Despite New Law, Midwives May Still Need Practice Orders to Practice Safe Medicine

The Midwifery Modernization Act has now become law as of last Friday. Although many previously thought that it would give midwives an increased ability to independently practice, it may not do anything at all unless midwives open their own independent practices. The law abolishes the previous requirement that midwives obtain a written practice agreement to operate independently without the need to have an obstetrician's or a hospital's signature. While the passage of the law was heralded by midwives, as they believed that it would allow them more control over their practices, local hospitals and practices have now indicated that they  will not change their requirements that all midwives obtain practice orders. This will prove an obstacle to midwives that may need to utilize hospital facilities.

For example, according to The Glens Falls Hospital by-laws, midwives must be employed by a physician practice to be granted hospital privileges. There is no indication that the hospital will change their by-laws unless absolutely required by law. This is unlikely, as the law only abolishes practice orders as a legal requirement; it does not state that they are prohibited completely. Dr. Douglas Provost, of Glens Falls Obstetrics & Gynecology Center, who has indicated his opposition to the law, stated that the passage of the law will not change the Center's requirement that midwives employed there obtain a practice order. According to Provost, the new law now states that midwives "can be independent, but they don't have to be independent". 

Many obstetricians opposed the act because of the concern that when complications during birth arise, midwives will need the help of physicians, yet be without medical malpractice insurance. The new law will now cause problems of what midwives will do with expectant mothers that are in emergency need of a Ceasarean Section, but do not have a practice order to work along side a doctor at the local hospital. Some hospital officals say that midwives may need to just drop off their patient at the emergency room and hope for the best in times of emergency.

As I wrote in an earlier blog, the new law is much to do about nothing for midwives that do not intend to go into private practice. Midwives that are employed by local hospitals or wish to have hospital privileges will still need to obtain practice orders, and midwives that have never even heard of practice orders and have never needed to obtain them can go on about business as usual. However, problems may arise in emergency situations where expectant mothers need the help of a physician, but the midwife has not made any arrangement to obtain a practice order from a hospital that requires it. Therefore, the only people that this new law really may affect is those patients that choose to go to a midwife in private practice that has not prepared for worse-case scenerios and made arrangements with the local hospital. My hopes are that although many midwives think that this new law gives them more power, they will take extra steps to safeguard their patients, swallow their pride, and still obtain practice orders in anticipation of any emergencies to ensure that there will be no problems if hospital services are needed.