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Licensure is limited to CNMs and CMs in Rhode Island.
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Rhode Island has one of the oldest midwifery laws on the books. Simple and straightforward, the statute itself encompasses direct-entry midwives. However, as the health care system has changed, the rules and regs for this statute have been amended in ways that effectively deny women and families access to attended out-of-hospital birth.
First the rules and regs were changed to provide expanded privileges for CNMs or nurse midwives, a good move. In the process, however, the regulatory board also added the word, "equivalent," to define the educational and certification qualifications for licensure of direct-entry midwives. Certified nurse midwives are required to have evidence of a relationship for collaboration, consultation or referral with a physician (June 2002).
Because the Board interpreted "equivalent" as "the same as," only midwives who completed an ACNM-recognized educational route were acceptable for licensing. In addition, nurse-midwives were also essentially eliminated from out-of-hospital birth settings, because getting the required relationship with a doctor or obstetrician is nearly impossible.
The result? The state effectively closed off access to the maternity care providers most qualified through education and training to provide such care in out-of-hospital settings. Fortunately, however, Rhode Island has a regulatory culture that allows for amending the rules and regulations on an almost annual basis.
In June 2002, rules and regs changes were passed despite hastily mobilized pro-midwifery and homebirth testimony and letters. The changes deleted the word "equivalent," but made only CNMs and CMs eligible for licensure. In fact, the new rules simply made explicit what was already happening --that the state would not consider licensing any midwife not educated and credentialed through the ACNM. And while "supervisory" was changed to "collaborative," the doctors with whom CNMs collaborate can and almost certainly will still prevent them from attending out-of-hospital births. Malpractice insurance is also a significant barrier in its price and availability to CNMs.
Now that the door is completely closed, midwifery advocates have both the opportunity and the challenge of organizing to change the rules and regs so that at least Certified Professional Midwives (CPMs) can be licensed.
A big "thank you!" to Michelle Gemma, a CNM with roots in the Amish tradition of home birth, who contacted DEMs and activists when the changes were proposed, giving people a chance to be heard.
While midwifery activism was unsuccessful this time, the crisis has spurred activists to organize! Rhode Island now has a fledgling Friends of Midwives group. For more information, see information below.
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American College of Nurse-MidwivesRhode Island Chapter , RI Rhode Island LiaisonContact: Michelle Palmer POBox 209 Charlestown , RI 02813 Phone: 401-364-0490 CfMRIContact: Laura Taylor PO Box 1017 Chepachet, RI 02814 Phone: 401-231-4926 |
University of Rhode Island, RI |
Click Here For Full Details!
Link to ACNM for
Information on Certified Nurse Midwives
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