Advocates say pending legislation on midwifery could help alleviate Mississippi’s lack of maternity health care and protect mothers and babies from those practicing without proper training.
But Senate Bill 2793 and House Bill 1081 are likely going to die without a vote in committee this session, as legislative leaders say they need more time to study the issue.
More than half of Mississippi’s 82 counties are considered “maternity care deserts,” with no hospitals providing obstetric care and no OB-GYNs. Advocates say trained midwives could help this shortage of care for low-risk pregnancies, but say the state should license and regulate them.
With the overturning of Roe v. Wade and a ban on abortions in Mississippi, advocates say trained midwives could help with the expected increase of thousands of deliveries a year for a health care system that is already woefully inadequate.
Mississippi is one of 14 states that does not regulate or license direct-entry midwives, those who practice without first becoming a nurse. Certified nurse midwives in the state are licensed as advanced practice registered nurses. There are only 26 certified nurse midwives in Mississippi, and only a few deliver babies, because only three hospitals allow them to.
Mississippi prevents free-standing, midwife-led clinics for low-risk births and prohibits certified nurse midwives from performing in-home births – both of which are popular in other states and in Europe. More mothers want personalized care at home or in a small clinic as opposed to giving birth in a larger hospital, and want natural birth instead of induced labor or non-necessary C-section surgeries for delivery that have become more and more common in hospitals.
But Mississippi’s lack of licensure or regulation also results in untrained or poorly trained people claiming to be midwives providing substandard – or dangerous – care to mothers and newborns at home.
“Anybody can say, ‘I’m a midwife,’ and nobody can stop them,” said Getty Israel, founder of Sisters in Birth, a nonprofit clinic that integrates nurse midwives with community health workers to improve patient care and birth outcomes. Israel hopes to open Mississippi’s first birth center. Such centers in other states serve women with low-risk pregnancies, and provide compromise between hospital births and home births.
Israel said she supports midwifery and wants to see it become a viable alternative in Mississippi, but believes they should be state regulated and licensed.
Erin Raftery is with Better Birth Mississippi, a group advocating for the midwifery legislation. The group says, “Community-based midwifery is a key solution to the challenges faced by the maternity care system in Mississippi.” Trained midwives could help with health care shortages caused by closure of rural hospitals and help save Medicaid money by “minimizing the use of costly, ineffective interventions.”
“The goal of these bills is accountability,” Raftery said. “… This would provide protection for patients, and for midwives. This would also hopefully open the door for insurance coverage for midwife services, and help with the maternity desert.”
Raftery said her group knows of at least one infant death in Mississippi overseen by an unlicensed midwife, and that a similar instance a decade or so ago had also prompted proposed legislation. Raftery said licensure would help protect patients from the “select few” midwives practicing without training.
Senate Medicaid Chairman Kevin Blackwell, R-Southaven, authored the Senate midwife bill.
“I think we need to look at all our opportunities for health care in Mississippi,” Blackwell said. “We are last, and we won’t change. We need to look at all the other states that are changing the way they do things.”
Both Blackwell’s bill and a mirror one authored by Rep. Dana McLean, R-Columbus, would create a state board of licensed midwifery.
“There are community midwives already practicing in this state, and this would help legitimize them, provide some oversight, and I think our primary responsibility is to make sure those that are practicing are doing so with some standard of care and level of experience,” McLean said. “Safety for moms and babies is the first priority. But I think there’s also an issue of allowing for reimbursement for Medicaid and private insurance. They do require some sort of certification or licensure before they would reimburse for these services.
“Rural areas are closing maternity wards, and if this is an option that can help for low-risk births, then we need to explore that.”
But many physicians and hospital groups say child delivery should be overseen by trained physicians in hospital settings. Beyond these arguments, there has been a push by conservative groups and GOP lawmakers to reduce government agencies, boards and regulations, not create new licensing and a new regulatory board.
Nurse practitioners have also struggled for more autonomy and expanded scope of practice in Mississippi – with limited legislative success – saying they, too, could help with the state’s shortage of doctors and health services.
Israel said doctors and hospitals treat cesarean deliveries as a “cash cow,” and that their lobbyists and influence at the Capitol prevent “progressive, evidence-based health care.”
The House and Senate bills are now in each chamber’s public health committee, facing a deadline for committee passage next week. That passage this year, or even a vote in committee, appeared unlikely days before the deadline.
House Public Health Chairman Sam Mims, R-McComb, asked Wednesday about the midwifery bill pending in his committee, said he was unaware of it.
“I’ll go look at it,” Mims said. “I will read it. I will go look at it. Thank you, though.”
Raftery said her group had met with Mims and his committee vice chair only a couple of weeks ago and outlined the bill. She said Mims told her he would be opposed because he’s against new government boards and licensing.
Senate Public Health Chairman Hob Bryan, D-Amory, said he doubts he will bring the bill up for a vote in his committee this year.
“It’s sort of late in the session, and I really wasn’t aware of this legislation before we got here,” said Senate Public Health Chairman Hob Bryan, D-Amory. “I don’t think the committee would have time to fully study this … I’ve met with two different midwife groups, and I try to listen to people. I learned that at least one group will assign someone to an individual, and they will stay with that person, work with them, throughout their pregnancy and after delivery, and be there for them to discuss other health care issues. I think that is a very good idea, that could perhaps carry over into other health care services, and I am interested in learning more.
“I am neither opposed to nor supportive (of the midwifery legislation), but I have an open mind,” Bryan said.