Proposed Texas Legislation 2021

It seems like it has always been legal to practice midwifery in Texas.  Before it was part of the United States of America, the Spanish Governor of Texas licensed midwives as early as 1806. Even as late as 1900 more than half of the births in the state (and in some counties more than ⅔) were attended by midwives. 
In 1956, the Texas Court of Criminal Appeals found that, as childbirth was “a normal function of womanhood,” it did not fall under the statute definition of practicing medicine (which would be the treatment of “disease, disorder or deformity”). Granted, we know these days it is not just women who give birth. Still, it is a reasonable recognition of childbearing as a physiologic function in court precedence.  
So, you’d think current Texas midwifery law would be more progressive.  We have leniency when it comes to twins, VBAC’s and breeches, but we have no formulary without a physician’s standing delegation orders.  Meaning that unless an independently practicing physician is generous enough to sign and annually update delegating access to medications and devices, we midwives in Texas, have no legal access to pitocin, methergine, misoprostol, vitamin K, IV fluids, or antibiotic prophylaxis for GBS, etc.
 I’m not going to preach to the choir about how important access to anti-hemorrhagics can be in community birth practice.  I love herbs and use them regularly in my home and my practice.  When a birthing person is bleeding, I, personally, want access to pitocin. In rural areas, where EMS arrival times are longer, it can save lives.  Standing Delegation Orders need to be signed and updated annually.  A physician who works in a group practice won’t be able to sign them without their colleagues’ approval as all their malpractice insurance is tied together.  Lucky is a midwife who can create a relationship of trust with a physician and be able to earn enough trust. Many physicians will charge a fee.  Considering that they are placing a trust in other practitioners, a fee can be a reasonable expectation, but also another financial obstacle to practice 
The pandemic has alerted us to all kinds of medical workforce shortages, causing some practitioners to come out of retirement and some licenses to be expanded. Folks are having trouble getting regular appointments, and those with chronic illnesses are having difficulty keeping up with their treatments. 
 In February of this year, Representative Stephanie Klick (R), introduced HB 2029.  This bill would give Advanced Practice Registered Nurses an expanded scope of practice to include prescriptive privileges and interpret diagnostic tests. By definition, this would include nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists. Over 30 other states have similar legislation which would expand access to care.  For maternity care, it means greater independence for nurse midwives.  While it is part of their education and training, only nurses who work under doctor’s orders can prescribe medications for devices.  If HB 2029 and it’s sister bill SB915 (which are identical) both pass in the House and the Senate, nurse midwives would have an easier time in independent practice providing well woman and maternity care.  This could also benefit the Licensed and Certified Professional Midwives who work with them.  
To be clear, this bill would not give nurse midwives the ability to delegate standing orders to licensed midwives, only that if they work in the same practice the licensed midwife could administer the prescribed treatment.   In the long term, it could open a door for licensed midwives in Texas to get their own formulary without a physician’s delegation. 
The bill is currently pending in the Public Health Committee and could stay there without moving this entire session. Updates are posted on Texas Legislature Online. It is supported by Texans for MidwiferyTexas Nurse Practitioners, Texas Association of Health Plans, and Every Texan. The bill is opposed by the Texas Medical Association, who sent out 4 physicians to give testimony when the bill was open for discussion on March 24th. If you are in Texas, please call/email your representative and tell them your thoughts.
Yesenia Guzman,
Director of Professional Development

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