Senate passes direct access to midwives

Conference needed to resolve differences with House version

Health care

March 31, 2000|By Timothy B. Wheeler | Timothy B. Wheeler,SUN STAFF

Women would have easier access to nurse midwives under a bill that passed the Senate in Annapolis yesterday.

Senators voted 46-1 to require health plans and HMOs to let their members go directly to certified nurse midwives for obstetric and gynecological care.

The House of Delegates has overwhelmingly approved a similar measure. The two chambers must work out differences between the bills before the General Assembly session ends April 10.

Alice J. Neily, lobbyist for the state's 200 nurse midwives, said the legislation would provide "very significant" health care benefits for women.

"It allows women to make a decision over what kind of provider they'll see for their OB-GYN care," Neily said, "and they don't have to go through gatekeepers to get to a midwife."

Under current law, patients wishing to see a midwife must be referred by an obstetrician/gynecologist.

About 19 percent of patients who seek OB-GYN services go to nurse midwives or to nurse practitioners, according to the Maryland Health Care Commission.

Thirty-one states require health insurers to provide coverage for midwife services, but they do not necessarily require direct access.

A midwife in Maryland would have to maintain a collaborative agreement with an OB/GYN physician and consult with the doctor on patient care, as is now required by law.

Midwives contend that there are fewer Caesarian sections and a lower infant mortality rate when they are involved in delivering babies than when physicians handle the deliveries.

Midwives also are generally cheaper than doctors. They charge an average of $95 for an annual checkup, according to state figures, compared with $150 to $200 for routine care by a physician.

More than half of the state's hospitals have nurse midwives practicing in them, but most require their patient-care orders to be signed by a physician.

Only five hospitals -- Anne Arundel, Mercy, Shady Grove, Sinai and Union Memorial -- grant admitting privileges to midwives, said Neily.

A bill that would require hospitals to make it possible for midwives to qualify for staff privileges awaits a vote in the House Environmental Matters Committee. It died there last year.

Doctors have opposed these and other bills to expand the abilities of midwives and other non-physicians to treat patients.

Michael Preston, executive director of Med-Chi, the state medical society, said doctors are uneasy about "the growing fragmentation of lines of responsibility between physicians and nurses, and the growing independence of nurses."

While nurse midwives have worked well with doctors under current requirements that they collaborate, Preston said physicians fear that patient care could suffer if midwives view themselves as competitors to doctors.

Doctors also contend that at least some of the pressure for giving midwives more independence comes from managed care organizations, which are seeking to cut health care costs.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.