Bills to allow more certified nurse midwives to practice in Mississippi died in committee Tuesday, two weeks after the state was named in a federal lawsuit over how it restricts access to midwives in a place with some of the worst outcomes for mothers and babies. 

If passed, the legislation would have removed the requirement that Mississippi nurse midwives pay for collaboration agreements with physicians, preventing the state from being sued. Advocates say these arrangements are costly and do not promote competition or produce better health outcomes in Mississippi. 

House Public Health Chairman Sam Creekmore, a Republican from New Albany, said he chose not to bring up House Bill 418 in committee because scope of practice is complicated and conversations around it “take a lot of energy and time.” 

“I want doctors and nurses to come to the table, out of session, and figure out some kind of pathway,” Creekmore said. 

Senate Public Health Chairman Hob Bryan, a Democrat from Amory, chose to allow the Senate version of the bill, Senate Bill 2553, to die in committee. 

“I think the whole area of midwives is something that needs more study, and we continue to look at it,” Bryan told Mississippi Today. 

The committee’s decision “bypassed an opportunity to improve public health and avoid the expense of a lawsuit the state is likely to lose,” said Rob McDuff, a Mississippi Center for Justice attorney and one of the lead lawyers representing the plaintiff, the American College of Nurse-Midwives. 

“I hope the legislators can find another way to fix the problem before the federal court once again has to step in and correct the Legislature’s mistakes.”

Legislators crafted House Bill 1389 to license professional midwives, a lower-ranking branch of midwives who typically assist with home births, which passed committee Tuesday. However, the bill does not offer sections of law that could revive the nurse midwife legislation. The bill’s author, Rep. Dana McLean, a Republican from Columbus, said she has no plans to amend her legislation and would like to keep her bill “clean” to make passage more likely.

Those in favor of abolishing collaboration agreements for nurse midwives argue that doing so would increase the number of providers in a state where most counties are maternity care deserts. Midwifery care has also been shown to improve outcomes for mothers and babies and reduce unnecessary medical interventions. Certified nurse midwives are advanced practice registered nurses with certification in midwifery, rendering them the highest-ranking midwives. 

Getty Israel, founder of a Jackson-based women’s health clinic called Sisters in Birth, has spent five years trying to open the state’s first birth center. Midwifery-led birth centers offer women with low-risk pregnancies an alternative to hospital birth.

Among the difficulties Israel has had, restrictive collaboration agreements are at the top, she said. For Israel, it’s hard to ignore that a profession that is 99% female has been consistently undermined. 

“The collaborative practice agreement is a sexist, unconstitutional law designed to increase the incomes of physicians on the backs of certified nurse midwives,” Israel said. “It ensures that Mississippi consumers do not have an alternative to physicians who routinely perform medically unnecessary inductions of labor of low-risk pregnant women that lead to brain-damaged newborns and cesarean deliveries – the number one surgery in the state and a cash cow for physicians and hospitals.”

Bryan would not answer questions about why he felt midwifery needed more study or how he planned to study the issue next year. He also mentioned being “greatly concerned” of the trend where wealthy patients get a higher standard of care than poor patients. However, he would not say how that concern was relevant to the issue of nurse midwife collaboration agreements. 

Mississippi is one of 15 states that received a federal grant from the Centers for Medicare and Medicaid Services last year to reduce costs and improve outcomes around maternal health. One of the pillars of that grant involves expanding access to midwives. 

Meanwhile, State Health Officer Dr. Dan Edney declared a public health emergency in August over the state’s rising infant mortality rate – the highest in the nation. Israel said lawmakers are turning “a deaf ear” to the crisis. 

“Although state legislators did not create the state’s protracted maternity crisis, their lack of action today perpetuates it,” Israel said.