Access to Certified Nurse-Midwives in Wichita Hospitals

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Since July 1, 2016 there have been no Certified Nurse Midwifes (CNM) with privileges at the Wichita hospitals. The Wichita Birth Alliance has been concerned about the lack of CNMs practicing in Wichita since the fall of 2013. Topeka and Overland Park hospitals, which have fewer births, have several CNMs practicing. CNMs within both the Ascension Health System and HCA system do not have the practice restrictions that the Wichita hospitals have.

CNMs are licensed as Advanced Practice Registered Nurses (APRNs) in Kansas and a signed collaborative agreement is necessary to practice. To practice at a hospital, CNMs need a physician sponsor. In 2009, supervision was removed from the APRN statutes. K.S.A. 60-11-1-1 states: “Each APRN shall be authorized to make independent decisions about advance practice nursing needs of families, patients, and clients and medical decisions based on the authorization for collaborative practice with one or more physicians. This regulation shall not be deemed to require the immediate and physical presence of the physician when care is given by an APRN. Each APRN shall be directly accountable and responsible to the consumer. “

Performing uncomplicated vaginal deliveries of term, low risk patients is well within both CNMs clinical and legal scope of practice under Kansas law and American Midwifery Certification Board national certification

The Wichita hospitals have declined to update their medical staff bylaws to remove the requirement for direct supervision of CNMs for normal births. No other hospital in Kansas requires the physical presence of a physician for normal, uncomplicated birth by a CNM.

Both Wichita hospitals have a physician in the hospital 24 hours a day to respond to labor emergencies and unattended deliveries. The practice that employed the one CNM with hospital privileges ended that relationship in June 2016. They cited the requirement for physician attendance at CNM births as one of the factors influencing their decision.

The American College of Obstetricians-Gynecologists (ACOG) is also in support of midwives practicing independently and with accountability as allowed by state law. According to the 2018 Joint Statement of Practice Relations Between Obstetrician-Gynecologist and Certified Nurse-Midwives/Certified Midwives, “Ob-gyns and CNMs/CMs are experts in their respective fields of practice and are educated, trained, and licensed, independent clinicians who collaborate depending on the needs of their patients. “

Several CNMs have been unable to find employment in the Wichita area due to this issue. Four nurse-midwives are currently practicing in the area, but unable to attend births.

Wichita women are limited in their ability to access midwifery care for hospital births. According to a report published by The American College of Nurse-Midwives, women cared for by CNMs compared to women of the same risk status cared for by physicians had:

o Lower rates of cesarean birth

o Lower rates of labor induction and augmentation

o Significant reduction in the incidence of third and fourth degree perineal tears

o Lower use of regional anesthesia

o Higher rates of breastfeeding

Source: Midwifery: Evidence-Based Practice, ACNM, 2012.

We ask the Wichita hospitals, Wesley Medical Center and Via Christi Health, to remove barriers that prevent CNMs from practicing to the full extent of their education and training. The restrictions to CNM practice limit women’s access to care by midwives for hospital births.

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