Michigan’s medical service licenses include a category of nurses called licensed certified nurse-midwives. Another group of individuals, certified professional midwives (CPMs), are not nurses and have not previously been subject to a full licensure regime. Their training is focused on normal deliveries and home births.
New Fees, Training Required
That changed on August 1. CPMs will be able to deliver babies legally, but they will be subject to the burdens of a full licensure regime.
Under the new rules, CPMs now must pay an application fee and a one-year licensing fee of $650, plus a $400 renewal fee every two years. They must complete an educational program accredited by the Midwifery Education and Accreditation Council or another organization approved by the state. Each CPM now must also complete at least 30 hours of continuing education every two years, including one hour in pain and symptom management and two hours on cultural awareness, complete training on identifying human trafficking, and undergo a criminal background check.
The changes are a modification to a law which went into effect in 2017.
Barrier to Entry
Institute for Justice Director of Strategic Research Dick Carpenter says 12 states and the District of Columbia do not require licenses for certified professional midwives. A professional’s reputation is a far more credible indicator of quality and trustworthiness than a state license, says Carpenter.
“We have at our fingertips, in the form of actual consumer reviews, voluminous information about service providers,” said Carpenter. “These reviews provide more information about a potential service provider than any licensing scheme will ever offer. If a mother-to-be wants to find a midwife, she will be better informed by the experiences of other mothers than licensing bureaucrats in Lansing.”
Occupational licensure can be more about job security and price protection than customers’ or patients’ safety, says Carpenter.
“This is a classic example of industry leaders and associations seeking to erect a fence around their own occupation,” said Carpenter. “This is, in fact, how most licenses are created: industry leaders going to the legislature and asking for a license of their own industry.”
Katie Lavery, a certified nurse-midwife and legislative liaison for the Michigan affiliate of the American College of Nurse-Midwives, was involved in developing the new law. She says licensing certified professional midwives is necessary to promote safety and consistency in care, and although the high fees may pose a barrier to entry for some prospective midwives, many will see the value of licensing and make it work.
“Our organization feels strongly that the women of our state deserve safe, seamless care for birthing,” said Lavery. “This means that women should be able to seek the provider of their choice in a safe and consistent manner and that their chosen provider should have open access to transfer and emergency services when needed. This has not always been the case in Michigan, and we hope that recognizing these providers [through licensing] will improve this.”
Lavery sayswhat this means is now, under licensure, midwives can have an “inter-professional relationship” with one another, whereas before, certified nurse midwives were “ethically prohibited” from consulting with CPMs.
Could Reduce Service Access
Licensing can reduce the supply of professionals, says Jarrett Skorup, marketing and communications director at the Mackinac Center for Public Policy.
“Fewer workers in the industry means less competition among themselves, higher demand and more customers for each licensee, and thus higher prices and ultimately, larger profits for those in the industry,” said Skorup.
If new regulations and higher fees reduce the number of people in the profession, there could be fewer options for expectant mothers, says Skorup.
“Hundreds of thousands of people in Michigan live in the 25 percent of counties in the state with no obstetric care,” said Skorup.
A July 11 article in the online publication MLive generated a comment from someone identifying as “old geezer” who said the new rules will cause older, experienced, midwives to retire.
“I know one that has been delivering babies for 40 years,” the commenter wrote. “She would have been required to go to college for two years, taking courses like math, English and some other actual medical course to get a certificate.”
Madeline Peltzer ([email protected]) writes from Hillsdale, Michigan. An earlier version of this article was published by Michigan Cap Con on July 12, 2019. Reprinted with permission.