Jun 13

Florida Legislation Update, Alabama Bill Passes

2017 Florida Legislative Report
by Sharon Hamilton, LM

Florida State SealAfter many years of very little Legislative activity the midwives of Florida rallied to prevent the opening of their practice act, F.S. 467, during the 2017 Legislative Session. In October, 2016, the midwives were alerted to a District XII ACOG driven plan to open F.S. 467 with the intention of requiring midwives to report Sentinel Events.

Having had many years of lobbying experience as President of the Midwives Association of Florida in the 80s and 90s, I was called into action to perform my old job of Legislative Chairperson. The group had established a Base Camp on the internet that allows us to communicate by Webex, making meetings so much easier than in that time period. The first meeting that I participated in, included a discussion of “Do we need a Lobbyist?” It did not take long to convince people that it was essential to have a lobbyist as this is the person who communicates for and represents us to the legislative and executive branches of the Government. This is the person who is our advocate, guide and defender. There was no telling what type of meddling the doctors may have intended but we had plenty of ideas. We were concerned for instance that they may want to require all mothers to be approved for out-of-hospital birth, although that topic was not part of their final proposal.

Our first discussion included brainstorming names of lobbyists and possible contacts regarding lobbyists. After reviewing 4 or 5 potential candidates, we chose one that was a referral from a home birth client. It turned out to be the perfect choice. The proposal that we received from them was well written and addressed our concerns and objectives. The interview that we had with them, though by phone, indicated their interests and goals. We hired two lobbyists for a fee of $15,000 each, spread out in 3 payments over a 6 month period. It was worth every penny. The two lobbyists between them had over 60 years of experience. They had both done considerable healthcare lobbying including for the Florida Medical Association. We suspected that could give us an advantage in the future and it did. Because they had good, strong relationships with previous associates who still lobbied for the ACOG and FMA, they were able to work congenially with the opposition. Justine Clegg passed along a power point to them on the history of Midwifery in Florida and gave them considerable guidance. They quickly became passionate about our mission.

ACOG’s stated goal, was the reporting of Sentinel Events in the out-of-hospital setting to the Department of Health. There are CNMs and a few doctors who attend out-of-hospital births in Florida, not just L.M.s, so it didn’t seem right that the proposed language should go into F.S. 467, because that would leave out all of the other practitioners attending out-of-hospital births. We did the research and discovered that 20% of out-of-hospital births in Florida are attended by CNMs and doctors. Armed with this new information and at our recommendation, our lobbyists approached their lobbyists to argue that any language should go into F.S. 456, which is an umbrella health care act that covers all health care practitioners. After much negotiation with the Chair of the ACOG Committee and their lobbyist, we were able to negotiate an agreement to leave our practice act alone and instead amend F.S. 456. An amendment was attached to a Health Care Bill in the House which passed. However, when the bill went over to the Senate it failed for unrelated reasons.

Florida Legislative Report

1. Before session began, our Committee prepared a legislative toolkit that included a Position Paper or Fact Sheet on Licensed Midwifery.

2. During Legislative Session our committee met weekly by webinar to discuss our strategy. Our lobbyists attended the first half of the meeting most of the time.

3. We identified every legislator on the health care committees in which we thought our issue would be heard.

4. We identified midwives in many of their districts so that they could be visited by their local midwife and possibly a mom and baby.

5. We kept a tally of each legislator visited and their position on midwifery.

6. Our lobbyists arranged a capitol day for us in the 3rd week of Session that was most effective.

7. We met the evening before in Tallahassee, at a local restaurant, 17 of us including our lobbyists to discuss our strategy and to prepare talking points.

8. Our lobbyists had arranged meetings with 19 legislators in the House and the Senate that were to occur every 15 minutes throughout the day. We divided into 3 groups with 1 experienced person acting as the spokesperson for the group. Our lobbyists accompanied the group that was visiting especially a Chairperson of a Committee or a legislator that was more likely to be particularly helpful.

9. We explained our position that: if the goal was the reporting of all Sentinel Events in the out of hospital setting being reported that the Statute amended needed to be F.S. 456, to address all health care provider rather than singling out Licensed Midwives. Every Legislator that we spoke with understood and supported our argument including the sponsor of the amendment that was initiated by the ACOG.
10. We presented to each Legislator, or their Aide, the benefits of midwifery including reduced costs to the state by Medicaid. Whenever you can argue saving money, it is a winning argument.


Alabama Passes Bill to License CPMs:  Congratulations!

Seal-of-AlabamaNACPM offers our heartfelt congratulations to all families in Alabama, Alabama Midwives Alliance (ALMA), and the Alabama Birth Coalition (ABC) on the long-sought passage of HB 315, the Childbirth Freedom Act, that will at long last allow Certified Professional Midwives to serve families choosing home birth.  The bill passed the Senate on May 19 on a 30-0 vote, and was signed into law by Governor Ivey on May 25th. The passage of this legislation is a triumph for families, led by the Alabama Birth Coalition in a resolute grassroots movement that persevered for over 15 years, and who welcomed the new legislation with great joy.  The mission of ABC is to unite and empower maternity care consumers in Alabama to advocate for informed choice among high-quality, integrated, evidence-based services in homes, birth centers and hospitals.

HB 315 previously passed the House on April 25 by a vote of 84-11, as a simple decriminalization bill, exempting CPMs from the crime of practicing nurse midwifery without a license, effectively allowing midwives to practice legally in Alabama.  The bill was changed in the Senate to provide for licensure and to include a State Board of Midwifery, consisting of four CPMs, one nurse practitioner, one CNM or registered nurse, and one consumer of midwifery services.  The bill requires the CPM certification and accredited education for midwives applying to be licensed.

Non-nurse midwives have not been able to practice legally in Alabama since 1976 when the State ended its DEM permitting program.  Since then home birth has only been legal if it is not attended by a midwife.  Advocates have been introducing bills to decriminalize the practice of Certified Professional Midwifery for over a decade, all in a state with a severe shortage of maternity care providers.  Of Alabama’s 67 counties, 33 have no obstetrician in practice, and women often must drive long distances for prenatal care and hospital care for their births.  Alabama is among the states with the worst infant mortality, outranked only by Louisiana and Mississippi.  In recent decades, the number of doctors delivering babies has declined, several rural hospitals have closed and other hospitals have dropped maternity services.  The passage of the new law providing for the legal practice of midwifery will help to alleviate the state’s shortage of maternity care providers and allow for much-needed choice for families.

Certified Professional Midwives are clearly urgently needed by families in Alabama.  Where before it was only legal to give birth at home with no help, families now have the right to hire competent, professional help.  “The only way this has been possible is because Alabama mothers and fathers have really joined together to let their legislators know how much they want midwives in Alabama,” said Courtney Sirmon, vice-president of the Alabama Birth Coalition.

Congratulations to all in Alabama on this momentous victory!

Register for the ICM webinar and read about the 2017 Journal of Midwifery & Women’s Health Best Research Article Award