Information and Talking Points For Memo of Support
Midwifery care is a safe option for low-risk expectant mothers.
Midwives have been licensed in NYS for more than 15 years with very positive outcomes, including lower mortality rates, fewer low birthweight babies, lower c/s rates, shorter hospital stays, higher breastfeeding rates.
Midwives, like all other primary care providers, consult with and refer to multiple care providers and appropriate specialists, including obstetricians as needed. Other primary care providers do not have written practice agreements, and midwives do not need them to effectively coordinate maternity or well-woman care.
The written practice agreement (WPA) , instead of enhancing care, instead acts as a barrier to care for those who most need it.
In areas where women are underserved, including rural and low-income urban areas, there is often a shortage of primary care and obstetric physicians.
Midwives are providing care to the underserved — including Medicaid, uninsured, and minorty patients — at a higher rate than most physicians. The WPA is limiting care to those most in need of health care access.
The written practice agreement does not enhance safety or improve outcomes for mothers or babies.
The WPA is also used as an artificial basis for limiting or eliminating the practice of midwifery, particularly since physicians are not required to sign agreements.
While the Professional Midwifery Practice Act does not require supervision by a physician, physicians can and do control the scopes of practice and protocols of midwives if they do sign or refuse to sign to avoid economic competition.
Midwives practice without the requirement of signed agreements in 15 other states.
Licensed midwives are key partners in NY’s health delivery system, particularly for women’s health and maternity care. Midwives need to be recognized as full partners to ensure that women and babies in NY, including in rural and underserved areas, have full access to comprehensive and quality health care.
Key Points/Do’s and Don’ts
Avoid discussion of out-of-hospital birth when at all possible. Even homebirth midwives have articulated the need to keep the focus off home birth and on access to midwives overall. If we hang this on home birth, we are almost certainly going to lose this fight to the medical associations. Also, DO NOT MENTION unlicensed providers at any point in this discussion.
Additionally, focusing on the birth experience and/or a “right” to midwifery care hands to the medical associations key weapons they will use to shout down the bill – “Those midwives and mothers put the ‘experience’ above the safety of the baby” and “What about the baby’s rights?” are arguments that have been used very successfully against midwifery legislation in other states.
Framing – There are a number of ways to frame this discussion, depending on the concerns of individual legislators:
· Midwives already collaborate with any number of professionals without a practice agreement and won’t stop referring just because the paper is no longer required. Safety net already in place with accountability in the hands of the Office of Professional Discipline – talk about how these are handled.
· Access to care, to the midwifery model, improved outcomes and improved health education, and lower costs. In addition to the need for more providers in underserved areas, many women want midwifery care for birth and well-woman care.
· Restraint of trade affects access to the full range of care (and its benefits). Docs have an economic incentive not to sign agreements. No other healthcare profession is overseen by its competitor. Docs are not required to sign the agreements.
· Control over scope of practice and protocols in the hands of individual doctors rather than the Office of Professions/Board of Midwifery. Also makes docs legally liable for patients they never see.