January 26th, was the first committee hearing for the sunset of the Direct-Entry Midwives (DEM) Practice Act.
A little explanation: periodically (every 5-10 years), our practice act “sunsets.” What this means is that, without reauthorization, we will cease to have regulated direct-entry midwifery in Colorado. We must go to the legislature during this time and introduce a bill to continue our practice act for another period of time (this year the recommendation is for a 7 year reauthorization). During the sunset process, the statute is opened up and changes to our practice act can be made. This year, we are hoping to add the suturing of 1st and 2nd degree lacerations to our scope of practice.
Our first hearing was held in the House of Representatives, in the Health, Insurance, and Environment committee, which is made up of 13 members. Testimony was given by both proponents and opponents of our proposed bill, along with that of the “sunset analyst” from the Department of Regulatory Agencies (DORA), who conducted a lengthy assessment of our profession and DORA’s recommendations for the next period.
DORA’s sunset analyst was the first to offer testimony. He explained the program to the committee and said that DORA recommends continuation of the Direct-Entry Midwives Practice Act for 7 years, with the inclusion of suturing for 1st and 2nd degree lacerations. He answered many questions from the committee.
Those opposed to our practice act testified directly after DORA. These opponents included a home birth Certified Nurse Midwife, a doula and nursing student, a panel of four nursing students, and members of the group the Center for Science in Medicine, which has historically opposed all “alternative” modalities, such as acupuncturists, naturopaths, and chiropractors.
Next was an economist (who is also the lobbyist for Colorado ACOG) who explained the history of how DEMs in Colorado have interacted with the malpractice insurance requirements for providers in our state. His testimony was neutral, and perhaps even more notable is the lack of opposition by ACOG.
Up next were the supporters.
Jan Lapetino, RM, CPM testified on behalf of the Colorado Midwives Association, and gave a history of the program, and explanation of our scope of practice, and made our desire for valid and accurate data reporting through a robust and rigorous method clear.
Next was Courtney Everson, PhD, who is the Dean of Graduate Studies at Midwives College of Utah and Director of Research Education for Midwives Alliance of North America. Dr. Everson explained the limitations of the data pertaining to home birth, particularly that collected by DORA and offered clarity as to current research on home birth safety. As well, she offered insight into the nature and accreditation of the CPM credential and educational process.
Next was Karen Robinson, RM, CPM, and former president of the CMA, now a licensed-practical nurse. Ms. Robinson explained the rigor of her training as a midwife, and how it did develop excellent critical thinking skills in rebuttal to previous testimony.
Next was a pediatrician in Centennial who cares for many Denver-area home born babies, and supports continuation of our program.
The President of the Colorado chapter of the American College of Nurse Midwives testified that her group is neutral on our bill.
The committee chair then opened up testimony to observers, and Larry Sarner, a long-time opponent, expressed his displeasure of our program and recommended deregulation.
At some point, two staff members from DORA returned to the stand to offer regulatory clarification to the committee.
The committee declined to vote on the bill, so an “action only” (meaning no testimony will be heard) committee will be rescheduled for a vote of whether or not to continue forward with our bill to continue the practice of direct entry midwifery in Colorado.
It goes without saying that we will need a lot of support during this legislative season. Once we have a bill number, we will be urging everyone to contact their state representatives (and then senators once the bill is introduced there). The deregulation of our program surely means home birth will cease to become an option for many women. Please stay tuned for how you can help.