Ohio House Children and Human Services Committee - 3-18-2026

Good morning, everyone. We will go ahead and begin the Children and Human Services Committee. We are in a new room that we're not typically in, so we can barely see you above these boards, but welcome to everyone. We will go ahead and, clerk, please call the roll.

Ranking Member Lett. Here.

Representative Bryant-Bailey. Here.

Representative Dieter. Representative Fowler-Arthur.

Here. Representative Ray.

Okay, we do have a full quorum, so we'll proceed as a full committee. If you could go ahead and check your iPads for the minutes, see if anyone has any objections to the minutes. Seeing no objections, the minutes are approved. As far as today goes, if you wish to take photographs, there are some forms up there that you just need to complete. We are planning on about 11 witnesses today for one of our bills, so we will need to limit our testimony time because we have a hard stop at 1 o'clock. So each person will have five minutes. Committee, if you can start with one question and one follow-up, we might have to cut that shorter if we go over, but hopefully we'll be able to move through all that. I apologize for my voice. I've got the bugs we're all getting. So with that, we will go ahead and start. And we've got two bills with amendments, so I will call up House Bill 647 for its fifth hearing.

Okay, the motion's in order. Thanks, please.

Does anyone have an objection, though, with this amendment? All right. Seeing none, the amendments are accepted. Do you want to go ahead and recognize you now for another motion?

Okay. The amendments in order to go ahead and submit, please.

All right. Does anyone object to this one? All right. The amendment is accepted as well. So this is going to conclude the fifth hearing on House Bill 647. Next, we will move to House Bill 649, and I'm recognizing you again for a motion.

The amendment's in order. Please continue.

okay are there any objections to that amendment i realized that it came in a bit late so we have a full week to kind of dig into this and see if there's anything else in these bills so we are currently in the third hearing for house bill 649 and we do have proponent opponent interested Party testimony open today. So right now we will go ahead and call up. Oh. Is there any objection? No. Seeing none, the amendment is ejected. Sorry, my brain is a little full of cold medicine. The amendment is accepted. So next we will move on to testimony. We have all testimony possible today, we have Shayla Favor here today from the Franklin County Prosecutor's

Thank you very much for your testimony. You hit it almost exactly on the nail with five minutes, Ms. Favre. Are there any questions?

I really appreciate that question. I think that what we would ask for this committee to do is to evaluate the current investigative authorities that would investigate these instances, should they be referred. Right now, identifying what that gap is incredibly important between when fraud has occurred and when the case reaches the prosecutor. That is an investigative gap and not a prosecutorial gap. And so to be direct, I cannot speak to why no child fraud cases were referred to our office in 2025. I believe that is a question that is better directed to those investigative agencies. What I can tell you is that, again, we stand ready to prosecute any of those properly referred cases. I think what we should also keep in mind is that my job is to be the prosecutor. It is to prosecute those cases when they come to us. I dare not step into an investigative space to weigh in on how they should improve their processes, if at all. All I can say is that for the Franklin County Prosecutor's Office, we have not received any of those referrals as of yet. What I will also add is that we understand that there are many ways that we can address fraud and other forms of criminal activity in our community. It's why this office created the very first nuisance abatement unit for Franklin County, and we are tackling crime from all different angles, utilizing the tools that are provided to us in the Ohio Revised Code to approach crime in a different way. So, again, that is not reflective of a prosecutor's office that is scapegoating their duties. Thank you.

Thank you, Chair, and thank you, Ms. Favreau, for coming in. I am not an attorney, so I certainly appreciate you educating us on that process. It is my understanding that there is good reason to believe that there was some fraud taking place in Franklin County. And I'm just curious, have you heard that as well, I mean, aside from in this committee? And if so, where is the breakdown that, you know, you've described the process. Just help me as a layman when it comes to the law. Help me to understand where the breakdown is and what you need in order to successfully prosecute what you believe is fraud.

Thank you. Thank you for that answer. And it's my understanding, and again, I'm not there, so I'm just putting out what I've heard as well and like to get your responses. My understanding is that there have been people who have been doing some of that research and some of that investigation, but the county commissioners have basically accused them of discrimination against a certain population of people for their investigation in that area. What role do the county commissioners play any role in this process whatsoever? Or is it possible that there are people who are holding back just because it may happen to affect a certain population of people and they're afraid of being accused of targeting that population. And my position is I don't care who you are, where you are. If what's right is right and what's wrong is wrong, and don't go after someone because of who they are, but don't ignore it because of who they are either. Could you respond to that, please?

Thank you for that response. Thank you.

Thank you, Madam Chair. Thank you, Madam Prosecutor, for sharing such critical testimony today. You mentioned something in your initial remarks. So I'd love for you to expound upon how stripping local prosecutorial authority would actually slow down enforcement in practice.

No. Okay. We've got Representative Sarah Fowler-Arthur.

And to be clear, I did not say that there are not cases that are moved up and prosecuted, handled by the attorney general's office. What I'm saying is that there is no reason why these types of cases that are no different than any other felony fraud matters need to be moved at this point in time. You may have missed the beginning part of my testimony, but our office was referred close to 50 cases related to COVID-19 pandemic relief funds. And we did not decline. We did not deprioritize one of those cases. And those cases ranged anywhere from twenty four thousand dollars to seven million dollars. And so respectfully, I wholeheartedly believe that we are just as motivated to prosecute those any instances of child care fraud, just the way in which we would a covid-19 pandemic fraud. then the argument could be made that every case should be referred to the attorney general's office. And so where does local accountability really matter when we're talking about accountability in general?

