Brief Nebraska Midwifery Advocacy and NFOM History
Please click on blue words to follow links for more detail.
For a creative an unique primer on how a Nebraska bill becomes law click here.
1983 (88th Legislature, long session)
Following a move to Nebraska and finding no midwives to attend her birth, Anne Seacrest organized support and achieved legal status for Certified Nurse Midwives (CNMs). However, at the last minute in order to ensure passage of the legislation, the midwifery supporters were forced to sacrifice the homebirth portion of the bill. Although it was believed that the home birth exclusion would be readily amended, CNMs are still restricted in 2011 from legally attending home births. CNMs have been practicing in Nebraska since 1984.
1990s
A bad outcome in a breech home birth threatened home birth’s status in Nebraska. We do not know the details of that birth. An attempt was made to pass legislation that would have made home birth attendance by Direct Entry Midwives a felony by statute. An effort supporting Direct Entry Midwives defeated the measure. In the future more information will be available on this chapter of midwifery history.
1994 (93rd Legislature, short session)
A Credentialing (407) Review was conducted.
"Credentialing review is a three-step process conducted by the following review bodies in the following order:
Following an outcome favorable to midwifery, no action was taken.
2003 (98th Legislature, long session)
LB 702 – Introduced by Senator Landis per the request of Lori Hack. Heather Swanson, CNM assisted with bill drafting. Lori Hack, Heather Swanson CNM, and Ann Seacrest RN testified (in addition to others). LB 702 would have removed the CNM-attended home birth restriction, but did not get out of committee.
Read LB 702 here.
2005 (99th Legislature, long session)
Nebraska Friends of Midwives formally organized in Kearney. Autumn Cook of Omaha began serving as chair- the consequence, she says, of she bringing a written agenda to the first meeting.
LB 256– Introduced by Senator Price. APRN “Umbrella Legislation” Bill Passed. LB 256 took CNM regulation out from under the Board of Medicine and remained under the Board of Nursing, redesigned the APRN Advisory Committee to include NPs, CRNAs, CNSs, and CNMs. Recognized license for CNM now APRN-CNM. Legislation was a move closer to national recommendations for APRN state licensing and regulation by the NIH & NCSBN. Jearlyn Schumacher, CNM and Heather Swanson, CNM represented midwifery on the APRN Coalition that met for several years prior to passage of LB 256.
Read LB 256 here.
LB 339- Introduced by Senator Smith, co-sponsored by Senator Erdman. LB 339 would have licensed Direct Entry Midwifery utilizing the North American Registry of Midwives' (NARM) Certified Professional Midwifery (CPM) credential, but the bill did not make it out of the Health and Human Services committee. Heather Swanson, CNM assisted with bill drafting after reviewing legislation from other states and in consultation with NARM.
Read LB 339 here.
LB 338 – Introduced by Senator Smith, co-sponsored by Senators Erdman and Brown. LB 338 would have added CNMs to list of providers that mandates insurance coverage of services legally provided, removed the CNM home birth restriction, removed the requirement for a written practice agreement between CNMs and physicians, but LB 338 did not get out of the Health and Human Services committee. Heather Swanson, CNM was involved with bill drafting.
Read LB 338 here.
At the urging of Senator Johnson a 407 Review was requested to review the Nebraska practice of Certified Nurse-Midwife regarding the requirement of written practice agreements and home birth, and regarding Direct Entry Midwives (DEM) for initial licensing. Heather Swanson submitted request with Nebraska Friends of Midwives' support.
For a creative an unique primer on how a Nebraska bill becomes law click here.
1983 (88th Legislature, long session)
Following a move to Nebraska and finding no midwives to attend her birth, Anne Seacrest organized support and achieved legal status for Certified Nurse Midwives (CNMs). However, at the last minute in order to ensure passage of the legislation, the midwifery supporters were forced to sacrifice the homebirth portion of the bill. Although it was believed that the home birth exclusion would be readily amended, CNMs are still restricted in 2011 from legally attending home births. CNMs have been practicing in Nebraska since 1984.
1990s
A bad outcome in a breech home birth threatened home birth’s status in Nebraska. We do not know the details of that birth. An attempt was made to pass legislation that would have made home birth attendance by Direct Entry Midwives a felony by statute. An effort supporting Direct Entry Midwives defeated the measure. In the future more information will be available on this chapter of midwifery history.
1994 (93rd Legislature, short session)
A Credentialing (407) Review was conducted.
"Credentialing review is a three-step process conducted by the following review bodies in the following order:
- The review of an ad hoc technical review committee appointed by the Director of the Division of Public Health
- The review of the State Board of Health
- The review of the Director of the Division of Public Health"
Following an outcome favorable to midwifery, no action was taken.
