Increasing Access to Medications and Devices for the Care of Low‐Risk Childbearing Families: An Analysis of Existing Law and Strategies for Advocacy

Abstract

Limited access to medications and devices relevant to the care of low‐risk childbearing families acts as a barrier to the successful integration of high‐quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community‐based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state‐licensed midwives. These professionals are the primary health care providers offering community‐based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community‐based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement. Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence‐based care. Policy makers can improve health, health equity, consumer choice, and access to evidence‐based care by using ideal legal language for midwifery practice authority.

Planned Out-of-Hospital Birth as a Risk Factor for Nonreceipt of Hepatitis B Immunization

“…Additionally, many states have regulations in place that limit the ability of midwives or other healthcare personnel to deliver vaccines. 21 Survey studies have demonstrated logistical, interprofessional and informational barriers to the certified nurse midwives or registered midwives providing vaccines. 22 If HBV is available at these locations, the freestanding birth center facilities may not have policies in place that prioritize the administration of HBV at the time of birth.…”

Prescriptive Authority for Direct Entry Midwives in Washington State: Increasing Client Access to Contraception

“…In Washington state, LMs have been regulated by the Department of Health since 1917 and have one of the most integrated and comprehensive practice statutes in the United States. 14,27 Immigrant midwives educated abroad advocated for initial midwifery regulation and practiced under that law for many decades; the statute was then revitalized in the 1970s when community midwifery reemerged. 14 Legislative updates in the 1980s laid the groundwork for future changes as community needs and the standard of care evolved over time.…”

“…14,27 Immigrant midwives educated abroad advocated for initial midwifery regulation and practiced under that law for many decades; the statute was then revitalized in the 1970s when community midwifery reemerged. 14 Legislative updates in the 1980s laid the groundwork for future changes as community needs and the standard of care evolved over time. Since that time, LMs have collaborated with legislators, community members, and other professional organizations to expand legal access to midwifery and to life-saving medications and devices.…”

Choosing a Birth Setting: A Shared Decision‐Making Approach

“…The country lacks a universal health care system that provides equitable insurance coverage for all birth settings 4 . Birth center and home birth options exist within an uneven network of state midwifery regulations and insurance reimbursement policies that largely do not guarantee coverage for people or payment to health care providers 33,34 . In addition, there are 1095 counties that are referred to as maternity care deserts , or areas in which there are extremely limited or no birth facilities or providers 35 .…”

“…4 Birth center and home birth options exist within an uneven network of state midwifery regulations and insurance reimbursement policies that largely do not guarantee coverage for people or payment to health care providers. 33,34 In addition, there are 1095 counties that are referred to as maternity care deserts, or areas in which there are extremely limited or no birth facilities or providers. 35 Additional barriers to shared decision-making about birth settings include health care provider biases about birth center and home birth, [36][37][38] media bias and lack of knowledge about such options among the public, 39,40 and financial profits linked to patient numbers and cesarean birth.…”