Signature drive wants Fijian midwives retained

A signature petition will be distributed to the public next week to obtain island-wide support for the retention of the Fijian midwives in the CNMI.

Christi Omengebar, a mother of one, has taken on the challenge of spearheading the signature drive and said Thursday that she will be pressing for the suspension of the requirement for the Fijian midwives to take the NCLEX, the licensure exam for nurses.

Omengebar said removing these midwives would be a tremendous loss to the CNMI, the Commonwealth Health Center, the families, the future mothers and their future babies. “Because the care you receive from the midwives is totally different from what you receive from an RN [registered nurse],” she said.

Omengebar said the Fijian midwives have special training and each of them have their own credentials. She said she could not see the reason why the board has force the midwives to take NCLEX. She said the licensing exam is insufficient to measure the skills of the midwives.

Commonwealth Board of Nurse Examiner chair Rosa M. Tudela explained earlier that nurses or nurse midwives who are graduates of a foreign nursing school will be allowed to practice nursing in the Commonwealth without taking the NCLEX for a period of no more than three or four years, depending on when the nurse’s license fall in the licensure cycle.

“After three or four years…the nurse has to take and pass the NCLEX to continue practicing as a nurse or nurse midwife in the Commonwealth….If a nurse or nurse midwife…takes the NCLEX and fails such examination, the license by foreign endorsement shall be subject to immediate revocation. The nurse or nurse midwife will not have a license and the only way for this nurse or nurse midwife to be licensed again to practice nursing in the Commonwealth is to take and pass the NCLEX,” she said in a letter to the Saipan Tribune.

Leticia Lochabay, a certified nurse midwife since 1998 and a former manager of labor and delivery at the Division of Public Health, also expressed concern in a letter to the Saipan Tribune, saying the NCLEX is designed to test nurses—not midwives.

Lochabay said all of the midwives employed by the Commonwealth Health Center’s hospital division have specialized training in midwifery as well as years of experience—whether they were previously registered nurses who passed the NCLEX, were “grandfathered” into the licensure process, or have endorsement from the midwifery education program in Fiji.

“The NCLEX does not certify midwives and does not examine the core competencies (the skills and knowledge base) of midwifery as set out by the International Confederation of Midwives or the American College of Nurse-Midwives,” she said.

Lochabay stressed that midwifery includes some nursing knowledge and skills, but midwives do practice as midwives without being nurses all over the world. She said U.S. certification as a registered nurse is not necessary for a midwife to safely practice midwifery.

“While the NCLEX is an appropriate tool for setting standards for professional nursing at the entry level, it is an inappropriate tool with which to certify midwives to practice midwifery. The NCLEX does not address the competencies of midwives and does not adequately assess the skills and knowledge base of midwives in their areas of practice.

“It is a case of apples and oranges: while both are fruit and taste sweet, they are inherently different. Neither the apple or orange is better than the other; they share some commonalities, but key differences exist that make one an apple while the other is an orange.

“The Fijian midwives, like other midwives, are experts in normal labor and birth and work very well with the obstetricians in caring for women who are experiencing high-risk or complicated pregnancies and births. In this setting, they work under the supervision of obstetricians and focus their practice on normal birth and in-hospital care of the high-risk pregnant woman. Their experience and dedication are priceless,” she said.