2003 (98th Legislature, long session)
LB 702 – Introduced by Senator Landis per the request of Lori Hack. Heather Swanson, CNM assisted with bill drafting. Lori Hack, Heather Swanson CNM, and Ann Seacrest RN testified (in addition to others). LB 702 would have removed the CNM-attended home birth restriction, but did not get out of committee.
Read LB 702 here.
2005 (99th Legislature, long session)
Nebraska Friends of Midwives formally organized in Kearney. Autumn Cook of Omaha began serving as chair- the consequence, she says, of she bringing a written agenda to the first meeting.
LB 256– Introduced by Senator Price. APRN “Umbrella Legislation” Bill Passed. LB 256 took CNM regulation out from under the Board of Medicine and remained under the Board of Nursing, redesigned the APRN Advisory Committee to include NPs, CRNAs, CNSs, and CNMs. Recognized license for CNM now APRN-CNM. Legislation was a move closer to national recommendations for APRN state licensing and regulation by the NIH & NCSBN. Jearlyn Schumacher, CNM and Heather Swanson, CNM represented midwifery on the APRN Coalition that met for several years prior to passage of LB 256.
Read LB 256 here.
LB 339- Introduced by Senator Smith, co-sponsored by Senator Erdman. LB 339 would have licensed Direct Entry Midwifery utilizing the North American Registry of Midwives' (NARM) Certified Professional Midwifery (CPM) credential, but the bill did not make it out of the Health and Human Services committee. Heather Swanson, CNM assisted with bill drafting after reviewing legislation from other states and in consultation with NARM.
Read LB 339 here.
LB 338 – Introduced by Senator Smith, co-sponsored by Senators Erdman and Brown. LB 338 would have added CNMs to list of providers that mandates insurance coverage of services legally provided, removed the CNM home birth restriction, removed the requirement for a written practice agreement between CNMs and physicians, but LB 338 did not get out of the Health and Human Services committee. Heather Swanson, CNM was involved with bill drafting.
Read LB 338 here.
At the urging of Senator Johnson a 407 Review was requested to review the Nebraska practice of Certified Nurse-Midwife regarding the requirement of written practice agreements and home birth, and regarding Direct Entry Midwives (DEM) for initial licensing. Heather Swanson submitted request with Nebraska Friends of Midwives' support.
2006- The 407 Reviews for CNMs and DEMs
2006 (99th Legislature, short session)
Two 407 reviews were conducted- one for Certified Nurse Midwives (CNMs), and one for Direct Entry Midwives (DEMs).
The Health and Human Services (HHS) Committee was asked again to look at the possibility of changing the state's regulation of midwives, both for CNMs and for DEMs.
The CNM Review
Heather Swanson, MSN, CNM was the applicant named in the 2006 Proposal for a Change in Scope of Practice for Certified Nurse Midwives in Nebraska. The proposed changes to the scope of CNM practice were:
1. Allow CNMs to attend home births,
2. Remove the requirement for a practice agreement with a physician,
3. Allow CNMs to care for infants through their first 28 days of life with such care to include newborn screening, immunizations, lab work, medications, and early well-child checkups,
4. Add CNMs to the list of providers that shall be reimbursed for services legally provided,
5. Add CNMs to the list of providers that cannot be denied clinical privileges solely on the basis of the type of license they possess, and
6. Provide CNMs with prescriptive authority as appropriate for their scope of practice.
The final report of the Midwifery Technical Review Committee regarding the proposed changes to CNM regulation is available below.
The final report of recommendations by the Nebraska State Board of Health regarding the proposed changes to CNM regulations is available below.
The report of the Director of the Department of Health and Human Services is available below.
In the end the technical review committee voted by majority to recommend against CNM attendance at homebirth, but in favor of all other proposed CNM regulation changes. The board of health voted by majority to recommend against the proposed changes to CNM regulation.
Despite the recommendation of the technical review committee in favor of all original proposals excluding the home birth proposal, no action was taken on the committee's recommendations to remove the requirement for a practice agreement with a physician, or to add CNMs to the list of providers that cannot be denied clinical privileges solely on the basis of the type of license they possess. It wasn't until 2011, following the passage of LB68 that it became illegal to discriminate against CMNs based solely on category.
