Readers Write: Midwifery, prior authorization, child care

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Although there are about 350,000 Latin people in Minnesota, I am one of only two Latina midwives working in the state. I work at Hennepin Healthcare, and I am the first and only Latina midwife in our practice. My schedule is filled for weeks; most of my patients are Latinas, and they specifically request to schedule with me. For them, an appointment with me is a comforting experience. More than sharing a language, we share an understanding of things beyond words. For a few minutes in their day, my patients feel at home.

I was an obstetriz in my home country of Ecuador. When I came to Minnesota, my extensive professional experience did not transfer to the U.S. certification system. Despite my university education and years of experience delivering babies, I had to start all over again. I attended an undergraduate nursing program, then went to graduate school to become a certified nurse midwife.

I am not alone in this experience. Many midwives from around the world come to the U.S. with skills, expertise and a passion for caring for women and families. We must start from zero, for the privilege of doing what we love. I strongly urge the Minnesota Legislature to pass certified midwife licensure this year to alleviate some of the time and cost for midwives educated abroad to become practicing midwives. It would ensure skilled midwives spend time in the workforce using their potential and bringing comfort to women during their most tender moments in life.

Fernanda Honebrink, Arden Hills

The writer is a certified nurse midwife.

Minnesota’s overall maternal mortality rate is much lower than the national average; however, it also shows stark disparities in mortality — especially among Black and American Indian Minnesotans. Midwifery is shown to reduce maternal mortality rates, but there is a shortage because it often requires a nursing degree with a minimum of six to eight years of post-high-school education. This pathway is time-intensive and expensive.

I am the director of the Park Nicollet Midwife Practice, and the first and only hospital-based Black midwife director of any hospital in Minnesota. The Legislature has the opportunity to pass legislation that would grow a diverse and skilled midwife workforce in Minnesota — by licensing certified midwives. Certified midwife licensure provides a pathway to midwifery without requiring a nursing degree and currently exists in 12 other states. During my term on the Minnesota Board of Nursing, I led the task force that thoroughly investigated, vetted and recommended that the Minnesota Board of Nursing license and regulate certified midwives. The Board of Nursing voted in favor and is now prepared to regulate certified midwives.

Minnesota is a known leader in health innovation, but we are falling behind in growing midwifery care and in turn decreasing disparities in maternal health. We must accept this challenge and create a pathway for certified midwives to serve Minnesotan families.

Sakeena Futrell-Carter, St. Paul

The writer is a certified nurse midwife.

My career path to midwifery began 10 years ago when I received my LPN licensure. Since then, I have attempted to complete an RN program but have met several personal and educational roadblocks along the way. Despite scoring in the 98th percentile in not only my cohort but also nationwide on an NCLEX predictor exam, the school I attended previously had a standard for passing that I missed by six points in a singular course. This has left me with few options to complete the required coursework (a nursing program) to apply for midwifery school. Nursing school is expensive and requires a time commitment that as a single mother to three, I simply can no longer afford. I have a bachelor’s degree in another field, and while there are options for post-baccalaureate nursing programs, there are limited options across the nation for those who want to practice as midwife, not a registered nurse. My time and educational dollars would be better spent in a program that allows me access to the desired career rather than another degree that only serves as steppingstone. A certified midwife program in Minnesota would allow others like me, as well as underserved populations, access to a program that has the potential to increase diversity in clinicians — not only in Minnesota, but also the 12 other states who have adopted this licensure. Minnesota has the chance to be part of the change the health care system needs to meet the needs of our citizens.

Dianne Hines, Rosemount

The writer is a licensed practical nurse.

I’m sure I can speak for most other physicians and health care providers when I say that seeing prior authorization in the cross hairs is a welcome and overdue change (”Prior authorization in cross hairs,” May 15). I actually laughed out loud when I read one of the “justifications” for it: that “most reviews support doctor recommendations.” Blue Cross and Blue Shield approved 76% of the 136,294 treatments it reviewed last year, and when patients appealed denials, they were overturned more than half of the time. Keep in mind that this was only one insurance company — so multiply that number manyfold and you can see what doctors and patients are dealing with on a daily basis. If any other business were spending that much time and money doing something that only was “successful” 24% of the time, it would likely look at other ways to divert resources, especially when the same futile process causes endless undue frustration, waste of time for health care workers (who already don’t have enough of that) and needless delays in care for the clients whose health they claim to care about.

I have an idea: Since doctors apparently do know what is in the best interest for their own patients most of the time, get rid of that bloated layer of obstruction in the system, and spend that money covering more of the drugs and tests that we know patients need, when they need them! The waste of time and resources is astounding and has grown exponentially over the last 10 years. Since the insurance industry has not only failed to address this, and rather just continued to make it worse, it’s good to see the Legislature taking some action!

The writer is a physician.

Even with a modest, middle-class income, I cannot afford child care. So, as a full-time mother, student, unpaid intern, volunteer and household executive, my life is like a game of Tetris: organized and enjoyable at a manageable pace but inevitably building toward chaos.

The solution is universal child care, meaning that from birth to pre-K, the state of Minnesota provides all families with government-funded, quality child care. In this vision, I spend attentive, playful time with my children. I restore my home to the standard of cleanliness I once enjoyed. I read for pleasure and resume drum lessons. Ordinary activities like walking, family meals and showers are no longer luxuries but everyday occurrences.

The conclusion I draw from Minnesota lawmakers’ choice to budget $0 dollars toward affordable child care in 2024: Women and other caregivers are responsible for cleaning up the mess of Minnesota’s child care crisis — like another pile of dishes. It’s discriminatory and dehumanizing. The rage I feel from a lack of equitable parenting and the capitalist agenda that supports it is so concentrated that it could produce a thousand gallons of juice or (ironically) wash a thousand loads of laundry.

For the countless parents and caregivers who read this and relate, join me in urging Minnesota lawmakers to show they value women, caregivers and children by making universal child care their top priority next session. We have the resources to care for each other. Every parent deserves rest, the ability to care for and be ourselves and enjoy time with loved ones.