I fully support HB 1904. As a midwife, representing the VIRGINIA MIDWIVES ALLIANCE, and midwives of VA, I echo the written testimonies already submitted stating that we must do all we can to improve maternal and neonatal outcomes in the commonwealth. We must do all that we can to ensure that rural labor and delivery departments are able to stay open 24/7. I serve Danville as a home birth midwife. When Sovah Danville Regional hospital abruptly closed their labor a delivery services for 5 days in November, 2024, one of my patients was 1 week from her due date. We had to scramble in order to secure an emergency care plan for her, should she need transfer to a hospital. The nearest VA birthing hospital is 1 hours 15 minutes away in Lynchburg. This is an unacceptably far commute for a laboring mother with an obstetric emergency to travel. We elected to take her to Greensboro, NC should she need hospital care. This is also unacceptable, as we were unsure if her insurance would be accepted. Additionally, we were unsure if a VA ambulance would transport her to a NC hospital. Additionally, because Licensed Midwives are prohibited from practicing in NC, we could have faced criminal charges if we had needed to provide midwifery care to her en route. This was all incredibly stressful for our birth team and the patient. I imagine that all of the pregnant women in Danville were even more stressed out. The commonwealth has an opportunity to fix this problem, and it is our responsibility to the citizens of VA to do so.

I am submitting testimony on behalf of the Justice & Witness Action Network – VA of the United Church of Christ. Our faith calls us to advocate for a health care system that is inclusive, affordable, accountable, and accessible to all. According to current Virginia code, if a pediatrician is not available on call at a hospital, that forces the hospital nursery to close, which means that labor & delivery must also close. Nearly one third of Virginia counties are considered maternity care deserts, due primarily to a lack of qualified maternity and newborn care providers. Licensed certified nurse-midwives are qualified to provide care not only to women but also to newborns up to the age of 28 days. HB1904 helps to address the disparity of care across the state by expanding the availability of appropriate care for newborns and mothers and helping to keep rural hospitals open for maternity care. We ask you to support this bill.

I am a Registered Nurse working in a rural hospital setting on a LDRP (Labor, Delivery, Recovery, Postpartum) unit in central VA. We currently have ONE pediatrician in our community. The hospital does not have a pediatric unit. We do however have the LDRP with a level 1 nursery and no NICU. We have a Certified Nurse Midwife (CNM) in house 24/7 and a CNM is at all of our deliveries (unless surgical). Our nurses are highly trained to care for well newborns and to stabilize and transport sick newborns. The pediatrician does not come to most births on our unit. They attend cesarean sections (though occasionally they do not arrive in time for an emergent cesarean birth), and may be called to attend if we anticipate a newborn resuscitation might be needed. The majority of newborns do not need any assistance at birth, and the ones that do often do not let us know ahead of time. The resuscitation of newborns is done primarily by nurses and respiratory therapists with no pediatrician on site, and when a higher level of care is needed, a transfer to a hospital with a higher level of care is initiated. This bill does not give any additional scope to Certified Nurse Midwives and Pediatric Nurse Practitioners. It simply allows them to work to the limits of their scope. Our hospital hires locums when possible to fill the gaps in pediatric coverage. However, they cannot always find someone for the job. The load for 24/7 coverage has fallen to this one physician over and over again. I cannot imagine the stress of being on call 24/7 and knowing that taking even one day off will cause the closure of an entire hospital unit. Imagine also knowing that there is a qualified professional on the unit who could cover for you, but the law will not allow it. My hospital is situated in the center of a maternity care desert. The two nearest hospitals with maternity care are 50 and 53 miles away. Imagine yourself, your spouse, your daughter, your friend is in labor. You show up to the hospital to find that the Birth Center is closed and you have to have your baby in the Emergency Department (we have done this) and then be transferred to another hospital once the baby arrives, or you can take the one hour trip to another facility. Neither of these is ideal, especially when there is already a trained and qualified health care provider on site. I encourage you to vote YES on HB 1904 to keep rural Labor and Delivery units open by permitting additional qualified providers to provide nursery care.

As a certified nurse midwife licensed in Virginia, I am for this bill. Advanced practice nurses to include certified nurse midwives and nurse practitioners and Certified Midwives should be allowed to practice within the scope of their education and training. Midwives are trained to provide care to the healthy newborn through the first 28 days of life, which you can read about on the American College of Nurse Midwives website: https://www.midwife.org/About-the-Midwifery-Profession. It is within the scope of practice of a certified nurse midwife, certified Midwife, or pediatric nurse practitioner to care for a healthy newborn. These providers can serve a critical role in serving communities that have a health care worker shortage. I personally provided care to newborns as a birth center midwife in Virginia. I assessed newborns at birth and conducted a thorough newborn exam shortly after birth. I conducted a follow up exam on the newborn and mother the next day after birth to reassess their status. Newborns were typically seen by their primary provider within a few days after the birth, consistent with hospital discharge procedure. When a newborn is discharged from the hospital after birth, they typically return to the outpatient office within a few days for an exam, weight check, and to discuss breastfeeding. I support health care providers practicing at the top of their education and training. I support this bill.

I am writing to strongly support HB1904. Certified nurse midwives and certified midwives can care for newborns from birth through 28 days of life and refer to other healthcare facilities when necessary. HB1904 allows hospitals to maintain active labor and delivery facilities if a certified nurse midwife or certified midwife is available even if a pediatrician is not available. This will be especially beneficial for rural hospitals to be able to provide labor and delivery services at times a pediatrician is not available, thereby helping pregnant women in rural areas to avoid long travel distances when they go into labor. We need to do everything we can to improve maternal mortality rates in the Commonwealth. This is one key step to help pregnant women living in rural areas. Thanks so much Dr. Lisa G Kaplowitz, MD, MSHA

I fully support HB1904 to allow coverage for nursery services by certified nurse midwives, licensed certified midwives, and nurse practitioners. As a Certified Pediatric Nurse Practitioner who is licensed to practice independently, I feel this is an excellent solution to the grave lack of maternity care especially in the rural areas of Virginia. By promoting more local care, transfers of laboring moms can be avoided, and the best possible outcomes can be achieved for both the baby and mother. Respectfully submitted, Robin W. Allman, CPNP (ret).