Midwife licensing in two states

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North Dakota could see more midwives in the future. Distance education technology creates opportunities to meet license requirements in the practice of midwifery.

The field “is more accessible because of online programs,” said Connie Kalanek, executive director of the North Dakota Board of Nursing, which oversees licensure for certified nurse midwives.

“It used to be: there were one or two programs — master’s-level programs — based at universities. There’s more flexible education (now).”

Most of the 13 certified nurse midwives who are licensed by the board to practice in North Dakota are associated with clinics or hospitals.

State licensure limits midwives’ “scope of practice,” or what they can and cannot do in caring for patients.

To be licensed as a certified nurse midwife in North Dakota, the applicant must be a registered nurse, hold a bachelor’s degree in nursing and complete a master’s degree in midwifery, Kalanek said.

“Once the master’s degree is finished, the individual can then sit for a national certification exam,” she said. Upon successful completion of that test, the midwife can apply for licensure.

Certified nurse midwives must carry malpractice insurance, she said, noting that North Dakota hasn’t seen a case of midwife malpractice for “a long time.”

Minnesota licensure

The Minnesota Board of Nursing grants licensure to certified nurse midwives who are registered nurses and have received certification from the American Midwifery Certification Board.

Of the 265 certified nurse midwives in Minnesota, “the vast majority are affiliated with hospitals, clinics or birthing centers,” said Shirley Brekken, the board’s executive director.

The Minnesota Board of Medical Practice handles licensure for “licensed traditional midwives,” who must be certified by the North American Registry of Midwives.

To attain this certification, a midwife must have completed an approved educational program or submit documentation verifying practical experience such as an apprenticeship, said Jeanne Hoffman, licensure supervisor of the Minnesota Board of Medical Practice, in addition to passing a national exam.

Over the years, the number of traditional midwives licensed to practice in Minnesota, 17, “hasn’t changed too much,” she said. “There’s a lot more midwives out there, but we don’t know how many.”

The North Dakota Board of Medical Examiners, which oversees licensure of physicians and other health professionals, does not license midwives.

Those who call themselves “lay midwives,” but have not been licensed by the state, have a broad range of education and training, according to Darleen Bartz, chief of the health resources section of the North Dakota Department of Health.

Some have learned skills by working alongside with a more-experienced midwife, like an apprentice, she said. “Some have actually gone to schools of midwifery and had good training.”

She estimates there are less than 10 lay midwives in North Dakota, “a lot of them in rural areas,” she said.

North Dakota legislative activity

During the last North Dakota Legislative session, a flurry of activity surrounded proposed legislation calling for regulation of lay midwives through the state Board of Nursing.

The proposal, sponsored by State Senator Judy Lee of Fargo, stemmed from the death of a newborn after a home birth attended by a lay midwife in Steele, N.D., Kalanek said.

“The hearing room was filled with people who had received that type of care and felt they had had good care, and there was no reason for any type of regulation,” she said.

Bartz led studies in preparation of the bill’s introduction.

“We did feel (regulation) was definitely best for the safety of people in North Dakota — for mothers, fetuses and newborns,” she said, by “having a physician to call if you ran into difficulties as well as for follow-up care such as immunizations.”

The state health department “had received reports about home births that had not gone well,” she said. “People were trying to find a place to report them.

“There’s no entity to refer these cases to for investigation and follow up, or to ensure that doesn’t happen again. And that’s still the case.”

The department “has no regulatory authority over that group (lay midwives),” she said. The bill proposed that the state’s Board of Nursing fill that role.

While North Dakota has a mechanism for licensing midwives with advanced degrees, “there is nothing in statute that limits someone from practicing without those credentials,” Bartz said.

‘Gray area in the law’

It’s not illegal for a lay midwife to deliver babies in homes in North Dakota, Kalanek said. “It’s a gray area in North Dakota law, our attorney has told us.”

The intent behind the bill “was not to limit or take away that option for parents who want (a home birth),” Bartz said.

Midwives’ reaction to the bill was mixed, she said. “Some saw it as a real positive. Others appreciate not having that oversight. It wasn’t that they, as a group, were opposed.”

Parents who testified at the hearing said it was their responsibility if things didn’t go right, Bartz said, and it was their choice to have home births.

These testimonies from parents advocating for no change in the law apparently convinced legislators to kill the bill.

The number of home deliveries by lay midwives in North Dakota is difficult to determine, Kalanek said. “We don’t hear about it unless something bad happens.”

She doesn’t expect legislation similar to that proposed in 2011 to come before the session next year, she said.

“I don’t think any professional board would put it forward in the next session — not us or pharmacy or medicine,” she said, adding it’s possible proposed legislation on this issue could arise in the next session.

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