One of the greatest barriers to the practice of nurse-midwifery in the state of Indiana is the requirement of a written collaborative agreement to prescribe legend drugs. This collaboration is not specific to the practice of midwifery. In fact, a physician of any speciality can sign such requirement so this isn’t about true collaboration, but rather an attempt to restrict the trade of midwifery.
Dr. Kathryn Osborne states in her (2011) article published with the Journal of Midwifery & Women’s Health, “The ability of midwives to dispense, administer, or in any way furnish medications for their patients is central to the provision of health care to women but has long been fraught with controversy and challenges” (p 543). The history of midwifery provides tales of midwives burnt at the stake because those in authority feared their power, especially because many mastered the therapeutic use of herbs and oils. Arguments point towards feminist inequality, religious corruption, or social class structuring but no matter the cause, the practice of midwifery has always been oppressed and continues to be today.
The profession was introduced to our country in the 1920’s by Mary Breckinridge, the mother of the Frontier Nursing Service, of which I am a proud alumni. Nurse-midwives, since the onset, have been more than birth attendants but also primary care providers. Osborne points out in her article that with the integration of the Patient Protection and Affordable Care Act (ACA), more primary care providers will be needed to meet the need of the growing insured population making it “crucial for clinicians and policymakers to remain aware of regulatory requirements for all health care providers and to move forward with modification of current laws that pose barriers to practice and limit patient’s access to primary care providers” (2011, p 543).
Certified nurse-midwives have been granted authority to write prescriptions in all fifty states and the District of Columbia, yet that regulation varies greatly from state to state. Ideally, advance practice nurses would have independent privileges to prescribe pharmaceutical medications and the rules and regulations would be consistent across the nation. However, in reality most states present rules and regulations that further create barriers to prescription privileges such as requirements for the number of hours in clinical practice, continuing education, quality assurance, notification of the regulatory board regarding a change in consulting physician, and recertification/certificate maintenance (Osborne, 2011).
Certified nurse-midwives provide primary care for women, “including the provision of all essential elements of primary care and case management: evaluation, assessment, treatment, and referral as necessary. Prescribing medications in an essential component of the treatment of patients” (Osborne, 2011, p 554). Limiting the ability of the advance practice nurse to prescribe is nothing less than limiting access of necessary care to consumers and a restriction of trade for our profession (Osborne, 2011).
Indiana State Board of Nursing. (2011). Retrieved from http://www.in.gov/pla/nursing.htm
Osborne, K. (2011). Regulation of prescriptive authority for certified nurse-midwives and certified midwives: a national overview. Journal of Midwifery & Women’s Health, 56(6), 543-556.