Midwife Rights: Colorado legislature approves continued regulation of midwives

Chalk it up to the crunchy granola types who populate the Republic of Boulder or to the plethora of Colorado residents who don’t even blink if you mention holistic health care practices: Colorado is one of only 27 states in the country where it is legal for midwives to practice.

There are an estimated 600 home births in Colorado per year, presided over by a midwife. But the practice was in jeopardy during the 2011 legislative session, when the Colorado Department of Regulatory Agencies conducted a mandatory “sunset review” of the profession, and the Colorado legislature had the final say on whether midwifery gets to stay in the state. Senate Bill 88—which renewed the regulation of direct-entry midwives—was signed into law May 11, and while it was a victory for midwives, the process was not without hurdles.

Prior to 1917, when obstetrics was officially recognized as a medical specialty, midwives were the most common practitioners available to help pregnant women through labor. In the 1940s, most states banned their use, citing the belief modern medical practices were safer, but in the 1970s, a resurgence in the popularity of home births began, and midwives began to earn back their traditional place at a woman’s side.

In 1993, the Colorado Midwives Association successfully lobbied to legalize what is known as direct-entry midwifery. A direct-entry midwife cares for pregnant women and their babies, including prenatal care, assistance in labor and delivery and newborn care. While a direct-entry midwife does not necessarily have training in nursing or have a nursing license, she must undergo a rigorous training and certification process, which starts with college-level anatomy and physiology as well as a doula course and covers more than 800 topics from administrating intramuscular shots to assessing postpartum hemorrhage and newborn vitality.

Colorado law dictates DORA must conduct “sunset reviews” for all regulated professions, including midwifery, most commonly every five to 15 years.

“While the sunset review has the potential to limit our scope of practice,” Karen Robinson, president of the CMA, wrote on the association’s blog prior to the bill’s approval, “it is actually an opportunity to improve the way DORA regulates midwifery.”

In mid-2010, the CMA created a political action committee to distribute funds to candidates in both parties who might be sympathetic to their cause. In addition, Robinson and other members of the CMA began meeting with officials from DORA and provided a wish list of changes they hoped the agency would consider with regards to the new regulations. While DORA did not include all the items on the CMA’s wish list, they did give the industry a positive review in their October report, which was submitted to the legislature.

The bill was taken up by the House Health Committee in late March. There, it found “intense” opposition to the addition of suturing to the bill. Rep. Cindy Acree, sponsor of the midwife bill, submitted an amendment to the bill, removing the portion that would allow midwives to suture mothers.

“If suturing had been included, our bill would not have been passed and midwifery would have been de-regulated,” Robinson wrote in her blog.

From there, the bill easily moved through the legislature. And both houses passed the bill in May. Registered certified professional midwives can now be simultaneously licensed as nurses (and vice versa); CPMs can obtain and use Vitamin K, Rogam, antihemorrhagic drugs and eye prohylaxis; and the language that spoke negatively of midwifery was removed.

For more information, visit colorado midwives.org.


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