Executive Order #36
In Response to Executive Order No. 36: Modification of Regulations Regarding the Practice of Non-Nurse Midwifery
The World Health Organization defines midwifery by saying: “Midwifery encompasses care of women during pregnancy, labour, and the postpartum period, as well as care of the newborn. It includes measures aimed at preventing health problems in pregnancy, the detection of abnormal conditions, the procurement of medical assistance when necessary, and the execution of emergency measures in the absence of medical help.” Around the world, midwives serve women in hospitals, birthing centers, and in women’s own homes. In the United States, most midwives attend births in out-of-hospital settings. Modern, large-scale research in the United States and in other countries has shown midwifery to be a safe, desirable, and cost-effective form of care for women with normal, healthy pregnancies.
Midwifery in Delaware
There are legal, logistical, and public health reasons that these regulations need to be revised. Please refer to the statute and regulations which are both appended to this document. In consideration of the law, the regulations are not consistent with the statute, Title 16, Chapter 1, section 122 (3)(h). The regulations adopted by DHSS violate the statute because they are NOT consistent with the statute, and attempt to EXTEND the midwife law — and the reasonable implications of the law — by requiring a written collaborative practice agreement with a physician, which the legislature did not authorize.
In the ten years since the most recent version of these rules went into effect, only one non-nurse midwife has received a permit. The primary cause of the inability to obtain a permit to practice is the requirement the DHSS has included in their rules that midwives must obtain a written collaborative agreement with a physician. Although many non-nurse midwives have endeavored to obtain such an agreement, no physician has been willing to enter into such an agreement.
By not issuing permits to midwives, DHSS also fails to obey the legislature’s directive to “protect and promote the health of” those mothers who choose to give birth to their children at home. This is a serious public health concern, as DHSS knows nothing about who might be practicing as a midwife, and whether that midwife is safe, because they have made it impossible for those midwives to be regulated through the permit process.
Because many midwives have unsuccessfully attempted to find a physician who will enter into a collaborative practice agreement for the purpose of obtaining a permit, and only one midwife has successfully obtained the permit; and because a midwife has had her collaborating physician back out of their agreement after being discouraged by DHSS personnel, there is reason to examine whether or not the DHSS has applied these rules with fairness and consistency.
Suggestions for Successful Revision of the Defective Rules Regarding Non-Nurse Midwifery
- Create an advisory panel of non-nurse midwives to guide the DHSS in writing and implementation of new regulations, with opportunity for public hearing and discussion.
- Create a committee of non-nurse midwives to advise on midwifery practice and disciplinary issues.
Midwives in Delaware
Midwives practicing in Delaware are offering care in both urban and rural areas, and to all socioeconomic groups. The cost of a midwife-assisted birth is significantly less than that of hospital birth, and numerous scientific studies have shown midwifery care and home birth to be at least as safe as physician assisted hospital births for the vast majority of mothers and babies. Currently, midwifery care with a CPM, in a Homebirth setting is legal by statute, but dis-allowed by the regulations which require CPMs to obtain a collaborative agreement with an OB in order to apply for the permit to practice.
No new CPMs have been able to obtain the collaborative agreement since that regulation was enacted in 2007, with the exception of the one midwife who was already licensed, but whose practice was limited to Amish & Mennonite women by her collaborating OBs, so there is still only one “permitted” CPM. The women of Delaware deserve more choices; we need more than one CPM serving the women & families who want to give birth at home! Furthermore those CPMs need to be able to work for the women & families that choose them as their care providers, so that they can truly provide the Midwifery Model of Care!
Political circumstances over the next few years are going to require a strong consumer voice in support of midwifery. In response to this emerging need, Delaware Friends of Midwives came together again in the spring of 2012 as a small group of consumers, students and midwives.
Follow this link to read the current Delaware code set in place for CPM’s and CM’s