SB 156-DIRECT-ENTRY MIDWIVES  1:49:08 PM CHAIR DUNLEAVY reconvened the meeting and announced the consideration of SB 156. "An Act relating to direct-entry midwives." He noted that this was the first hearing. 1:49:27 PM HEATHER SHADDUCK, Staff, Senator Pete Kelly, introduced SB 156 on behalf of the sponsor speaking to the following sponsor statement: SB 156 will update and streamline the Certified Direct-entry Midwife ("CDM") practice act. The initial law was enacted in 1992, prior to establishing a functioning Board of Certified Direct-entry Midwives. Due to the lack of a professional board to set ongoing regulations at the time, a detailed set of practices were placed in Alaska Statue. The Board has tried to establish and develop a comprehensive regulatory framework through practice regulations and guidelines crafted to ensure public safety and professional discipline. However, the outdated statute cements certain obsolete practice requirements in place, and can only be updated by an act of the legislature. SB 156 will neither lessen the regulatory governance of CDMs, nor will it expand their scope of practice. Rather, the bill clarifies regulatory intent and defines CDM scope of practice. SB 156 would give the board greater flexibility and efficiency by placing CDM required practices into regulation rather than statute. This enables the Board to oversee the profession more effectively and incorporate current nationally-recognized best practices. This type of authority is granted to most professional boards in order to develop and maintain professional practice standards. The proposed changes in the bill will also ensure greater public safety in the field of midwifery. SB 156 requires a CDM to be licensed arid practicing for two years and attend 50 or more births as a primary or assistant midwife in order to supervise an apprentice direct-entry midwife. Well-baby care will also be covered under the scope of CDM practice for up to 4 weeks after birth, which ensures the delivering midwife can properly follow up with both mother and baby. SB 156 repeals the cultural midwives exemption, requiring all CDMs in the state to be licensed and under the disciplinary regulation of the Board of CDMs. Currently, an individual whose cultural traditions have included, for at least two generations, the attendance of midwives at birth, and has assisted in at least 10 births does not fall under regulation of the board. The health and safety of all mothers and babies using midwifery services will be improved by holding all certified direct-entry midwives to a higher level of training and care. 1:54:06 PM SENATOR OLSON asked what the current requirement is to become a certified direct-entry midwife. MS. SHADDUCK clarified that the bill requires a CDM to be licensed and to practice for two years and to attend 50 births as a primary or assistant midwife to qualify to supervise an apprentice direct-entry midwife. She deferred to Cheryl Corrick to discuss the licensing requirements. SENATOR OLSON asked how many midwives practicing in rural Alaska would be affected by the bill. MS. SHADDUCK said she didn't have a number but her understanding was that the board brought the provision forward because it hasn't been used as intended. SENATOR OLSON asked how many rural midwives would be affected. MS. SHADDUCK said she didn't have a number but it would be very small. SENATOR OLSON asked if there were complaints that prompted this legislation. MS. SHADDUCK deferred the question to the representative from the Board of Certified Direct-entry Midwives. 1:56:31 PM SUSAN TERWILLIGER, CDM and President, Midwives Association of Alaska (MAA), Eagle River, Alaska, stated support for SB 167. Addressing an earlier question, she clarified that the 50 birth requirement only applies to midwives who seek to be preceptors. The number 50 applies to qualifying as a teacher, not certification to be a CDM. She said that Alaska has a fairly good midwifery law, but it needs updating for public safety and to keep current with the latest childbirth information and studies. Many Alaskan women seek midwifery care as an option for their pregnancy care and birth and they expect the licensing laws to reflect best practices, she said. Moving the practice requirements that are currently in statute into regulation will make it easier for the board to make additions and updates. The bill also adds to the definition of midwifery that the well-baby care is given up to four weeks and that apprentices are supervised. She said that midwives have been doing this for years but it isn't in statute. She opined that passing the bill gives Alaska the opportunity to be a leader in the nation. 