Unfortunately, I don't know the money side of the question that you're asking because my job is to prosecute the crimes that occur within Franklin County. And again, I want to center us back on the reality that this legislation is potentially doing is removing all county prosecutors authority to prosecute fraud as it relates to child care We could have the same line of thinking for any other instance of fraud in the state of Ohio Again, if there has not been any derelict of duty on behalf of county prosecutors in the state of Ohio as it relates to child care fraud, If we have demonstrated our commitment collectively and individually to pursue fraud without favor, without any discrepancy, I am concerned why would we be focusing our endeavors on prosecution and not where the problem actually lies, which is in the investigation and the referral part of this process. And that would get to the heart of protecting the taxpayers' dollars.

for lots of money? Thank you for the question, Chair. And I would, again, echo my testimony and my thorough line, which is that we wholeheartedly stand in opposition to any elimination of our authority to prosecute these cases. Again, because there has been no evidence in Franklin County and I think across the state and Massa Form that would prematurely ask you all to do this With that being said, there are cases that are referred to our office for findings of recovery. These cases often come to us from the state auditor's office where there has been, for example, alleged fraud committed by a township individual. This is purely, this is not a real case. I am just speaking very, giving you all an example. If a township individual has mishandled funds, misappropriated funds, and the auditor investigates that alleged activity and finds that, in fact, that individual has done that, they will send that case to us. And we have 120 days to evaluate said case before making our final decision and letting all of the entities up the line, let them know what our process would be in moving forward. To be clear, I have not rejected any of those cases that have come before me, and I have had two findings of recovery since I have been in this office. So, again, I stand in opposition to the underlying sentiment of this bill, which would eliminate our authority to prosecute child care fraud cases. But again, I want to caution this committee and putting in inherent timelines because as a prosecutor, we are rarely handed a case that is ready to go when it is immediately referred to us. We are often going back to our investigators, whether it is the Columbus Police Department, the Franklin County Sheriff's Office, or any other investigatory body to get the evidence, get the other information that we need to be able to present a strong case to the grand jury. We could be in the same situation with a child care fraud case that is referred to us. So inherent timelines are arbitrary at best.

Yes, it is.

Thank you for the question. And ma'am, I believe in checks and balances. I think that's what strengthens our government. I believe that the 120-day timeline that we are on with the auditor's office is challenging to meet. Because, again, as I just described, we are often having to go back and forth in order to have enough evidence that we need to move forward with the prosecution, evaluating, and things of that nature. The wheels of justice move a little too slow, in my opinion. But respectfully, I think there is an opportunity to discuss a timeline that is not 120 days. It is not stripping away our prosecutorial authority, but that does provide the attorney general with some oversight should a prosecutor elect to do that. But again, I want to be very clear. It is not removing our authority altogether, nor is it putting us on a timeline that is strictly unreachable.

I might have mispronounced that. Colans, Community Midwives of Ohio. Thank you for coming in. Actually, you did very well with that pronunciation. Thank you. Chairperson White, Vice Chair Salvo, Ranking Member Lett, and members of the Distinguished Children and Human Services Committee, thank you for allowing me the opportunity to share my profession with you today. My name is Pam Colans, and I am a traditional midwife and also an officer of the Ohio Midwives Alliance and Community Midwives of Ohio. I am here today in strong support of House Bill 537. I would like to impress upon each of the committee members how important it is to codify the time-honored practice of traditional midwives in Ohio through this legislation. House Bill 537 rightly gives sole discretion to women with regard to all matters of birth. It recognizes and regulates the different midwifery types and leaves the important care decisions in the hands of women and their families where it belongs. Since the beginning of time, traditional midwives are the original birth attendants who have served women and continue to do so to this day. It is very likely that every person on this committee has parents, grandparents, or great-grandparents who were safely born at home under traditional midwives. That was the cultural norm before 1940. All midwifery professions today trace their roots to this traditional practice. Traditional midwives are typically trained through an apprenticeship model, working closely with experienced midwives for three to five years. Through this mentorship, they learned the art and skill of supporting normal pregnancy and birth, while also recognizing when a transfer of care to medical providers is appropriate. I personally went out of state and out of country for a portion of my training, and this is a common apprenticeship training. I'm neonatal resuscitation certified and basic life support certified. As an experienced traditional midwife, I've also mentored six student midwife apprenticeships. In Ohio today and throughout history, traditional midwives have assisted in the births of women at homes. Safety for the mother and baby is always their highest concern. More than 20 years ago the state of Ohio wisely decided that traditional midwives are safe practitioners and desired by many consumers of our state regardless of the availability of other licensed practitioners. Legislation was passed for religious freestanding birth centers, which legally define a traditional midwife as a legitimate provider in the state of Ohio administrative code. Traditional midwives are authorized to register birth certificates and perform newborn screenings through the Ohio Department of Health, and we're eligible for payment through some insurance plans. We skillfully provide prenatal birth and postpartum care for at least six weeks postpartum, along with breastfeeding education and support in the home environment. House Bill 537 provides important codification within the laws of the state of Ohio to recognize the essential role of traditional midwives in today's modern culture. House Bill 537 also acknowledges the importance of expanding midwifery care of all kinds to meet the needs of expectant moms in our state. With 13 counties being considered maternity deserts and having unacceptable maternal and infant mortality rates, Ohio mothers need more care options, not less. I currently estimate that at least half of the midwives serving families in their homes are traditional midwives. Consumers desire traditional midwives for safe, compassionate, and personal care, generally at a lesser cost. This bill addresses traditional midwives and important consumer protections by written conformed consent, outlining a midwife's training, her services, her experience, and a transfer of care plan. This legislation includes penalties for misrepresentation of those credentials and experience by a traditional midwife. In conclusion, traditional midwifery is already recognized in Ohio law, and codification through House Bill 537 is essential. For generations, traditional midwives have quietly served women and babies in their homes and communities. This bill recognizes that reality and provides clarity, accountability, and protection for both families and providers. Most importantly, it respects a woman's right to choose who will walk beside her during the most important time of her life for the birth of her child. House Bill 537 will help grow midwifery care for the citizens of Ohio in the important ways that childbearing families have chosen for many decades. Thank you for the opportunity to testify today, and I will be happy to take any questions.

