Midwifery measure considered

The Health and Human Services Committee heard testimony Feb. 12 on a proposal that seeks to expand birthing options for Nebraska mothers.

LB1234, introduced by Blair Sen. Ben Hansen, would create the Freestanding Birth Center Act, which would establish an accreditation process for birth centers with the primary purpose of midwifery practice.

Among other provisions, the bill would require birth centers to be accredited by the Commission for the Accreditation of Birth Centers, or be in the process of obtaining accreditation, to be eligible for a license. In addition, it would require birth centers to employ a clinical director who is a certified nurse midwife.

Admission to a birth center would be limited to low-risk, uncomplicated pregnancies with anticipated vaginal delivery. Birth centers would be prohibited from providing epidurals or other general anesthesia, inducing labor during the first or second stages and using vacuum extractors, vaginal forceps or continuous fetal monitoring.

Hansen offered an amendment at the hearing that would replace the bill with a modified proposal, which also would expand the practice authority of certified nurse-midwives, establish licensure for certified professional midwives, require the state Department of Health and Human Services to provide Medicaid coverage for doula services and allow doulas to practice in freestanding birth centers.

Hansen said that although freestanding birth centers already are licensed in Nebraska, current midwifery restrictions have made the centers “unworkable,” limiting women’s birthing rights. He noted that 73% of birth centers are staffed by certified practical midwives and 39 states already provide CPM licensure.

“We need to join the rest of the country and let [women] birth in birth centers [with the] midwives and doulas they desire,” Hansen said.

Joy Kathurima of I Be Black Girl testified in support. She said the bill and proposed amendment would remove “bureaucratic red tape” that currently prevents women — especially those from underserved and underrepresented communities who may feel unsafe in a hospital setting — from receiving the care they want and deserve.

“Freestanding birth centers create an option for lower-risk clients to choose [to experience] their prenatal care and birth in an environment where they feel safe, listened to and cared for,” Kathurima said.

Chandra Stewart, a certified professional midwife, also testified in support of the bill. She said freestanding birth centers provide low-risk individuals with an affordable birthing option in a state that has the highest out-of-pocket childbirth costs in the country.

“Nebraska hospitals have an absolute monopoly on birth in [the state],” Stewart said. “Midwifery care and out-of-hospital births reduce costs for families and for Medicaid, reduce unnecessary interventions for women and reduce NICU stays for newborns.”

Timothy Tesmer, chief medical officer for DHHS, opposed the bill as introduced. He said the department does not have a relationship with the commission that would oversee the accreditation process and, as a result, would have no control over accreditation requirements.

“Consistent standards create value in the provision of health care and enable the regulation of health care facilities and services in a coherent manner,” Tesmer said. “In essence, [LB1234] would divest the state licensing authority and surrender this authority to a third-party commission.”

Robert Wergin, president of the Nebraska Medical Association, also testified in opposition. The bill and the amendment would pose significant risks for Nebraska mothers and infants, he said, noting that CPMs have no formal medical training. Their standards fall far short of what is required to provide safe maternal care, he said, especially in obstetrical emergencies.

Wergin said many life-threatening situations that occur during and after childbirth — such as hemorrhaging, shoulder dystocia and fetal distress — can happen suddenly in what were previously normal pregnancies and labors.

The committee took no immediate action on LB1234.