1:59:12 PM SENATOR OLSON asked how many births a CDM needs to be eligible for a license. MS. TERWILLIGER said she didn't know because she received her Alaska license nine years ago through a reciprocity agreement with Texas that only required passing an examination. SENATOR OLSON asked how many births she'd attended. MS. TERWILLIGER replied she's attended about 750 births. SENATOR OLSON asked if complaints prompted the legislation. MS. TERWILLIGER answered no; it was prompted by years of frustration at not being able to update for best practices. SENATOR OLSON commented that births have occurred since Cain and Able and he questioned the sudden need to attend 50 births before someone can become a preceptor. MS. TERWILLIGER explained that both the board and the MAA membership agreed that it was in the profession's best interest to add to the requirement. It's a matter of professionalism, she said. SENATOR OLSON maintained that this would put midwives practicing in rural areas at a disadvantage. MS. TERWILLIGER responded that the bill is about the ability to teach other midwives, not practice midwifery. SENATOR OLSON said teaching needs to take place in rural areas, too, and he was reluctant to prohibit someone from being a preceptor just because they haven't acted as a primary or assistant midwife at 50 births. He again stressed that it puts rural sites at a disadvantage. MS. TERWILLIGER suggested Ms. Corrick be added to the discussion. 2:03:42 PM CHERYL CORRICK, Chair, Board of Certified Direct-entry Midwives, Fairbanks, Alaska, said the board considered that it would be more difficult for midwives in rural areas to attend 50 births but as they looked at professionalism they noticed a trend that the complaints that resulted in investigations were about preceptors who didn't have much experience. This was discussed in board meetings and the MAA made the decision to include this provision in the bill. SENATOR OLSON observed that there have been complaints that prompted this legislation. MS. CORRICK responded that she's been on the board for six years and has noticed that trend. SENATOR OLSON asked how he would find out how many licenses have been revoked or suspended because of complaints. MS. CORRICK replied there have been no suspensions or revocations imposed during her six-year tenure on the board, but there have been some memorandums of agreement and other disciplinary measures. SENATOR OLSON asked how many midwives practice in rural areas and how many would be affected by this legislation. MS. CORRICK said her understanding was that very few midwives are practicing in rural areas. 2:07:28 PM DANA BROWN, Director, Alaska Family Health and Birth Center, Fairbanks, Alaska, stated that she has been licensed since 1993, has served on the board in the past, and was speaking in support of SB 156. She related that during her tenure the board tried to pass regulations to update practices only to have the statute prevent it from happening. She pointed out that the statute was passed many years ago and never updated so it needs to be brought up to current standards. SENATOR OLSON asked if she had practiced in rural Alaska. MS. BROWN said no and added that the direct-entry midwifes in Alaska generally practice near cities and towns, but serve rural areas. She explained that women who live in villages usually come to town for their births so that they're closer to a hospital. SENATOR OLSON responded that the bill puts his rural constituents at a disadvantage because precipitous births do occur. MS. BROWN pointed out that there are no licensed midwives in those areas and the bill doesn't affect a health aide working in a village because they aren't under the jurisdiction of a direct-entry midwife license. SENATOR OLSON asked if she was saying that there are no certified direct-entry midwives in rural Alaska. MS. BROWN asked him to define rural. SENATOR OLSON said he was talking about places like Bethel, Barrow, Kotzebue, or Nome. MS. BROWN responded that she was not aware of any direct-entry midwives practicing in villages that are off the road system. 2:11:51 PM JENNITH LUCAS, representing herself, Anchorage, Alaska, testified in support of SB 156. She said she used a midwife for the births of her children and she knows that they were aware of the most recent studies and best practices for safe childbirth. She described the bill as important for Alaskan consumers. 2:13:32 PM SASKIA ESSLINGER, representing herself, Anchorage, Alaska, said she used midwives for the births of her two children. This was the best option for her, but she did notice that the regulations didn't always allow for the most current standards of practice. She said she supports SB 156 because it will allow the board to update and revise the practice guidelines. It will also enhance public safety by requiring more experience for preceptors. 