work with midwives, many are reluctant to sign these agreements. Many OBs fear that these agreements will make them liable for the actions of the midwives, when in fact these agreements simply codify the practice guidelines midwives are already bound by according to the standards set by their professional association: the American College of Nurse Midwives. In the age of ever increasing malpractice insurance costs for both doctors and midwives, the fear of increased liability, even if unwarranted, is a serious problem. Attempting a Solution through Legislation The requirement that these agreements be signed by an OB and approved by the Board of Nursing creates an imbalance of power in what should be a collaboration between peers, each with different and complementary expertise and skills. Introduced in the 2008 Maryland legislative session by Del. Heather Mizeur (D-Takoma Park), the Birth Options Preservation Act (H.B. 1407) would have eliminated written collaborative agreements as a requirement of practice for CNMs. (Original bill as introduced: mlis.state.md.us/google_docs$/2008rs/bills_noln/hb/fhb1407.pdf) Supporters of birth options showed the power of this grass roots movement by turning out in large numbers for a rally in support of the bill in February and a hearing on the bill by the House of Delegates' Health and Government Operations Committee in April. Birth Options Alliance (BOA) Co-President Mary Beth Hastings, BOA member Diana Mayer, noted CNM Mairi Breen Rothman, and well-known author and Maryland resident Marsden Wagner (author of Born in the U.S.A. and many other books) were among those who testified in favor of the bill. Unfortunately, in order to attain passage of the bill, it had to be amended to become the Birth Options Preservation Study, which required five organizations – the State Board of Nursing, the State Board of Physicians, the Obstetrical and Gynecological Society of Maryland, the Maryland Hospital Association, and the Maryland chapter of the American College of Nurse Midwives (ACNM) – to come together to find an "alternative to the existing requirement for a physician-signed practice agreement." The amended bill was passed by both chambers and signed by the Governor. (Version of the bill that was passed and signed: mlis.state.md.us/google_docs$/2008rs/chapters_noln/Ch_319_hb1407e.pdf) Convened by Del. Heather Mizeur, the five-member study group met throughout the remainder of 2008 and early 2009, but could not come to consensus on a change in the WCA requirement. However, through the tireless fact gathering and persuasive arguments put together by a team of activists and interns lead by Mairi Breen Rothman, who represented the Maryland ACNM, many members of the group went from opposed to a change to neutral and others went from neutral to positive. As the study group's work drew to a close, it became apparent that the best way to eliminate the WCA requirement was through a regulatory change, not additional legislation. Attempting a Solution through Regulation Step 1 Step 2 – Grass Roots Support Needed (Probably) Step 3 – Grass Roots Support Needed (Maybe) Step 4 – Light at the End of the Tunnel Success! (Hopefully) If Governor O'Malley approves the regulatory change, birth activists should hold a well-deserved |