Thank you, Chairwoman. Thank you so much for your testimony. I can barely see you. I know. I just had a quick question. You know, I think the point of this bill is to just establish regulation through licensure and certification. You know, does it make sense, does making licensure optional for traditional midwives leave a gap in oversight, in your opinion?

In oversight, sorry. There's a blower behind us that's very loud. Okay, I hear it too.

Can I have a follow-up? Follow-up. Thank you. I just want to follow up real quickly So thinking about all of this regulation if a certified nurse midwife then has their license revoked under this bill they could just go practice as a traditional midwife Is that correct?

Thank you.

Thank you for that question, Representative White. My training specifically as a traditional midwife, as I said, is through an apprenticeship model. Apprenticeship models match and meet the person's skills and where they have come from prior to that when they enter that. It's generally a three-year, three- to five-year apprenticeship. Mine was five. I apprenticed with six different midwives, senior midwives around Ohio. I went out of state and out of country for portions of my training. I'm sorry, I'm drawing a blank on what your other questions were.

I have attended over 4,000 births successfully at home. I've never lost a mom or a baby. I can say to you that parents are in charge. They get to decide what is safest for them in their own personal, religious, and philosophical backgrounds. No, this bill does not restrict someone's right to birth at home. And, yes, in my practice, I have declined care based on risk factors and things that I didn't think were appropriate to continue that way.

It varies with your clients. I have declined care for someone who nutritionally was not very in a good place and that put themselves at risk by not creating a strong, healthy pregnancy, such as someone who would have drug or alcohol addiction issues. Those are something that I would not personally think is a good idea to be at home. certain kinds of major illnesses, heart disease, insulin-dependent, diabetics. Those are some of the major things that are not appropriate for my care.

that about one baby every three days It doesn work that way with midwifery You get a bunch at once and then you get a space but that a day Interestingly have you done any multiple births Yes, I have. Okay, how did that work out? Were there any complications involved with that? No. Again, with good oversight and assessment of risk factors, that was not a problem.

Well, you have to get to at least 37 weeks in the pregnancy. The baby should be in ideal positions, and ultrasound is usually utilized to affirm that the babies are in two amniotic sacs. I'm getting technical here. I hope that's okay. But there are pieces of that that I personally, I can only speak for me, would review and decide with the family if this is an important thing for them. I don't advertise my services. People seek me out, and they seek traditional midwives and all midwives out because they have a belief system. And that belief system is that they need to be in charge of their own birth. And that is whether it's twins or other.

I serve an eight-county area in northeast Ohio. It is very difficult to, in that large of a span, to have a particular doctor or nurse midwife affiliate, but I have many affiliates all over northeast Ohio that I could refer to if needed.

The multiples that I have helped with have had full obstetric care in conjunction with the decision for home birth.

I'm providing midwifery care, which is very comprehensive. but we additionally have what is called co-care, where they're receiving medical care through an obstetrician or a nurse midwife in conjunction with that. Not I'll choose that, but in a multiple situation, that would be one of those considerations.

We all deal with that. I have less than a 4% transfer rate, and that would be in that category. Statistically, the most women that are going to transfer from home to hospital are first-time moms with long labors. Maybe there's some maternal exhaustion going on. And now they want that care and maybe pain management that they can get in a hospital that we don't have at home.

We probably only have time for one more follow-up. Go ahead.

Yes, part of overseeing the well-being of the mom and the baby, especially for which you were speaking, is to monitor the baby's heartbeat. It's a very simple device called a dappler. It's handheld, and it lets us assess how the baby is doing in labor and how happy they are. So that's done very regularly.

Okay. We appreciate your testimony.

And since many of you are probably here for the first time, just to give you an idea of our, like, format here, when we start asking you questions, it's just technically we address through the chair. So you could say Chair White, Representative Ray, or you could say through the chair to Representative Ray. It's just kind of this thing we do for formality. So once you get to that and if you forget, it's not a problem. I just thought I'd let you know that's kind of how we do things here. So thank you very much. We'll now have Megan Noland up.

