Midwives in Alaska are speaking out against a plan from Gov. Mike Dunleavy to dissolve the board that governs their profession. The executive order dissolving the midwife board is one of 12 that the governor submitted in January to the Legislature.
Mary Yanagawa, a direct-entry midwife and former president of the Midwives Association of Alaska, said the board is critical to the profession and patient care.
“The states where families can have the best options for midwifery care are states that are licensed, and they have a board made up of peers, and that board oversees regulation and scope of practice,” Yanagawa said.
According to research from Yale, midwives generally improve the care the mother and baby get during a pregnancy and at birth; there are fewer preterm births, cesarean sections and deaths.
Board certification is required in order for midwife work to be covered by insurance. To be reimbursed by Medicaid, which serves low-income Alaskans, midwives said they must be certified by a board of their peers.
If the board is dissolved, it’s unclear how certification would work. The responsibilities of the board would be transferred to state employees. Yanagawa said it’s hard to imagine how that would work, since the state is already struggling to support the board.
Direct-entry midwives study midwifery without first becoming a nurse. Their training is a combination of education and apprenticeship and they generally facilitate births outside hospitals. Because of that, they work with lower-risk pregnancies. And Yanagawa said they must have a plan in case someone needs to move to a higher level of care.
Yanagawa said decades ago, midwives went to Juneau to advocate for licensing. She said dissolving the board is a step in the wrong direction.
“They advocated to have a board, they advocated to get insurance reimbursement,” Yanagawa said. “And many states in the Lower 48 still don’t have licensure, they still don’t have a board, but they’re all fighting for it.”
A spokesperson for Dunleavy wrote in an email that the executive order “eliminates duplication of functions and provides a single point of responsibility for the licensing and regulation” of direct-entry midwives. That’s similar to the rationale the governor provided for 11 other executive orders largely aimed at reconfiguring boards and commissions.
In February, midwives, doulas and low-income mothers spoke to a senate committee about their concerns if the board is dismantled. The senate took an early step toward rejecting some of Dunleavy’s proposed executive orders on Feb. 11, including the order dissolving the board for direct-entry midwifery.
RELATED: A dozen executive orders from Gov. Dunleavy draw scrutiny
Rachel Cassandra covers health and wellness for Alaska Public Media. Reach her at rcassandra@alaskapublic.org. Read more about Rachel here.
