On July 1, Virginia will enact standards for midwives who are not nurses, in an effort to better regulate home births.
Gov. Mark R. Warner (D) signed the rules into law in March. They will allow midwives who are not nurses but are certified by national midwifery groups to be licensed by the Virginia Board of Medicine to supervise births at home. The midwives, who are in a category called "certified professional midwives," will be required to meet competency standards.
Only midwives who are certified nurses and doctors are allowed to supervise home births under current Virginia law. The practice of non-nurse midwives supervising births occurs outside the law and without state oversight, lawmakers and state officials said. The new laws were passed to ensure standards for the common practice.
"There already is midwifery going on, and this simply regulates it," said Del. Adam P. Ebbin (D-Alexandria), who co-sponsored the House version of the bill. "It's a choice that a lot of women are making these days."
The new laws complete an eight-year effort to establish the rules, said Brynne Potter, president of Virginia Friends of Midwifery, an advocacy group. She and other supporters said the new laws will help alleviate the problem of the low number of obstetricians in rural and low-income areas, and will give women in the state's more populous areas more birthing options.
Under separate legislation passed this year, Virginia will set up a pilot program to increase the number of nurse midwives in rural areas, which have experienced a rapid decrease in available obstetric services.
"We wanted to take a stand for what we do and give women options," Potter said last week. She said there are only a couple of dozen midwives in Virginia who are not nurses, but that she expects the number to rise under the new laws.
There were 403 home births out of more than 100,000 total births statewide in 2003, according to the Virginia Department of Health. Doctors or nurse midwives attended about half of those home deliveries.
It is unclear how many of those babies were delivered by non-nurse midwives. Several state certified professional midwives estimated that many of the 150 births listed as "other" in state health records were likely delivered by non-nurse midwives.
Virginia joins about 20 other states that regulate certified professional midwives. Those midwives are not trained as nurses or nurse midwives, people who take extra midwifery classes in addition to receiving a nursing degree. Instead, non-nurse midwives receive formal training at schools, including out-of-hospital clinical experience.
Non-nurse midwives are nationally certified through the North American Registry of Midwives, an organization charged with developing and maintaining certification standards for the certified professional midwife license.
The legislation has been difficult to pass because it has run into opposition from lawmakers and some lobbyists for the medical profession who have said that midwives should be required to work with a physician who could intervene if complications arise. Last year, several state senators who blocked the bill in a committee said they were concerned about malpractice liability.
This year lawmakers overcame those hurdles by requiring non-nurse midwives to inform clients whether they have medical malpractice insurance. The law also says that any doctor who treats a woman who has had a home birth is not liable for malpractice caused by a midwife.
Those who support the changes said that with the new regulations, the number of home births will increase as women become more comfortable with the practice.
"Many are finding that it's more family-centered, where women have more control and often feel much more comfortable," said Tammi McKinley, a prospective certified professional midwife in Arlington who has assisted in about 20 births. "These are well-educated women who are making different choices."
