Tuesday, July 3, 2018

#TXLEGE: Trib's Midwives Article Illustrates Need for Medical Scope of Practice Reform

"Dishonest scales are an abomination to the Lord,
But a just weight is His delight."
Proverbs 11:1

The Trib has a long article today about the role midwives could potentially play in alleviating Texas' maternal mortality challenges.  The whole thing is worth taking 15 minutes to read.  But here's the relevant section for policy:
In Texas, midwives must have oversight from a doctor before they can see patients, and physician groups around the country have lobbied state legislatures to block bills that would give midwives more autonomy, claiming they don’t have the required skills to handle high-risk pregnancy complications like postpartum preeclampsia or hemorrhaging.

In the United States, midwives can provide women with services such as contraceptive and nutrition counseling, prescriptions and labor and delivery care. They try to help women have low-risk pregnancies by assessing their health and making sure they can safely give birth outside of the hospital. They also help women prepare for natural births — giving birth without being induced or needing a cesarean section.

The American College of Nurse-Midwives has touted the benefits of midwifery, including reduced rates of labor induction, reduced use of anesthesia, lower costs for both clients and insurers and increased satisfaction with quality of care.


Kelli Beaty, executive director for the Association of Texas Midwives and a midwife in Midland, said most midwives believe Texas is a good place to practice but “there’s not a lot of mutual respect” between doctors and midwives. Building relationships with doctors can be difficult since many are not homebirth friendly, are wary of midwifery in general and territorial about the type of care they should be allowed to provide patients.

“There’s not a lot of integration,” Beaty said. “There’s a lot of areas in Texas that have populations that exceed the physician availability, so people are beginning their pregnancy care later and later ... there could be midwives who could fill in the gap.”

Licensed midwives in the state have also expressed exasperation about a 2015 legislative change that moved them from being regulated by the Texas Department of State Health Services to the Texas Department of Licensing and Regulation — the same agency that oversees laser hair removal businesses, electricians, podiatrists and tow truck operators. Midwives complain that the agency doesn’t have the expertise to properly oversee them, particularly when it comes to understanding various medical terminology. Certified nurse midwives are overseen by the state’s Board of Nursing.

Beaty said the Texas Department of Licensing and Regulation and midwives are beginning to work together to address some of those concerns. The agency held a series of listening sessions for midwives in recent months and is working on changes to licensing and the complaint review process.
Followed, of course, with the same 'health and safety' drivel you always hear:
Moss Hampton, chair of the Department of Obstetrics and Gynecology at Texas Tech University Health Sciences Center in Odessa, said he doesn’t “want to sound like I’m bashing midwives” because he believes they have a place in maternal health care.

But he said midwives don’t have the same level of training for independent practice as doctors and should have more clinical training. Licensed midwives must have at least a high school diploma or GED, take midwifery courses and complete a clinical apprenticeship. They then have to pass the North American Registry of Midwives exam to be licensed in Texas.

“There's just situations where the midwife maybe thinks it's better to do it one way than the obstetrician,” Hampton said, adding that doctors are typically the caregiver that gets sued if something goes wrong with a birth. “If the liability was spread equally, I don’t think people would be quite as concerned, but the obstetrician is responsible for the situation if something bad happens ... I think that’s where people get concerned.”
We've written before about "Scope of Practice."  The short version is that you allow non-physician medical personnel (eg. Nurse Practitioners, Midwives, and Physician assistants) to perform routine medical procedures that are currently restricted by law to licensed physicians.  This increase in the supply lowers costs while freeing up licensed physicians to care for genuinely medically serious patients.

The problem, unfortunately, is the so-called Texas "Medical" Association.  As stated above: Increasing medical providers decreases the cost.  The Texas "Medical" wants high health care costs.  That's how a cartel makes its money.

Meanwhile, Texas' politically induced shortage of health care providers (including midwives) continues; this is especially a problem in rural areas.

Bottom Line: This is a textbook example of an incumbent industry using the force of government to restrict competition....

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