The DEM Review
Heather Swanson, MSN, CNM was the applicant named in the 2006 Proposal to License Direct Entry Midwives In Nebraska. A summary of the proposal as stated in the report of the technical review committee is as follows:
"The applicant’s proposal seeks licensure for those Direct Entry Midwives (DEMs) who satisfy standards defined in the proposal. The proposal states that those Direct Entry Midwives who seek licensure must pass the North American Registry of Midwives (NARM) Examination. Those who pass this exam would be required to pay a fee that would permit them to use the title Certified Professional Midwife (CPM). Those who earn this title could then be granted a license as a Licensed Midwife (LM) by the state of Nebraska."
Public Documents
Available in a PDF format below are:
The names of Nebraskans serving as members of Midwifery Technical Review Committee, the Nebraska Board of Health and the Director of the Department of Health and Human Services at that time can be found here.
Two 407 reviews were conducted- one for Certified Nurse Midwives (CNMs), and one for Direct Entry Midwives (DEMs).
The Health and Human Services (HHS) Committee was asked again to look at the possibility of changing the state's regulation of midwives, both for CNMs and for DEMs.
The CNM Review
Heather Swanson, MSN, CNM was the applicant named in the 2006 Proposal for a Change in Scope of Practice for Certified Nurse Midwives in Nebraska. The proposed changes to the scope of CNM practice were:
1. Allow CNMs to attend home births,
2. Remove the requirement for a practice agreement with a physician,
3. Allow CNMs to care for infants through their first 28 days of life with such care to include newborn screening, immunizations, lab work, medications, and early well-child checkups,
4. Add CNMs to the list of providers that shall be reimbursed for services legally provided,
5. Add CNMs to the list of providers that cannot be denied clinical privileges solely on the basis of the type of license they possess, and
6. Provide CNMs with prescriptive authority as appropriate for their scope of practice.
The final report of the Midwifery Technical Review Committee regarding the proposed changes to CNM regulation is available below.
The final report of recommendations by the Nebraska State Board of Health regarding the proposed changes to CNM regulations is available below.
The report of the Director of the Department of Health and Human Services is available below.
In the end the technical review committee voted by majority to recommend against CNM attendance at homebirth, but in favor of all other proposed CNM regulation changes. The board of health voted by majority to recommend against the proposed changes to CNM regulation.
Despite the recommendation of the technical review committee in favor of all original proposals excluding the home birth proposal, no action was taken on the committee's recommendations to remove the requirement for a practice agreement with a physician, or to add CNMs to the list of providers that cannot be denied clinical privileges solely on the basis of the type of license they possess. It wasn't until 2011, following the passage of LB68 that it became illegal to discriminate against CMNs based solely on category.
The DEM Review
Heather Swanson, MSN, CNM was the applicant named in the 2006 Proposal to License Direct Entry Midwives In Nebraska. A summary of the proposal as stated in the report of the technical review committee is as follows:
"The applicant’s proposal seeks licensure for those Direct Entry Midwives (DEMs) who satisfy standards defined in the proposal. The proposal states that those Direct Entry Midwives who seek licensure must pass the North American Registry of Midwives (NARM) Examination. Those who pass this exam would be required to pay a fee that would permit them to use the title Certified Professional Midwife (CPM). Those who earn this title could then be granted a license as a Licensed Midwife (LM) by the state of Nebraska."
Public Documents
Available in a PDF format below are:
- The final report of the Midwifery Technical Review Committee regarding the proposal to license Direct Entry Midwives
- The final report of the Midwifery Technical Review Committee regarding the proposal change scope of practice of Certified Nurse Midwives
- The final (combined) report of recommendations by the Nebraska State Board of Health regarding the proposal to license Direct Entry Midwives and change the scope of practice of Certified Nurse-Midwives
- The report of the Director of the Department of Health and Human Services containing the director's responses to both the CNM and DEM proposals
The names of Nebraskans serving as members of Midwifery Technical Review Committee, the Nebraska Board of Health and the Director of the Department of Health and Human Services at that time can be found here.
