Licensed Direct Entry Midwives Adopt New Rules

The rules, which took effect January 1, are intended to improve birth outcomes, and the relationship between the pregnant woman and the midwife
January 13, 2011 -- Licensed Direct Entry Midwives (LDMs) in Oregon have new rules to follow. After more than a year of reviewing regulatory requirements, the Board of Direct Entry Midwifery adopted important revisions to Oregon Administrative Rules
Specifically, they changed (OAR) Chapter 332, Divisions 015-030 by adding new sections with requirements related to informed consent and risk information, standards and objectives of professional conduct, a procedure for terminating midwifery care and statistical reporting. The new rules went into effect January 1. 
"It's been a long, sometimes difficult journey, but ultimately a productive one," said Board of Direct Entry Midwifery Chair Melissa Cheyney, PhD. "We believe we have been as thorough as possible and considered all available evidence and perspectives in developing these revised rules."
Prior to the changes, LDMs were required to provide clients with a disclosure form that included information about:
  • Philosophy of care
  • Training and education
  • Clinical experience (births attended)
  • Services provided to clients
  • Types of emergency medications and equipment used
  • Responsibilities of the mother and family
  • Fees for services including financial arrangements
  • Malpractice coverage (not required to hold but must inform client of coverage status)
Now, licensed midwives must also include risk assessment criteria listed in OAR 332-025-0021 as part of this disclosure statement. In addition, OAR 332-025-0028, a new section, institutes expanded informed consent requirements for vaginal births after cesarean (VBAC), malpresentation (also called a breech birth), multiple gestation (twins), and post-date (exceeding 42 weeks gestation) births.
Under the revised rules, licensed midwives must explain and document that the mother to-be understands the type of birth, the advantages of delivery by a licensed midwife, any potential negative outcomes, alternative procedures and associated risks.
Another administrative rule change deals with providing statistical information on birth outcomes, transports from the home to hospital settings, and specific data on certain birth types such as VBAC, breech and multiple gestation.
The Oregon Health Licensing Agency (OHLA) and the Board of Direct Entry Midwifery now require licensed midwives to electronically submit data on every mother and baby into a database, MANAstats, which is managed by the Midwives Alliance of North America. Under the new rule, licensed midwives must begin submitting such data for each mother who begins care on June 1.  
Reviewing and revising the regulatory requirements for licensed midwives was a lengthy process. In addition to monthly meetings and countless hours of consideration, the Board also received an overwhelming volume of public comment during the public rulemaking process. OHLA extended the written comment period by 30 days after a public rules hearing on October 28.
"I applaud the time, effort, and expertise of board members, agency staff and numerous stakeholders who may not have always agreed but who understood that this review process was necessary," said OHLA Director Randy Everitt.
In addition to soliciting public feedback, OHLA and the Board obtained the help of four external subject matter experts to review the changes and make recommendations.
"Our goal was to establish more specific parameters, particularly regarding informed consent and during transfer of care," Cheyney explained. "We believe these steps will improve not only birth outcomes but also the midwife and client relationship and interaction between midwives and other care providers"
Another less controversial change involved the license and renewal fees for LDMs. The application fee for new applicants was reduced from $500 to $150 and the licensing fee from $1,900 for two years to $630 annually. The Board reduced the fees in response to feedback that the former fee structure was the primary barrier to licensure.

For more information

Permanent rules effective January 1 were filed with the Secretary of State and posted to


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Requiring reports regarding patients will drive some patients to do it themselves. Just saying. Oregon women are an independent bunch, some of us. We do not wish to visit MRSA-ville unless it is absolutely necessary, from our own point of view. Expecting anyone official to herd us there has the potential to backfire from the point of view of the herders. Client-centered care seems to me to have a long way to go in Oregon, though I acknowledge Oregon is better than other states by some ways of measuring.

I think that this is a great idea. I think that it would be to the midwife's advantage if she/he could present their birth stats from a objective source. It would really increase their credibility, and increase the public's confidence in their skills. If the women chooses to deliver indep without the assist. of any medical personnel at all that is truly their choice, and they will have to deal with the consequences of their decisions. Just note that in yester year, childbirth was the number one cause of death in young women.