AB 386 is a bill that will severely harm midwifery and home birth in Nevada. It proposes to create an oversight Board to regulate midwifery, and to establish a framework for mandatory state licensure. Midwives who fail to adhere to the requirements and regulations enacted by the Board could face civil and criminal charges. You can read the full text of the bill here: https://www.leg.state.nv.us/App/NELIS/REL/82nd2023/Bill/10315/Text
Save Midwifery In Nevada
by Lenny Sue Tinseth, of Alpine Midwifery
I’ve recently learned more about why Assemblywoman Daniele Monroe-Moreno chose to sponsor AB386, and it has been eye opening. Our stand against the bill has been falling on deaf ears - because the supporters of this effort have one focus, and it is a noble one. Their goal is to expand access to midwifery care for women of color and other marginalized groups. We know that midwifery care -and only midwifery care- produces better outcomes for these mothers.
The two midwives behind this bill are ultimately seeking to establish a centralized birth center in Reno which would accept Medicaid in order to meet this need that they see. In addition to establishing licensing, this bill would allow a state-licensed midwife to serve as the director of such a center. Current law already allows midwives to serve as directors of a birthing center if they are certified by certain nation-wide accreditation boards. This bill would expand who can be a birthing center director, for the price of creating mandatory state licensing.
Supporters of the bill may consider home-birth midwifery practices and the apprenticeship model as acceptable losses in this endeavor. But what about the rural Nevadan families they serve? They have abandoned one marginalized group for another. When the number of home birth midwives and students decrease, or they are pulled into the cities, rural access to care decreases.
The possibility of midwifery schools rising up, students coming to a birth center learning environment, and serving marginalized groups is exciting. Preceptors are few. Students can get their training fast and hopefully go directly into an apprenticeship. On the other hand, birth centers are only lucrative for their owners and administrators - not the midwives. Most students will need scholarships and financial aid, as the pay in birth centers is usually very low for midwives. The turn over is substantial. Birthing centers are a great place for older midwives to continue working without needing to travel and be on-call. They are a great middle-ground birthing plan for families that are not comfortable with home birth. But the midwives will not financially sustain the center. The families with financial resources and insurance will support the birth center. They will be the actual heroes serving the underserved.
I hope we can appeal to other members of the Assembly Labor and Commerce Committee who are concerned about small business-women, rural Nevada’s access to care, consumer choice, and allowing all models of training for midwives to exist without restrictions or conditions.
We can remind them that women of color and marginalized groups exist in rural Nevada as well. Everyone deserves the option of midwifery care. Currently, home birth midwives allow for Medicaid or what we would term "hardship" cases without laws or agencies requiring them to do so. Lawmakers should not deprive families by placing restrictions on students, which are unattainable to many.
Higher level education programs have not been proven to produce better outcomes. Requiring training that is unattainable in this state or is financially burdensome will lead many to exit the call. Experienced Midwives in Nevada are already few and far between, and they already travel far to provide care. They also cannot sustain a board to oversee them. Low-paid students are not a base the state can rely on to maintain a board (hence why students will be regulated in the law). Who will pay for it? Will they have to eventually capture the larger resource in Nevada - the traditional, spiritual, unlicensed midwife?
We must appeal to the larger picture. Don’t support one noble cause by the neglecting the care of others. There can be a way of serving all, maybe not perfectly, but admirably.
This is why we, as midwives in Nevada, oppose AB386. With the exception of the two midwives who are pushing this bill, all other midwives in the state of Nevada oppose this bill. If you agree with our stance and the industry consensus, please find AB386 on NELIS and vote against it in the public opinion poll. A comment is important, and they like personality in the comments.
Please also join us at the hearing on Monday, April 10th to oppose this bill. All are welcome to come and give a two minute statement. They do not like repeat statements, so if you feel led to be there and speak and agree with the person before; just say your name and then “ditto”. It counts! Emails, letters, and exhibits are all important. WE NEED THE VOTES ON NELIS by the 10th!! Please take the time. Ask everyone you know to vote.
We need no law or a better law for the future of all birthing Nevadans.
AB386 Public Opinion Poll: https://www.leg.state.nv.us/App/NELIS/REL/82nd2023/Bill/10315/Opinions