Pass new pathway to become a midwife

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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More than 8% of Minnesota babies are born to women living in rural counties. Just 3.7% of maternity care providers, however, practice in these areas.

It’s a troubling medical care imbalance, one documented by the most recent March of Dimes state-by-state maternity care report. Unfortunately, it’s one that’s likely to widen as hospital systems in Minnesota and elsewhere continue to consolidate services.

Too often, labor and delivery is care that small counties and communities lose when hospital systems group together certain services at one large facility to improve efficiency, control costs and grapple with the ongoing difficulty of recruiting medical specialists. Essentia Health’s announcement earlier this year that it intends to stop delivering babies at the Fosston, Minn., hospital is a recent example of this, with moms expected to travel to Detroit Lakes or Fargo to deliver.

Fortunately, Minnesota lawmakers have an opportunity this session to pass a pragmatic measure that could help remedy maternity care shortages in rural communities and other medically underserved areas. Lawmakers should ensure that this important measure, one that could expand the state’s maternity care workforce, is included in legislative packages approved during final days.

The measure, HF 1324/SF 1743, is known as Minnesota Certified Midwife Practice Act. It would create a new pathway to become a licensed certified midwife in the state, easing entry into this honorable profession’s ranks.

In turn, having more trained midwives would increase the pool of people who could be recruited to provide reproductive health care in underserved communities. That’s important with the March of Dimes reporting that 17 counties in the state are “maternity care deserts.”

For centuries, likely even longer, midwives have cared for women during pregnancy, delivery and the postpartum period. Modern-day midwives can also provide a range of well-woman care that includes annual exams, screening, birth control and treatment of sexually transmitted diseases.

Minnesota already has certified nurse midwives (CNMs), with science and health requirements achieved through a bachelor’s degree in registered nursing and completion of an accredited graduate-level midwifery education program. Requirements also include passing a certified national board examination.

The new pathway to become a certified midwife (CM), if passed, is similar. It still would require a bachelor’s degree, graduate education and passing an exam. But that bachelor’s degree wouldn’t have to be in nursing.

Instead, the sensible reform under consideration would allow these degree holders to take key science and health courses outside of a nursing program and then go onto the graduate-level midwife program and take the national exam.

“The only difference between the educational pathway for CMs and CNMs is the foundational science and health competencies are achieved within a [registered nursing] program for CNMs. CMs achieve the health competencies with required prerequisite courses that may be earned in an intensive foundational course prior to matriculation, or previous health care experience,” according to information shared with legislators by Mandy Huber, who is a certified nurse midwife and lactation consultant in Minneapolis.

Huber is also active in local and national committees for the American College of Nurse Midwives and is an energetic supporter of the new educational pathway. The legislative change has strong support as well from other influential Minnesota women’s health care experts.

In an interview, Dr. Siri Fiebiger, the immediate past chair of the American College of Obstetricians and Gynecologists’ Minnesota Section, praised the midwives she has worked with over her career. She said that they made her a “better obstetrician” and that she was impressed with their depth of knowledge.

Two internationally known Minnesota maternal health researchers have added their names to the list of supporters:

Katy Kozhimannil is a distinguished McKnight professor at the University of Minnesota’s School of Public Health. She directs the U’s Rural Health Research Center and Rural Health Program.

Rachel Hardeman directs the Center for Antiracism Research for Health Equity at the U and is the Blue Cross endowed professor of health and racial equity.

The professor pair endorsed the new midwife pathway in a letter to legislators, writing that “midwifery care is evidence-based, cost saving and associated with improved outcomes in low-risk pregnancies.” They also note that this change could increase the diversity of Minnesota’s health care workforce. That’s critical as a growing body of research indicates that “patients have better outcomes and report higher quality care when their clinicians share their race or cultural background.”

The new route to become a midwife isn’t a panacea for maternity care access concerns, of course. But getting more people to enter this profession will surely help. Twelve other states, plus Washington, D.C., already have passed this reform. There’s no reason Minnesota lawmakers should hesitate.