Birthing a Movement by Renée Ann Cramer

Author:Renée Ann Cramer
Language: eng
Format: epub, pdf
Publisher: Stanford University Press
Published: 2020-06-15T00:00:00+00:00

Even so, the outcomes of rulemaking vary tremendously from state to state. Differences abound around composition of the regulatory board, scope of practice, insurance requirements, eligibility for reimbursement, autonomous practice, and review of regulations. And, though midwives and advocates do not lack for models from around the country to consult for guidance, the language is often obfuscatory, alienating, and confusing—requiring, in some instances, both legal and medical translation.52 The effort is also worth it, though: Well-written regulations, midwives and researchers agree, can positively impact, “on a generational level, the quality of care.”53

Because it is easier to pass a bill that doesn’t have details regarding practice—and because passing bills that are vague usually means that constituents and midwives end up with better practice recommendations for safe out-of-hospital birth—most state advocates seek bills that simply legalize and regulate, while deferring the work of rulemaking to after enactment. National advocates advise groups to write bills “using boilerplate language for other professionals in your state, and just put CPM in there” or to take boilerplate language from other states’ CPM legalization bills and “insert your state.”54

This makes tremendous sense to get a bill passed, and to get midwifery regulated appropriately. But, as a Michigan attorney told us, “It took us eight years to get a law in Michigan—and let me tell you, writing and passing a bill is a walk in the park, compared to rulemaking.”55 At this point in the process, though the rulemaking was accomplished by a committee that didn’t include attorneys (at least not in their capacity as attorneys), legal expertise around regulatory policymaking was useful to have. Both legislative and administrative processes “necessitate insider baseball,” but the former necessitated political savvy and interpersonal relationship building, the latter required knowledge of other states’ regulatory bodies, combined with a deep understanding of the best practices for out-of-hospital birth attendants.56 A presenter at a MANA session explained that while the political process was winner-take-all and zero sum, at its best “Rulemaking on regulations is consensus-based and evidence-based.”57 Rulemaking combines both legal and midwifery expertise.

Before the state can adopt rules for midwives and adequately regulate them, it must authorize a committee to make decisions. And even that decision is controversial. How many midwives will be on the committee? How many consumers? How many ob-gyns, labor and delivery nurses, and nurse-midwives? Should organizations who opposed the licensure bill have a seat at the table for rulemaking? Sometimes legislation outlines the composition of the study committee for rulemaking, oftentimes it does not. After the number and types of board members are decided, the question of specificity comes up. Which ob-gyn should serve? Which midwife? Which consumer?

To even get to the table can be exhausting.

Most midwives and advocates agree that the best board is one that is made up of people familiar with out-of-hospital birth, and certainly not made up of people hostile to the practice. Because a primary role of the governing board is to field and investigate complaints that are brought to it, it is

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