1. FINAL REPORT OF RECOMMENDATIONS AND FINDINGS
By the Midwifery Technical Review Committee on the Proposal to License Direct Entry Midwives in Nebraska
By the Midwifery Technical Review Committee on the Proposal to License Direct Entry Midwives in Nebraska
| nfom_407_dem_final_report.pdf |
2. FINAL REPORT OF RECOMMENDATIONS AND FINDINGS
By the Midwifery Technical Review Committee on the Proposal for a Change in Scope of Practice for Certified Nurse Midwives in Nebraska
By the Midwifery Technical Review Committee on the Proposal for a Change in Scope of Practice for Certified Nurse Midwives in Nebraska
| nfom_407_cnms_final_report.pdf |
3. FINAL REPORT OF RECOMMENDATIONS
By the Nebraska State Board of Health on Proposals for a Change in Scope of Practice for Certified Nurse Midwives and for the Licensure of Direct Entry Midwives
By the Nebraska State Board of Health on Proposals for a Change in Scope of Practice for Certified Nurse Midwives and for the Licensure of Direct Entry Midwives
| nfom_dem_cpm_final_report_2006.pdf |
4. HHS DIRECTOR’S REPORT ON A PROPOSAL FOR A CHANGE IN SCOPE OF PRACTICE FOR CERTIFIED NURSE MIDWIVES AND A PROPOSAL TO LICENSE DIRECT ENTRY MIDWIVES
| director_js-both-midwifery-dem.pdf |
2007 to Present
2007 (100th Legislature, long session)
NFOM held a rally at a freestanding birth center as it neared completion in Norfolk. The birth center was the investment and creation of Gail Consoli, CNM. Despite her best efforts, her work to open the center was derailed and the birth center never opened. Gail continued to practice as a CNM in Norfolk.
2008 (100th Legislature, short session)
NFOM decided to focus efforts and only pursue CNM legislation for a time based on the reasoning that Nebraska, a state that had only just licensed CNMs in 1984
2009 (101st Legislature, long session)
Drafted legislation for three bills. Issues were separated in order to lend clarity and allow support of individual issues. The bills were as follows:
1. LB 406 Hospital Privileges: CNMs cannot be prevented from applying to work at a hospital because of their CNM credentials. Requires hospitals to accept applications from CNMs. Find out more about LB 406 here. [This legislation eventually passed in 2011 as LB 68, sponsored by Senator Tony Fulton.] *
2. LB 457 Eliminate the requirement for a written practice agreement with a supervising physician. Eliminate the risk of CNMs losing their businesses or being prevented from practicing because they can’t find physicians to sign practice agreements; increased ability to practice to the full extent of the CNM scope. Find out more about LB 457 here. *
LB 481 Removes the home birth exclusion from the previous legislation. Includes home birth as a location for CNM practice. Find more information on the LB 481 here. *
*A transcript of the March 9 Health and Human Services committee hearing on all three bills is available here.
LB 406: Begins page 7
LB 457: Begins page 23
LB 481: Begins page 40
2010 (101st Legislature, short session)
Bills were heard by the Health and Human Services Committee. Although no vote was taken by the HHS, the bills were heard and not killed in committee.
2011 (102nd Legislature, long session)
Achievement! LB68 Passed!
LB 68, sponsored by Senator Tony Fulton, prevents the legal denial of hospital privileges to Certified Nurse-Midwives based solely upon credentialing under the Health Care Facility Licensure Act.
View the bill's complete history and read all related transcripts here, or read through the following overview:
January 20: LB 68 was heard by the Health and Human Services Committee. Read the transcripts here. Scroll to page 24 to read LB 68. (The "barber
pole" hearing transcripts for LB 46 are on pages 21-24.) View the Committee Statement here. (Members were Senators Kathy Campbell- Lincoln, Mike Gloor- Grand Island, Dave Bloomfield- Hoskins, Tanya Cook- Omaha, Gwen Howard- Omaha, Bob Krist- Omaha, and Norm Wallman-Cortland.)
January 25: LB 68 placed in General File.
Feb 4: LB 68 heard in General File. The bill advanced to select file following a general file vote of the Unicameral of 40-0.
February 14: Read in select file, advanced to final reading.
Feb 16: Final reading, LB 68 passed with a vote of 49-0.
Feb 22: LB 68 approved by the Governor Heineman. Feeling foggy on how a Nebraska bill becomes law? Check out this creative and simple explanation of the process.
2012 (102nd Legislature, short session)
LB 712, a bill to remove the home birth exclusion from the Nebraska statues governing Certified Nurse Midwives (CNMs), was heard by the Health and Human Services committee on February 22. Senator Ken Haar sponsored the bill. Supporters wrote many letters, made many calls, and sent many emails to their own district senators and the senators serving on the HHS committee.
NFOM hosted a rally (it's a great link!) on the west steps of the Capitol and enjoyed a good showing. It received local television and newspaper coverage; Cindy Lange-Kubick's story in the Lincoln journal Star inspired more than 55 comments. National recognition that Nebraska is one of two states in which consumers have no access to licensed care in a home birth setting began to appear. State, national, and international supporters signed a petition demonstrating their desire to see Nebraska's law changed. The names and comments will be delivered to senators at the start of the session in 2013, so there is still time to sign.
The session ended Wednesday, April 18 with LB 712 still in committee. Because 2012 is the end of the two-year legislative session, the bill died in committee and the legislative process will begin again in January of 2013. (If you didn't click on that last link, go back and do it. It is a good one.)
