Hospital midwives seek right to certify false labor: EMTALA's guidelines leave it up to the hospital to determine whether doctors should examine the patient.(Practice Trends)

WASHINGTON -- Federal regulations should recognize the expertise of nurse-midwives in certifying false-labor cases in the hospital, Deanne Williams, a certified nurse-midwife, testified at a meeting of the Department of Health and Human Services technical advisory group on the Emergency Medical Treatment and Labor Act.

Under EMTALA, "only a physician is recognized to certify that a woman who presents to a hospital for evaluation is actually experiencing false labor," said Ms. Williams, executive director of the American College of Nurse-Midwives (ACNM). In the college's view, the regulation fails to acknowledge the scope of practice under which certified nurse-midwives and certified midwives are authorized to treat patients, she said.

"Midwives have a very long history of working collaboratively with physicians to provide women's health care, with a particular focus on care during the maternity cycle," Ms. Williams said, adding that midwives attend more than 10% of the vaginal births in the United States, and 98% of the births attended by midwives occur in hospitals.

EMTALA's requirement for physician certification "places unnecessary costs on the hospital, which is required to take physicians away from other matters to certify that the woman is in false labor, when a certified nurse-midwife or certified midwife is also licensed to make that decision," Ms. Williams testified.

While EMTALA regulations require a signed certification that a woman is experiencing false labor and may be discharged, "there is no requirement in the regulations that a physician must personally examine the patient," noted one advisory group member, Charlotte Yeh, M.D., who is an emergency physician and the CMS regional administrator for Region I in Boston.

The law's interpretive guidelines explain further that a physician must be contacted by the qualified medical professional--i.e. nurse-midwife--to ensure that the woman with contractions has false labor. The guidelines leave it up to the individual hospitals to determine whether physicians should personally examine the patient, she said.

The issue before the technical advisory group is whether the latitude provided by EMTALA's interpretive guidelines is sufficient to protect patients, yet recognizes the value that nurse-midwives bring to labor and delivery, Dr. Yeh told this newspaper. "Or, the [technical advisory group] could say that the regulations are too prescriptive, and that certification should be removed altogether, letting individual hospitals decide who's qualified to determine emergency medical conditions" in patients.