2:15:07 PM SARA CHAMBERS, Administrative Operations Manager, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), introduced herself and offered to answer questions. SENATOR OLSON asked if there were any licensed midwives in rural Alaska. MS. CHAMBERS replied the division doesn't track licenses that way but she would look at the addresses on the licenses and follow up with the information. SENATOR OLSON asked how many midwives would be affected by the 50-birth requirement to be a preceptor. MS. CHAMBERS said it would take additional research to make that determination. SENATOR OLSON asked how many births are required to qualify for a license. MS. CHAMBERS suggested he pose the question to Ms. Corrick. SENATOR OLSON asked if DCCED was in favor of the bill. MS. CHAMBERS answered that the department didn't have a position. SENATOR MICCICHE offered his perspective that the current two- year requirement had less value in measuring experience than the proposed 50-birth requirement. MS. CHAMBERS, responding to an earlier question, reported that there were 62 midwife licensees in FY13 and 8 investigations. 2:20:48 PM SENATOR MICCICHE asked Ms. Corrick if she agrees with his logic that the number of births has more value than the length of time a person has held a license. MS. CORRICK agreed that 50 births is more telling of experience. Responding to an earlier question, she relayed that to get licensed as a certified direct-entry midwife the apprentice has to attend 60 births. Ten of the births are observations, 20 are assisting at the birth, and 30 are as the primary provider under the supervision of the preceptor. The licensing process takes approximately two years so a midwife should be able to get the required 50 births within that timeframe. She acknowledged that it would be more difficult for someone who moved to a more rural area, less populated area. CHAIR DUNLEAVY opened public testimony. 2:23:00 PM JUDY DAVIDSON, CDM, MatSu Midwifery and Family Health, Wasilla, Alaska, said she's been licensed since 1993 when the state first provided licensure for direct-entry midwives. She said it's important to understand that direct-entry midwives are licensed to provide care to low-risk women and their training includes precipitous births. She and a number of other midwives provide training for people living in other areas and part of the reason for updating the statute is to show that they're qualified as preceptors. She said Alaska has the highest rate of out of hospital births in the nation and it is looked to as an example. Updating the statute shows continued progress to reflect the standard of maternity care that midwives offer. 2:26:21 PM KAYE KANNE, CDM, Juneau, Alaska, said she's been practicing as a midwife for 30 years and was involved in the 1985 legislation to keep midwifery legal. Legislation passed in 1992 created a board for certified direct-entry midwives and she served on the board for eight years and helped craft the current regulations. MS. KANNE said she believes that the number of births that a midwife has attended since being licensed is important in terms of having the knowledge to be a preceptor, but the number of years is not important. For example, a former student who has been licensed for eight months has attended 180 births. She's very qualified to be a preceptor, but she can't until she's been licensed for two years. She explained that the required practices that they're trying to move into regulation were put into statute in 1985 because there wasn't a board and there were no regulations. Now that there's a very well-functioning board it makes sense to move those required practices into regulation so that the board can keep it up to date, she said. SENATOR OLSON asked if she was in favor of the legislation. MS. KANNE replied she was definitely in favor of the legislation. SENATOR OLSON asked if midwives have a requirement for continuing education. MS. KANNE replied the law requires 20 hours of continuing education per licensing period. SENATOR OLSON asked where a midwife can get continuing education. MS. KANNE said there's an annual midwifery conference in Juneau and there are a number of them held every year in other states. SENATOR OLSON asked if courses were available online. MS. KANNE answered yes. SENATOR OLSON asked if she had ever practiced in rural Alaska. MS. KANNE said she has practiced in Juneau for 30 years serving this community and all of Southeast Alaska. SENATOR OLSON asked if there were midwives in places like Klawock, Hollis, or Coffman Cove. MS. KANNE replied she wasn't aware of any. SENATOR OLSON asked to hear from the recently licensed midwife. 2:31:41 PM MADISON NOLAN, CDM, Juneau, Alaska, told the committee that she was an apprentice for three years and was licensed last September. SENATOR OLSON, noting that she had attended 180 births, asked if she feels qualified to be a preceptor. MS. NOLAN said she had only attended 40 births since she was licensed so she wouldn't qualify under the proposed 50-birth requirement. She added that for her personal comfort she'd want at least a year of licensure before becoming a preceptor. The time component isn't as important, but it does have some value. SENATOR OLSON said he'd like to hear from rural hospitals. CHAIR DUNLEAVY agreed. 2:33:42 PM CHAIR DUNLEAVY announced that he would hold SB 156 in committee for further consideration. Public testimony remained open.