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Senate bill would enable midwives to continue providing ‘high-quality, low-cost maternity care’

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Texas has one of the worst rates of maternal mortality in the nation, as well as one of the highest rates of uninsured pregnant women, but Texas midwives are determined to change that.

A 2019 report for “PBS Newshour” said the death rate for new mothers was 14.6 for every 100,000 live births. For black women, it was nearly twice as high at 27.8 for every 100,000.

Laurie Fremgen, a longtime midwife and member of the Midwives Advisory Board, said a proposed law in the Texas Legislature can improve the chances that mothers survive to cherish and nurture their babies.

Fremgen supports SB 735, which would authorize licensed midwives to carry specific, life-saving standard of care medications without orders from a physician.

“The bill does not grant prescriptive authority or expand the scope of licensed midwives,” she said. “It does require specific training in pharmacology and grants TDLR rule-making authority over this training and in the use of the medications. Midwives provide high-quality, low-cost maternity care for low-risk women.”

Fremgen has been a licensed midwife for over 20 years and has served on the midwives advisory board for over 13 years. She chairs the Midwives Advisory Board at the Texas Department of Licensing and Regulation.

State Sen. Angela Paxton (R-McKinney) introduced SB 735, focusing on the administration of certain drugs by a midwife. A Health and Human Services Committee hearing was held on April 21; the bill remains pending. Fremgen and Association of Texas Midwives representative Brielle Esptein both testified before the committee on the bill.

Paxton said the “goal of this legislation is to expand the number and types of drugs a licensed midwife may access in order to care for a woman and her newborn before, during, and after the process of childbirth.”

SB 735 adds a new section to the occupations code that “outlines the specific drugs a midwife would be allowed to administer, including drugs that are focused on improving the standard of care for the mother and the newborn child that meet the applicable standard of care for a woman or newborn,” she said.

The legislation would also require licensed midwives to complete additional training and coursework in pharmacology and the administration of drugs.

During the committee hearing, 21 people testified or registered in favor of the bill while only five registered or spoke against it.

Fremgen said this proposed law would increase safety for mothers and their children.

“These medications are essential to the safe practice of midwifery and the protection of the mothers and newborns we serve,” she told Dallas Express. “Access to these medications allows families to choose their preferred location of birth and provider of choice without sacrificing safety. The COVID-19 crisis showed us that it is important for Texans to have access to multiple types of care providers in case hospitals are inundated with sick people or people are uncomfortable with rules imposed by hospitals.

“While midwives currently carry these medications with physician orders, it is becoming increasingly difficult for midwives to find physicians willing to write the orders. The ultimate goal is expanding access to high-quality midwifery care at a time when hospitals are closing labor and delivery units and many Texans, especially in rural areas, lack access to maternity care. There are over 100 counties served by midwives but these counties do not have an obstetrician.”

The medicine that midwives would be allowed to use is not extensive, but, Fremgen said, they are crucial.

“The list is very short — anti-hemorrhagic drugs, Vitamin K for newborns, Rhogam for Rh negative women, IV fluids, and lidocaine for local anesthesia in emergencies,” she said.

Research continues to pour in about the benefits of the midwifery model, Fremgen said.

“A recent report by the Aspen Health Strategy Group highlights the opportunity for midwives to help reduce racial and ethnic disparities in maternity care and assist in the fight to reduce maternal mortality,” she said.

On Page 20, the report recommends that “(s)tates should review and, if necessary, revise their midwifery professional licensing and scope of practice laws to maximize midwives’ ability to provide services commensurate with their training.”

In addition, a report from The Centers for Medicare & Medicaid Services on the Strong Start program in midwifery-attended birth centers shows improved outcomes in multiple categories and reduced racial and ethnic disparities.

Home births are on the rise, as concerns about COVID-19 access issues closed maternity wards to provide more space for Covid patients, insurance issues and government-imposed restrictions persuaded expectant mothers to consider giving birth in their homes or in birthing centers.

“The midwifery model of care provides family-centered, individualized care,” Fremgen said. “Midwives look at the individual and tailor care to the client’s needs. In addition to standard clinical care, midwives focus on nutrition, lifestyle, and social, emotional and spiritual health.

“The midwifery model seeks to empower the pregnant person to become educated about tests and procedures and make the best decisions for them as an individual,” she said. “In addition, high-quality, low-tech care can reduce unnecessary intervention saving billions of dollars a year in health care costs. Professor David Anderson of Centre College has written on this subject and has some shocking numbers on the cost savings if out of hospital births attended by midwives increased from 1% to 5% or 10%.

This issue hits home for Texans, Fremgen said.

“It is a personal freedom issue — for the families who choose midwifery care and for the midwives to freely practice their trade,” she said. “As George W. Bush said in his governor’s proclamation on May 5, 1995, Midwives’ Day: “Midwives have helped Texas women and children throughout Texas history. They provide a childbirth option which continues to be the choice of thousands of Texas women … Texas Department of Health data show that midwifery is a safe health care alternative for women with normal pregnancies and that midwives have the lowest incidence of low birthweight babies of all types of obstetrical attendants.

“The World Health Organization has noted the impact that midwifery care has on decreasing the rate of infant mortality. The Association of Texas Midwives is dedicated to promoting high standards of midwifery practice and improving birth outcomes in our state.”

Fremgen is optimistic the bill will emerge from the Senate Health and Human Services Committee in the Senate.

“We believe there is an excellent chance that we can pass out of committee,” she said. “We have a passionate consumer base that will do whatever is necessary to preserve midwifery and out-of-hospital birth.”

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