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

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.