Thank you, Ms. Long. Noland, are there any questions for the witness? Representative Bryant Bailey.

Through the chair to Rep. Bailey, I want to say that I possess a letter from the University of Cincinnati Hospital that says they would love to collaborate with me. They give me the number for the line that I would call in the need for a transfer. And so some of the relationships that I have with hospitals are really good. Some of them are less positive. I just had an NBC story that highlighted a story where I called a hospital and they said we don take walk which is I think not accurate but the issue that I facing to be able to open the birth center is that I have to have a transfer agreement with a hospital, and none of them will sign it, citing liability concerns. So I've approached all of the area hospitals within the hour-and-a-half radius, and just two or three weeks ago, the Ohio Birth Center, which was in the same predicament in Columbus, shut down because they were not able to open for the same reason.

So this legislation would allow birth centers that are accredited by the CABC, which is the accrediting body for birth centers. It's the gold standard. It would waive the transfer agreement requirement for birth centers in that instance. As it's written right now, it also would require hospitals that accept Medicaid to sign a transfer agreement. I feel nervous that hospitals are going to oppose that. And I would hope to see, I think the best solution would be to write a transfer plan to make sure that the birth centers have a transfer plan with all the hospitals, but not require a transfer agreement.

Thank you for coming in. I did have a question for you. So you've mentioned Medicaid a few times. So is it your plan to pursue Medicaid funding once your birth center is open or even at home births?

Okay, thank you. And I'm curious also, sorry, I'm curious if you could tell me, Ms. Nolan, how is this law that you're working on in Ohio different than the one you worked on in Kentucky? You practice in multiple states. How is this bill different? And, you know, where are we at with that?

Did you say that the Kentucky bill does not license certified midwives?

Got it. Okay.

I give greetings to the chair and all the members of the committee. Jackie Gruer, and I am from Cincinnati, and I'm also the immediate past president of the Ohio affiliate of the American College of Nurse Midwives. The other nurse midwives are all in clinic today, so I'm here. And I want to let you know that I've practiced for 37 years attending births at home, in birth centers, and in the hospital, as well as providing well-woman gynecologic care. Throughout my career of attending births, I worked with traditional midwives for whom I have a lot of respect. I'm here to impress upon you how House Bill 537 can improve Ohio's maternity care services. According to the March of Dimes in 2025, Ohio ranked 48th nationally in infant mortality and 37th overall for maternal and infant health. I think these rankings are totally unacceptable, and I think they're totally preventable. In 2018, a multidisciplinary team of experts in research legislation, BIRTH, came together and scored states on laws and regulations that support or limit midwifery access to insurance coverage and smooth access to advanced care when needed. Ohio ranked 46th amongst these states. When midwives are integrated into a state's maternity care delivery system, there are higher rates of spontaneous vaginal birth, lower preterm birth rates, lower rates of low birth weight, and significantly higher breastfeeding rates. The study was corroborated in 2024. I submitted two charts with my testimony that come from this study. The upper chart, it should be on your notes. The upper chart shows the regulations in dark purple where midwifery is well integrated into the health care systems. It's the green states, which are most of the dark purple states, have lower infant, lower neonatal mortality. And the red lines where midwifery is not integrated show where the rates are highest. The percent of black births per state is in the orange chart. The darker states have the greater number of black births happening. And the green outlines, again, show where the infant mortality is the best and the red lines where they are not. And you will see that they also correlate with where midwifery is integrated. So it's also been shown that hospital environments protract essential care when transfer is needed. It's House Bill 537 licenses CMs, which are certified midwives, and certified professional midwives, and certified international midwives. This creates access to a greater midwifery force. CMs are licensed in 12 states. they take the same boards as certified nurse midwives. They have the same education of bachelors, masters, sometimes doctors of nursing practice or PhDs, and they're just not nurses first. Accredited freestanding birth centers are proven providers of maternity care. House Bill 537 eliminates the need for a written transfer agreement with a hospital, but maintains the integrity of a transfer plan. Home birth and birth center midwives typically provide newborn care to the extent of our training. We also follow the mother and the baby throughout the postpartum period. Initially, there are daily contacts, including home visits. We examine and assess both the mother and the baby. How are they doing physically and emotionally? How is breastfeeding going? Is the baby gaining weight? We recognize the mother and the baby as a dyad, and they deserve care as such. Newborn care is not recognized for certified nurse midwives in the current legislation. HB 537 acknowledges the education of certified nurse midwives and certified midwives by recognizing our ability to provide newborn care to the extent of our training.

Okay. 537 has been the work of a coalition of midwives, and I thank you very much for your attention.

I have Representative Sarah Fowler-Arthur. Thank you, Madam Chair. Thank you for your testimony. and I realize this question may go to some of what the previous witness said as well, but in your fourth bullet point you say that this language will make the accredited freestanding birth centers more accessible. Do you believe that this bill would enable some of our more rural areas, such as the area that I'm from, to be able to have additional birthing clinics or centers where women can receive maternity care?

Thank you very much, and thank you, Madam Chair. So I have one birth center in my district currently. I represent Asheville and Geauga counties, and I believe that the birth center that we currently have represents or currently serves primarily Amish and Mennonite women. I guess my question is with the language in the bill allowing the transfer plan how how would that impact if we don have any other maternal hospitals for the individual to be transferred to Because I currently live in a county that doesn't have any maternity services available. It's like an hour and a half to the nearest hospital that provides that. I'd love to see some of these services available for women, but how would that work when we don't have a hospital available?

