HB 35-EXTEND BOARD OF MIDWIVES CHAIR OLSON announced that the final order of business would be HOUSE BILL NO. 35, "An Act extending the termination date for the Board of Certified Direct-Entry Midwives; and providing for an effective date." 4:12:00 PM REPRESENTATIVE KAWASAKI explained that HB 35 extends the Board of Certified Direct-Entry Midwives ("the Board") to 2015, in accordance with the recommendations made by the Division of Legislative Audit. He explained that the purpose of the Board is to protect the health and safety of the public. The Board identifies those individuals who are willing to pursue the training and meet the qualifications necessary to become a licensed midwife. The Board is composed of 5 members: 2 certified direct-entry midwives, 1 certified nurse midwife, 1 physician, and 1 public member. He explained that the audit did not contain any substantive changes. 4:14:36 PM KAYE KANNE, Executive Director, Juneau Family Birth Center; Midwives Association of Alaska, explained that there are two types of midwives in the United States: direct-entry midwives, and nurse midwives. She explained the differences in the aforementioned midwives. She then gave a brief history of the board and the work done by direct-entry midwives. She stated her support for extending the Board until 2015. 4:17:09 PM MS. KANNE, in response to a question from Representative Gatto, explained the training for certified direct-entry midwives and certified nurse midwives is not the same. Certified direct- entry midwives must attend 60 births in order to obtain licensure, which can take 2-4 years. She then explained the details of this training. A certified nurse midwife becomes a registered nurse (RN) and then completes an additional year of training in nurse midwifery. She then explained the details of this training. MS. KANNE, in response to questions regarding midwifery in Alaska, explained that out-of-hospital births attended by a certified midwife are "just as safe, if not safer" than hospital births. Certified direct-entry midwives are trained to deal with emergencies. The cesarean section (C-Section) rate at the Juneau Family Birth Center is 8 percent, and 12-15 percent of women must be transported to the hospital. She pointed out that two years ago, Juneau had a total C-Section rate of 43 percent. She explained that the majority of certified direct-entry midwives practice in urban areas, adding that many prefer to be near a hospital. 4:22:20 PM REPRESENTATIVE GARDNER inquired as to whether midwives attend home births. MS. KANNE replied that the majority of certified direct-entry midwives attend home births. She commented that the opposite is true for certified nurse midwives. In response to a question from Representative Gatto, she stated that she is not aware of any male midwives in Alaska. 4:23:32 PM PAT DAVIDSON, Legislative Auditor, Division of Legislative Audit, Alaska State Legislature, in response to a question form Representative Gatto, explained that the sunset extension was recently changed from 4 years to 8 years. She said "[We saw that] the Board was competently dealing with the issues that were coming before it, and therefore, we saw no reason to recommend anything less than the 8 year extension." In response to additional questions, she explained that the Division also considers how investigations are carried out. The Division found that the investigations were being dealt with in a timely manner. She pointed out that the legislature may pass legislation to shorten the extension date. She pointed out that additional audits may be requested if concerns are raised prior to the next extension date. REPRESENTATIVE LEDOUX asked if there is a Board for nurse midwives. MS. DAVIDSON replied that nurse midwives are included in the Board of Nursing. MS. KANNE, in response to questions from Representative Gatto, explained that if the midwife was aware that the baby was deceased prior to birth, the patient would be referred to a hospital. Certified direct-entry midwives are trained in neo- natal resuscitation. The infant mortality rate of births attended by midwives are "much lower" than those attended in hospitals. In regard to pre-natal care, she explained that midwifery pre-natal care is different than medical model pre- natal care. She also offered details regarding prices for in- hospital versus out-of-hospital births. 4:32:27 PM REPRESENTATIVE NEUMAN offered Amendment 1, which would change the extension from 8 years to 6 years. He opined that this is "more in-line" with other board extensions. REPRESENTATIVE GARDNER objected. 4:33:29 PM A roll call vote was taken. Representatives Neuman, Ramras, and Olson voted in favor of Amendment 1. Representatives Gatto, Gardner, Buch, and LeDoux voted against it. Therefore, Amendment 1 failed by a vote of 3-4. 4:33:39 PM REPRESENTATIVE GARDNER moved to report HB 35 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 35 was reported from the House Labor and Commerce Standing Committee.