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OHLA @ 10 Years: Direct Entry Midwifery
Regulation provides choice, protection of mother and baby
Midwife
Rather than prohibiting the practice of midwifery, as some states have done, Oregon has allowed midwives to practice while overseeing voluntary licensure establishing health and safety standards.
 
Unlicensed midwives may legally practice in Oregon without being held to those health and safety standards.
 
The Oregon Health Licensing Agency (OHLA) and the Board of Direct Entry Midwifery continue to explore how best to ensure the health and safety of mothers and infants, either through existing voluntary licensure, or through a range of other potential options, from mandatory licensure to informed consent requirements.
 
Communication of existing regulation as well as potential changes to regulatory oversight of both licensed and unlicensed midwives is a key factor to inclusive and effective decision-making that incorporates all perspectives.
 
The goal is to enable consumers to make an informed decision when selecting a provider and to eliminate potential consumer confusion over a provider’s licensing status and accountability.   Under current law, unlicensed midwives, including those who are no longer licensed due to practice standard violations, may continue to practice without being held to national or state standards as licensed midwives. 
 
Licensure holds practitioners accountable to core competency standards and requires compliance to absolute and non-absolute risk criteria, professional practice standards and conduct, safety and infection control requirements and emergency transport and medical backup plans.

Central Issues in Direct Entry Midwifery
Sherry Dress
Sherry Dress, Board of Direct Entry Midwifery 2009 Chair
  • Updating Two-Tiered Voluntary Licensure:  To strengthen consumer protection and awareness for women utilizing out-of-hospital providers, OHLA and the Board of Direct Entry Midwifery are exploring potential options, from mandatory licensure to informed consent requirements enabling consumers to make an informed decision when selecting a provider.

  • Safety of Out-of-Hospital Births:  OHLA and the Board of Direct Entry Midwifery continue to review standards established to safeguard the health and safety of mothers and infants in out-of-hospital deliveries. Midwives predominantly deliver babies at the home of the mother or at birthing centers.

  • Partnering with Hospital-based Providers:  Midwives work with other care providers, many of whom are hospital-based, in the course of providing midwifery services.  OHLA and the Board of Direct Entry Midwifery want to foster open communication and cooperation between midwives and hospital-based providers.

Regulatory Timeline
1993
The Oregon State Legislature establishes voluntary licensure of midwifery and third-party reimbursement through medical assistance programs for licensed midwives.  Legislation also creates the Board of Direct Entry Midwifery within the Health Division.
                                              
2001
Legislation allows licensed midwives to purchase and use certain legend, or prescription, drugs and devices for use in providing services for pregnancy, birth, postpartum care, newborn care and resuscitation.
 
2004
OHLA and the Board of Direct Entry Midwifery serve on a Department of Human Services (DHS) task force to review risk factors involved in birth center deliveries.  The task force recommends changes to better protect mothers and babies when births are in non-hospital settings such as birth centers and private homes.
 
2008
OHLA and the Board of Direct Entry Midwifery propose legislation to assist consumers in choosing a midwife based on their licensure status.