Thank you.

Thank you for having me today. My name is Dr. Rebecca Keys. I'm a perinatal chiropractor with a focus on emotional stress. I'm also a board member of the United Birth Coalition. I work with women during their pregnancy and postpartum period. I recognize birth as a normal physiological process, a process that a woman's body is built to do. Childbirth deserves respect, safety, and security When I was pregnant with my own babies I wanted to work with providers who met this level of respect and security Which is why I chose to work with midwives I'm a mother of two sons Both of my babies were born at home Under the care of a certified professional midwife The basic level of care provided by my midwife Included regular 60-minute prenatal and postpartum visits To discuss my physical and emotional health nutrition to check my vitals and assess my baby's health. Because of these extended visits, I was able to ask any questions without feeling rushed, and I developed a strong relationship with the person who would be caring for me during the most important experiences of my life. We even had a prenatal home visit to get familiar with the birth environment. A core pillar of a safe delivery is that the mother feels safe in her environment. For me, there was no place safer than my own home. To have the choice to birth my babies in my own home meant everything to me. My second baby was born at 42 weeks. During the last two weeks of pregnancy, a time where many mothers choose or are pressured into an induction, I felt in control of every choice that I made. My midwife explained all of my options and supported me through every choice, while ensuring that my baby and I remained in good health. During labor, we discovered my son was rotated in a difficult position, which led to a swollen cervix and a cervical lip. My midwife calmly coached me through position changes and pushing around the swelling and cervical lip and ultimately birthing my nine baby in my own bed While his birth was a difficult feat requiring immense physical and mental strength, I felt fully supported by my team to honor my wishes of a home birth and a healthy delivery. My midwives remained calm throughout the entire labor, and I felt safe and secure in their care. With their knowledge and calm presence, I was able to meet my son from a place of empowerment, which no doubt has carried into my postpartum experience. Where our children are born matters. The experience mothers have during labor matters. The safety and empowerment a mother feels birthing her baby with the freedom to make her own choices can change the course of her postpartum experience and the first few months of her baby's life. It matters to the mental and emotional state of the mother and her ability to provide for her new baby. It matters to the ability to produce milk and get rest. It matters to the stability and security of her baby as they adjust to life outside the womb A mother's birth experience should always be her choice when possible And providing more opportunity for women to choose their birth setting Whether it be at home, at the hospital, or at a birth center And be under the care of midwives will have a ripple effect of improved maternal and infant health outcomes The importance of which cannot be overstated I imagine a world where mothers are given more opportunities and empowered through their birth experiences would be a very different world indeed. Thank you for your time and attention.

Good afternoon, Chair White, Vice Chair Salvo, Ranking Member Letty, and the other committee members. My name is India Stringer. I'm a community midwife and birth assistant serving the greater Cincinnati area. I've been a birth worker since 2020, and I started my midwifery apprenticeship in 2021. I finished it in 2023, and I became a full-time midwife at the Cincinnati Birth Center, working with Megan Alland. My perspective is both personal and professional. I experienced a traumatic birth and postpartum period due to a lack of adequate medical support and advocacy. Now as a midwife, I understand that my experience could have been very different with access to midwifery care. That realization drives my commitment to expanding safe, accessible, and patient-centered maternity options in Ohio. House Bill 537 provides a much-needed licensing pathway for certified professional midwives and certified international midwives, while serving the important role of traditional midwives. This balanced approach ensures that families maintain the freedom to choose the type of care that best meets their needs. This legislation is especially critical as Ohio faces increasing maternity care shortages, particularly in rural and underserved communities. By expanding access to community-based midwifery care, House Bill 537 helps address the growing number of maternity deserts deserts and improves outcomes for families across the state. Additionally, House Bill 537 helps clarify the legal status of home birth, expands access to midwifery services, and advances the broader conversations around insurance coverage and affordability. It also removes significant barriers to the establishment and operation of freestanding birth centers, increasing safe and out-of-hospital birth options for families. House Bill 537 is a necessary step toward improving maternal health outcomes increasing access to care and ensuring that all Ohio families have safe and respectable birth options I urge the Ohio legislator to recognize the importance of this bill and move swiftly towards this passage. Thank you for your time and consideration.

and I appreciate your testimony, Ms. Stringer. Could you clarify for us? So you mentioned you're a certified midwife.

Okay, so just to clarify, right now you are in the category of traditional midwife.

Pursuing the CPM.

Okay, and so the differences in the level, what are you going to need to do to get the CPM? I'm trying to compare the different midwives who are testifying today. So one of them mentioned the average is three to five years experience for a traditional midwife. It looks like you had a shorter experience. Could you tell us what your experience was like and what your requirements will be for getting the CPM?

continue with care. Thank you. And just as a follow-up to kind of, for me to have a general idea, what is a birth assistant that you started from? What was the training required for that? And then in terms of the number of hours before you were on your own, the number of hours of training, the number of births you participated and took a lead role in before you were on your own. And then what are you doing to get the CPM? What is the path you're taking to get that?

And during that time, you were observed by a midwife in your primary.

What do you have to do in order to get that? Thank you for asking.

