I have been a Licensed Midwife in Virginia for nearly 13 years. I served on the Midwifery Advisory Board from 2014 to 2021, and I serve as Vice-Chair and Director of Professional Development for the North American Registry of Midwives (NARM), the organization that administers the CPM credential. I own two accredited freestanding birth centers where our Licensed Midwives have served over 2000 families for home and birth center births. Most births go well, but there are times when our training to provide first-line management of common complications is needed. As CPMs, we have the knowledge and skills needed to administer medications that can prevent or help manage life and death emergencies. It is frustrating for us to essentially have to practice with our hands tied when it comes to the medications we need for managing complications.

Our law in Virginia does not reflect our scope of practice as defined by the North American Registry of Midwives' Job Analysis (the blueprint for the NARM Exam and the list of skills requiring verification of competency by NARM Registered Preceptors). This law is outdated and adds unnecessary risks for community birth. There is only one other state (Arkansas) that licenses midwives yet restricts them from accessing these medications. Providers should be able to work within their full scope of practice.

The March of Dimes states that 47% of Virginia counties are Maternity Care Deserts. Maternity care deserts are areas where there is limited or no access to maternity health care services. Maternal mortality in the United States is higher than in all other industrialized countries, and postpartum hemorrhage is the leading cause of maternal mortality worldwide. Postpartum hemorrhage requires quick action to prevent severe maternal morbidity and mortality. It is unconscionable to withhold access to life-saving antihemorrhagic medications for any maternity care provider, but it is especially important given the maternity care desert situation in Virginia. 

If families want injectable vitamin K or erythromycin eye ointment, they need to go to the hospital to get those within the recommended time parameters. This creates unnecessary strain on already struggling hospital systems. It is unnecessary to burden hospitals with the responsibility of providing basic medications that could safely be administered outside the hospital setting. Families have to jump through unnecessary hoops to access the medications that make birth safer. Some must self-administer medications while their Licensed Midwife stands by, unable to assist them due to this outdated law. Some women have to endure the pain of being sutured without the use of a local anesthetic or choose to risk permanent damage to their bodies by not having those lacerations repaired properly.

It is time to support Virginia Licensed Midwives and the people they serve. This outdated law needs to be changed to reflect the current scope of practice of Licensed Midwives, and Virginia families deserve these life-saving medications wherever they choose to give birth.