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A bill before the North Carolina Senate provides a good example of how politics usually is done in the Tar Heel State, and it also offers an opportunity — with a few tweaks — for Republicans in control of the General Assembly to chart a new path.

The bill is S.B. 106, the Home Birth Freedom Act. The companion bill is in the House. The intent is to legalize independent midwifery* in North Carolina, one of a handful of states left not to allow it. As presently drafted, however, the bill would do so through the creation of yet another occupational licensing board, which would be called "The North Carolina Council of Certified Professional Midwives."

The bill would do the following:

  • State several findings in support of allowing the practice of midwifery in North Carolina, and define terms
  • Require people who practice midwifery in North Carolina to be licensed beginning in 2014
  • Establish the North Carolina Council of Certified Professional Midwives and list its powers and duties
  • Establish the requirements for licensure as a professional midwife in this state
  • List the responsibilities of a certified professional midwife
  • Establish the guidelines for license renewal, inactive status or lapsed license, and reciprocity
  • Establish guidelines for fees, salaries, compensation, etc. set by the council
  • Establish reasons for suspension, revocation, and refusal to renew licenses
  • Handle other matters such as third-party reimbursement, illegal practices, and vicarious liability

The main issue with the bill is this: Why should allowing midwifery in North Carolina require establishing yet another state licensing board?

My recent report "Guild By Association: N.C.’s Aggressive Occupational Licensing Hurts Job Creation and Raises Consumer Costs" makes the case for significantly cutting back on occupational licensure in North Carolina. We are already one of the most aggressive licensing states, with 50-plus boards licensing (depending on how they’re counted) 154 occupations. Just crossing the state line into South Carolina cuts the number of state-licensed occupations by two-thirds. Licensure drives up costs to consumers, harms job creation, and creates a protected class of professionals.

"Without state licensure, who would ensure safety and quality?" the study asks. Here is the answer: "Private providers of reviews and certification, Internet sites and consumer applications, social media, and competitors and market forces. The government would still enforce safety and quality through the courts system."

With that background, here is how this bill could chart a new path for bringing in occupational freedom to North Carolina with respect to midwives: Strike out everything to do with state licensure and a new licensing board.

Keep the findings in support of allowing midwifery; they are important. Strike the licensure requirement. Strike the creation of the licensing council.

Here is the key: the bill’s requirements for licensure would include the applicant having obtained certification from the North American Registry of Midwives (NARM) and be titled a certified professional midwife. It would also have the applicant obtain certification in cardiopulmonary resuscitation (CPR) and neonatal resuscitation. Such certification does not need a state licensure board to validate it.

Furthermore, the responsibilities listed in the bill for a licensed midwife — e.g., providing care, providing informed consent forms, ordering routing antepartal or postpartal screening or laboratory analysis when necessary, on down to maintaining a birth certificate for each birth in accordance with state requirements — could just as easily be the legal responsibilities expected of certified professional midwives without state licensure.

So retain the NARM, CPR, and neonatal resuscitation certification, as well as the responsibilities for certified professional midwives. Then strike the rest of the bill that deals with licensure matters, preserving the final segment that protects health care providers from vicarious liability for acts of omission or commission by certified professional midwives.

The legislature would be wise to allow greater freedom for home birth in North Carolina — and that would necessarily include freedom from state licensure when even the legislation that would establish it recognizes the importance of outside certification.

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* As opposed to what is currently allowed: certified nurse-midwives "under the supervision of a physician licensed to practice medicine who is actively engaged in the practice of obstetrics" per the Nurse Midwifery Law.