And I don't mean to belabor the, no pun intended, belabor the point, Ms. Stringer, but I guess what I'm trying to figure out, so you are currently a community midwife and doing wonderful things. You're just basically using your experience as a community midwife to be able to take a test to become a CPM. You're not taking additional coursework or having any additional requirements?

And each of those classes is eight hours, did you say?

Thank you. So you do them on your own. All right.

Absolutely. All right.

Thank you.

Chair White, Vice Chair Salvo, ranking member Lett, and members of the committee. I brought my wrong readers this morning, so bear with me. My name is Tanya DeMa. I serve as the co-founder and chair of the Safer Birth Foundation. I am here as a grandmother who has lost her first grandchild at birth and a woman whose family legacy has been defined by the maternal health crisis. I am writing in strong support of House Bill 537, which the passing of the legislation, our foundation cannot fully, I should say without the passage of this legislation, our foundation cannot fully operate as a birth center to serve the historically underserved and priority populations of Hamilton County. House Bill 537 provides the common sense regulatory relief and professional recognition necessary to open doors that have been closed in our community far too long Removing the transfer agreement barrier, currently birth centers face an insurmountable hurdle in securing mandatory transfer agreements with hospitals. HB 537 removes the requirement for CABC accredited center and mandates that hospitals accepting medical must sign these agreements. Without this, our center in Juana Hills, a neighborhood where I grew up and where my mother struggled to find care, cannot open its doors. A licensure for CPMs, the Cincinnati Birth Center, is owned by a certified professional midwife, a CPM. She is currently restricted in her ability to serve as a primary provider. This bill creates a pathway for her licensure that would allow her and others with her credentials to attend births at our center as primary providers, ensuring that women in our community receive care from providers they trust. Expanded scope for nurse midwives by allowing nurse midwives to provide the newborn care they are already expertly trained to perform, this bill streamlines the birthing process and ensures a continuity of care that is vital in the first hours of a child's life. Our foundation is located in the 45206 zip code, and that area has historically been a food desert. I watched my own mother, a pregnant diabetic, struggle to find nutrition she needed in the Avondale, Evanston, and Juana Hills areas, where I might add the infant mortality rate is at 13.7. It has increased since 2023, which was at that time 9 point something. We provide fresh produce and scholarships for doula care because we know that survival should not be determined by your zip code. It shouldn't matter. House Bill 537 is the key to making our vision a reality. It allows us to provide a safe, accredited, and accessible place for women on Medicare and Medicaid to birth their children with dignity. I urge you to pass this bill during Women's History Month, I should add, that we can begin the work of lowering the infant mortality rate in Ohio once and for all. Respectively, Tanya DeMoss, co-founder and chair of the Safer Birth Foundation, vice president of the Cincinnati Recreation Foundation, and much more. But thank you all so much. And I just want to add that I think that it's profound that we're all here today as women and men. I believe all mothers deserve a safe birth. Fathers deserve to have their children born safely. And children deserve to have the right to have a safe birth. We have the power. We have not had this power in the past. we stand here with power that we need to execute to make a difference in the lives of everyone. This touches everyone. Mothers, fathers, grandmothers, uncles, aunts. I lost my aunt.

Thank you very much for coming in. I'll turn to Representative Sarah Fowler-Arthur.

Thank you for your question. And yes, there should be, mothers should receive the advice from their midwives because they've trusted them in the beginning, right? And so, yes, I think that should happen. What was your other question?

Thank you.

Absolutely, and I'll tell you why. My daughter-in-law was healthy. She had a healthy birth. There was no complications. For some reason, they decided to induce her labor and bring her in when her doctor was out of town at a wedding. And that made me, you know, signals go up for me. She told me, oh, don't worry, everything's going to be fine. And it was not. I think because she was young, and at the time my son and her were not married, I just thought, in my mind, I just think they did not listen to a little young black girl on welfare. And I think they made the decision of what they wanted to do, what was going to be most convenient for them. and she never talked to me about it until about two years ago. And she said to me they just wouldn't listen to me. They never listened to me when she said that she didn't want certain vaccines, when she said that, you know, let's say she didn't have transportation to come in. She just said that she just didn't feel listened to and she didn't really feel safe. even when they asked her to come in and have her pregnancy induced, she never told me. Like, it just happened, right? And so she was intimidated. She was intimidated by the doctors and the nurses that did not look like her. And I'm just going to say that to make it clear because the birth rate in Hamilton County is at, I don't want to get the numbers too wrong, But it 13 per thousand the mortality rate for black women but it at about nine point something for other women So I don understand why we living in the same area and there this discrepancy My sister lives in Atlanta, Georgia. She had all five of her children by a midwife. The last one, she had a water birth. And at the time, I wasn't having babies. I'm 58. So at the time, my sister was having all these babies. I was like, oh, I don't know nothing about that. That sounds interesting. But then it hit my front door. And had I listened more to my sister and learned more, I could have made that recommendation for my own granddaughter. And that's why I'm here, because I believe that knowledge is power, and I believe that we need choices. We have several choices when it comes to shopping and buying clothes and shoes and handbags. We should have more choices when it comes to doing the most important thing that we'll ever do, which is give birth.

