203186 A midwife-unifying cause: Inducing state regulation of midwifery through grassroots lobbying

Wednesday, November 11, 2009: 11:04 AM

Margaret Zoe Heimann, MPH , Maternal and Child Health Department, Boston University School of Public Health, Boston, MA
Eugene Declercq, PhD , Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA
Background: Between 1990 and 2006 in the United States, nurse-midwife attended births rose from 3.4% to 7.4% of all births while non-nurse midwife attended births account for an additional 0.4%. Boards of Nursing regulate nurse-midwives in 36 states. Non-nurse midwives traditionally worked without regulation, though a national campaign led to establishment of accreditation for their training and regulations in 24 states. For over twenty years, nurse and non-nurse midwives in Massachusetts unsuccessfully attempted to implement professional regulatory policies separately. Two groups, once at odds, united in 2000. This case follows their legislative campaign to create a joint Board of Midwifery.

Methods: The lead author was a participant observer in the Massachusetts Legislature as a staff member to the legislation's sponsor. Findings are also based on interviews with key policy actors, reviews of documents and legislation and participation in planning and strategy meetings.

Results: The coalition called for the establishment of a single Board of Registration in Midwifery. They hired a professional lobbyist and midwives and their supporters repeatedly came to the State House to petition legislators. Opposition from lobbyists hired by the Massachusetts chapter of ACOG focused on the possibility that any recognition of non-nurse midwives would encourage home births. In 2008, the midwifery bill unanimously passed the Senate, but failed in the House. It has been refiled for the 2009-2010 session.

Conclusions: This case study examines two key concepts: the role of grassroots lobbying in maternal and child health policy and the regulation of women's health professionals.

Learning Objectives:
1. To describe the trends in midwife-attended births in the United States and Massachusetts 2. To describe the barriers to midwifery regulation 3. To dicuss the role of grassroots lobbying in the state legislative process

Keywords: Midwifery, Health Care Politics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Education: Boston University School of Public Health, MPH in Maternal and Child Health Experience: Boston University School of Public Health, Boston, MA October 2007-May 2008 Maternal and Child Health Fellow •Worked with the Massachusetts Coalition for Midwifery •Advocated for the creation of a Board of Registration in Midwifery in Massachusetts •Compiled Midwife Means “With Woman”: A Resource Guide to Practices and Policies of Certified Nurse Midwives, Certified Midwives, and Certified Professional Midwives” •Lobbied/networked with legislative aides in the Senate and House of the Massachusetts Legislature Massachusetts State House, Boston, MA June-December 2008 Legislative Intern for Representative Kay Khan •Assisted in research, committee meetings, legislative redrafts for current session bills on public health topics •Main bill of research: House 2142, An Act Establishing a Board of Registration in Midwifery
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.