To read transcripts from the hearing click the downloadable file below. The testimony can also be viewed on Youtube. There are fifteen separate recordings.
NFOM held a rally at a freestanding birth center as it neared completion in Norfolk. The birth center was the investment and creation of Gail Consoli, CNM. Despite her best efforts, her work to open the center was derailed and the birth center never opened. Gail continued to practice as a CNM in Norfolk.
2008 (100th Legislature, short session)
NFOM decided to focus efforts and only pursue CNM legislation for a time based on the reasoning that Nebraska, a state that had only just licensed CNMs in 1984
2009 (101st Legislature, long session)
Drafted legislation for three bills. Issues were separated in order to lend clarity and allow support of individual issues. The bills were as follows:
1. LB 406 Hospital Privileges: CNMs cannot be prevented from applying to work at a hospital because of their CNM credentials. Requires hospitals to accept applications from CNMs. Find out more about LB 406 here. [This legislation eventually passed in 2011 as LB 68, sponsored by Senator Tony Fulton.] *
2. LB 457 Eliminate the requirement for a written practice agreement with a supervising physician. Eliminate the risk of CNMs losing their businesses or being prevented from practicing because they can’t find physicians to sign practice agreements; increased ability to practice to the full extent of the CNM scope. Find out more about LB 457 here. *
LB 481 Removes the home birth exclusion from the previous legislation. Includes home birth as a location for CNM practice. Find more information on the LB 481 here. *
*A transcript of the March 9 Health and Human Services committee hearing on all three bills is available here.
LB 406: Begins page 7
LB 457: Begins page 23
LB 481: Begins page 40
2010 (101st Legislature, short session)
Bills were heard by the Health and Human Services Committee. Although no vote was taken by the HHS, the bills were heard and not killed in committee.
2011 (102nd Legislature, long session)
Achievement! LB68 Passed!
LB 68, sponsored by Senator Tony Fulton, prevents the legal denial of hospital privileges to Certified Nurse-Midwives based solely upon credentialing under the Health Care Facility Licensure Act.
View the bill's complete history and read all related transcripts here, or read through the following overview:
January 20: LB 68 was heard by the Health and Human Services Committee. Read the transcripts here. Scroll to page 24 to read LB 68. (The "barber
pole" hearing transcripts for LB 46 are on pages 21-24.) View the Committee Statement here. (Members were Senators Kathy Campbell- Lincoln, Mike Gloor- Grand Island, Dave Bloomfield- Hoskins, Tanya Cook- Omaha, Gwen Howard- Omaha, Bob Krist- Omaha, and Norm Wallman-Cortland.)
January 25: LB 68 placed in General File.
Feb 4: LB 68 heard in General File. The bill advanced to select file following a general file vote of the Unicameral of 40-0.
February 14: Read in select file, advanced to final reading.
Feb 16: Final reading, LB 68 passed with a vote of 49-0.
Feb 22: LB 68 approved by the Governor Heineman. Feeling foggy on how a Nebraska bill becomes law? Check out this creative and simple explanation of the process.
2012 (102nd Legislature, short session)
LB 712, a bill to remove the home birth exclusion from the Nebraska statues governing Certified Nurse Midwives (CNMs), was heard by the Health and Human Services committee on February 22. Senator Ken Haar sponsored the bill. Supporters wrote many letters, made many calls, and sent many emails to their own district senators and the senators serving on the HHS committee.
NFOM hosted a rally (it's a great link!) on the west steps of the Capitol and enjoyed a good showing. It received local television and newspaper coverage; Cindy Lange-Kubick's story in the Lincoln journal Star inspired more than 55 comments. National recognition that Nebraska is one of two states in which consumers have no access to licensed care in a home birth setting began to appear. State, national, and international supporters signed a petition demonstrating their desire to see Nebraska's law changed. The names and comments will be delivered to senators at the start of the session in 2013, so there is still time to sign.
The session ended Wednesday, April 18 with LB 712 still in committee. Because 2012 is the end of the two-year legislative session, the bill died in committee and the legislative process will begin again in January of 2013. (If you didn't click on that last link, go back and do it. It is a good one.)
To read transcripts from the hearing click the downloadable file below. The testimony can also be viewed on Youtube. There are fifteen separate recordings.
LB 712 Committee Hearing Testimony
| lb712_health_2-22-12.pdf |
What is Up with the Yellow Roses?
Worn back in 1920 by suffragists- those supporting the right of women to vote- the yellow rose remains an enduring symbol of the right and capacity of a woman to make determinations for herself.