Thank you, Madam Chair. Thank you for sharing that. So I just want to make sure I'm understanding correctly what you're saying, is that even if she did have some sort of medical complication, that she would have felt more supported by having a midwife along with her for those appointments or for the care, and that you believe that the support would have been a positive impact. Am I understanding that correctly?

Thank you. Are there any other questions?

Yes.

No. The Safer Birth Foundation is part of the Cincinnati Birth Center. I met Megan, and she came into my furniture store, long story, and when she began to tell me about the work she was doing, and I began to say to her, we're glad to have you in our community, but I'm afraid that many of the women in this community may not be able to afford your services. And then she sat down with me and said, what can we do about it? And she worked with me to start the Safer Birth Foundation, and I'm very grateful for that. And I'm working to collaborate with Queens Village and other birth centers. But, no, I'm not going to open a birth center. I'm going to keep growing this work, and we are hoping to one day be able to grow the doulas, midwives, and lactation consultants to make sure that they're young. I'm an educator. I work for Cincinnati Public Schools. I would love for some of my students to become male wives, lactation consultants, doulas, things of that nature, because that's going to continue to help us lower the infant mortality rate. Thank you very much.

Hello. Chairperson White, Vice Chair Salvo, Ranking Member Lutt, and members of the House Children and Human Services Committee, thank you for giving me the opportunity to testify today as a proponent of House Bill 537 as it's currently written. My name is Bobbi Boyd. I'm a certified professional midwife. My educational route to become a CPM was enrollment in midwifery college, an apprenticeship where I attended over 250 births and took the National Midwifery Board exam through the North American Registry of Midwives. I've been a CPM for 20 years. In my experience as a midwife, I have been licensed in the state of New Mexico and am currently attending home births and birth centers in mid-Ohio. I also serve as the director of a religious exempt birth center called the New Bedford Care Center in Coshocton County. That currently delivers about 250 babies a year. If given the opportunity, I would choose to become a licensed midwife in Ohio. Today I speak on behalf of the community midwives of Ohio as their president. CMO is a 501c6 midwifery-led organization formed to advocate for the protection of practicing rights of all midwives. CMO is the largest direct entry midwifery organization in the state. The midwives in the group include traditional midwives, certified professional midwives, and certified international midwives. CMO represents over half of Ohio's current practicing midwives. Direct entry midwife is an umbrella term that encompasses all types of midwives that are not nurses. CMO understands it's very important to preserve the art of traditional midwifery in Ohio and at the same time expand midwifery care by creating an avenue for licensure for CPMs and CIMs. Home birth and freestanding birth centers are a safe option for women and babies. There are several studies that prove this. One study reviewed over 500,000 planned home births, and the outcome was that they are associated with very low and comparable rates of perinatal death, reduce rates of obstetric interventions and other adverse perinatal outcomes. In the United States, 37 states and the District of Columbia have instituted licensing for direct entry midwives. It's time for Ohio to join what the majority of the United States is already offering for midwives and families. Licensure in House Bill 537 would do the following. Increase safety standards and accountability set forth by the Licensed Midwifery Advisory Council. Licensing requires midwives to meet educational training, competency standards by accredited midwifery education, including clinical training and passing certification and continuing education. Licensure would provide consumer transparency through regulated disclosure forms, written protocols, outcomes reporting, while also giving consumers the ability to file complaints and pursue disciplinary action if care is unsafe, and will make Medicaid and insurance coverage available, making midwifery services more affordable. Licensure will allow for better integration with the health care system by enabling midwives to order lab tests, access necessary medications, and facilitate better coordinated transfers between providers, ensuring continuity of care when necessary. Community midwives of Ohio are dedicated to protecting the rights of diverse types of midwives while advocating for safe accessible midwifery care for Ohio families House Bill 537 allows for traditional midwives to continue providing care for their communities while expanding a pathway for licensure for certified professional midwives and certified international midwives. Licensure strengthens and preserves autonomy and diversity of midwifery practice in our state. By passing House Bill 537, Ohio has the opportunity to join the majority of the United States in supporting midwifery care. Thank you for taking the time to hear my proponent testimony. On behalf of Community Midwives of Ohio, we ask for an expedient passage of House Bill 537.

Representative Miller. Thank you, Chair White. And, Bobbi, I'd like to thank you for coming and for your work representing these wonderful ladies. And I don't mean to stump you. I'm just curious because it sparked my curiosity as you were reading your testimony. You said more than half of the midwives in Ohio are part of your group. Do you know how many practicing midwives, depending on not necessarily a particular level of care, but do you know about how many are practicing in the state of Ohio?

Thank you, Chair, for the follow-up. Again, I didn't mean to stump you. It was just my curiosity right away. I just was curious to know how many we have in the state of Ohio. And then also, I know there are so many great data points and research that shows that midwives do improve infant mortality and maternal health in our state. Can you share maybe a personal story about how maybe you were able to help a mom in your in Coshocton County or any of the ladies that you serve that with some of those positive birth outcomes or success stories?

Anybody else? Yes, I know ranking member Len. Thank you.

Through the chair to representative. That's a very good question. If someone were to have their license and then have it revoked, I don't know the answer to that. Maybe because we haven't established that. Maybe that would be something that would be established in the licensing committee. but I do know as it stands now that the traditional midwives will be required to give informed consent of their education and their background. So hopefully that would be part of the discussion.

Are there any other questions?

