Here is a story from a Virginia Licensed Midwife who has experienced the frustration of the current law restricting LMs from using the medications within their scope of practice. As she points out, much of Virginia is rural, and there are many families who live far from hospitals where emergency medications can be administered. Licensed Midwives are on the front lines for these families and need the support to provide the best first-line response when there is a medical emergency. This midwife also points out the barrier of cost for people who have Medicaid.
Here in the state of Virginia licensed midwives are restricted from administering life saving medications in the out of hospital settings regardless of the fact that we are trained to administer things like: oxygen, iv fluids, anti hemorrhagic medications, rhogam, vit k and antibiotic eye ointment for newborns. While some midwives like myself have been able to establish collaborative arrangements with prescribing physicians in order for their clients to have these important medication prescribed that to them and available to them at the birth site, under the current laws we are unable to administer them. In these situations, where a prescribing provider provides the prescriptions for these medications, midwives are forced to hired registered nurses in order to administer these medications. These kinds of arrangements are a huge work around. And since insurance companies often do not cover the cost of midwifery care in the out of hospital setting, many of these families cannot afford the added cost of going to a prescribing provider. One of the biggest obstacles I have found in my practice in terms of gaining access to these life-saving medications is that my Medicaid clients could not afford to see the prescribing providers. It is simply time for the state of Virginia to grant accessibility for licensed midwives to carry and administer these life-saving medications. While we very rarely need to use these types of medications in the out of hospital setting, when there is a need for them the clients must have them. Our state is behind the times in terms of granting licensed midwives who provide care and specialize in the out of hospital setting access and administrating rights to these medications. As a result of these out dated laws, our state has taken to persecuting licensed midwives for the skill and knowledge of which we are trained. As a licensed midwife here in the state of Virginia I am begging for the medical board to consider granting us the ability to carry and administer these medications. Women and families all over our state are seeking out midwives in the out of hospital setting in droves. Because of the high morbidity and mortality rates in our state inside of the hospital settings of labor and delivery, they are looking for more individualized care. Not only this, but our state of Virginia does not have very many metropolitan areas. The vast majority of the state of Virginia is rural. We have huge communities of Mennonite and Amish who will choose to birth alone without prenatal care or a trained birth attendant if there is none available. It is within the state's best interest to allow licensed midwives who practice exclusively in the out of hospital setting to gain access to these important medications and to administer them in which we were trained which is solely for emergency situations. Things like vitamin K in rhogam and antibiotic I ointment, these things are important medication that all birthing people should have access to without the hassle of seeing multiple providers. Please look at the other states that are granting licensure for licensed midwives. Our laws in terms of the administration of these medications are very outdated. I am begging the state of Virginia board of medicine to grant licensed midwives access and change these laws so we can practice safely and responsibly.
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