Thank you. through the chair to Representative Richardson. As a certified professional midwife, I do have accountability that there is a complaint process through something called the National... What is it called? North American Registry of Midwives. That is who my certification goes through. So there actually is a process to make complaints. and I guess I just have never had this personal experience myself. I work in an area in Holmes County, which is predominantly Amish Mennonite Plain community, and the hospital that I transfer to, the name is Palm Marine Hospital. It's in Millersburg, Ohio, and we have a fantastic continuity of care with that hospital, So in areas where the reception might be hostile, punitive to mothers that are delivering and midwives, I think there could be a tendency to have a delay in care because of the reception From my personal experience I usually transfer early and often as needed, and that reduces a lot of the what you call train wrecks coming in through the ER. We have nurse midwives that we have their personal cell phone numbers we call. We have relationships with. It's really a standard of care, if you ask me, in our community. that it's seamless. We call ahead of time. We tell them that's what's coming. We transfer records. We stay there until the baby is born and then out. So I understand what you're asking, but it hasn't been my experience.

Sure. Do you need a follow-up? Okay. Are there any other questions of this witness? I did want to clarify, and thank you for coming in again. So could you help us the difference between the certified international midwife and the other types?

Thank you. I know it's very confusing, so I want to repeat it for our committees to make sure we're getting this as we go. So my final question has to do, in your mind as a community midwife, you said you would choose licensure. Why is that?

What are some other benefits?

And in terms of that continuity of care, for you, you just have what would be kind of a transfer plan versus a transfer agreement with your facility then.

Thank you.

Thank you very much for your testimony. Okay. We have one more individual. Lisa, well, actually we have two. Lisa Gonzalez. So, committee, we're going to have to limit our questions.

Thank you, Ms. Gonzalez. Are there any questions for the witness? I know I talked about us limiting our questions. Since you did bring up the pharmacological aspect, and when you use the term community midwife, are you talking about traditional midwife when you state that community midwives need a path for ordering and interpreting lab tests, ultrasounds, and administering maternal and newborn medications? I'm curious about what kind of training for ordering and interpreting lab results and ultrasounds and administering maternal and newborn meds?

Okay, so we'll have to go quickly. Hannah, if you want to come up and do your testimony, if you are here. Okay, if you could fill out a witness form after you testify and then just State your name for the record when you come up. Thank you. And the witness forms should be right up there.

I'm sorry.

Thank you.

mortality and how these things make a difference and can and how midwifery can change our communities and help us out. However, the biggest way that we can help how midwifery can help is in a physical standpoint because it is out of reach for most families, if that makes sense. And as people who are here to represent the state of Ohio, families, and human resources, since that is the room that we're in, right, it is our responsibility to do something about that. Home birth tracks consistently to 40 to 60 percent less than what insurance companies are paying for hospital births. Hospital births right now vaginally are running around $12,000, and for C-sections, they're $22,000. Home birth in the state of Ohio right now is running anywhere between $4,000 and $7,000. That is a significant difference on taxpayers' pockets than it is to be paying $12,000 or even $22,000 as our C-section rate continues to climb to almost 50%. $22,000 a birth when you're having over 10,000 children a year in Ohio, that's a lot of money that we could be saving. And if you look at that in a long standpoint right that is millions and millions of dollars that we could be using to fund other programs in the state of Ohio to make all of us Buckeyes just that much more peanut buttery So in my opinion yes midwifery is necessary This House bill is necessary Licensure is necessary because right now I am practicing in a technically illegal illegal standpoint If you are diagnosed in a pregnancy by somebody who, and at the risk of incriminating myself, if you are diagnosing a pregnancy by somebody who's peeing on a stick and you're like, oh, yeah, you're pregnant. Here, let's try to do some things to help you along. That is technically practicing medicine without a license. How dumb is that, right? If you are at home and you're reading your own pee stick and you send it to your sister and your sister says, hey, yeah, I see two lines. Guess what your sister just did? Practice medicine without a license. you know and for licensure for protection for families in Ohio when I heard that you know there are representatives who don't believe that this is happening that shocked me because as a midwife who has delivered over 753 babies and had three home births of my own I cannot understand that and if there's there's nothing to believe when it's readily happening in our communities every single day. I was late here today because I came from a birth. Please support our bill. We need the support. We need the licensure. We are readily changing our communities. Midwifery has changed my family. It has saved my children. And because I had midwives moving forward, and even in my experience, my midwife still made sure to know that I, to tell me what I needed to do and give me the information to go out and find so I could better take care of myself, and because of that, me and my family are better people. And that is how we as midwives are changing our communities, and that is why we need to be licensed. Thank you very much.

Thank you, Madam Chair. Thank you for your testimony. You mentioned the insurance portion. Is that specifically to Medicaid in this bill, or are you envisioning that this would eventually be covered by other insurance carriers, or can you just briefly elaborate on that portion of your comments, please?

And I just wanted to clarify then, thank you for coming in, Mackenzie. Could you tell us then what your training was as far as an educational and classes and coursework to become a CPM, and what training did you have specifically in ordering any lab tests or ultrasounds and doing any kind of medication work?

I appreciate all of you coming in today. If you could just make sure you fill out that form. So this is going to conclude the second hearing for this bill. And we will, seeing no further business, we will adjourn.