Gov. Ed Rendell signed the bill in 2007 as part of health care reforms that granted certain health care professionals who are not doctors broader authority to provide basic medical care. But the law went into effect only last weekend, because of the time it took to craft rules to implement the law and complete the complicated final review process.
It's "a sign of how slow it is to get things done in Pennsylvania," said Vivian Lowenstein, president of the Pennsylvania Association of Licensed Midwives.
There are about 330 nurse-midwives in the state, although Lowenstein said only about 250 are practicing.
To be licensed as a nurse-midwife by the state Board of Medicine, applicants must be registered nurses, have completed a midwife program and adhere to agreements with their collaborating physicians. To prescribe medications, nurse-midwives will be required have a master's degree or its equivalent, national certification and ongoing training in pharmacology.
Among other things, the law also allows nurse-midwives to prescribe medical devices, administer immunizations and order laboratory tests.
Previous attempts to give prescription-writing authority to nurse-midwives encountered resistance from doctors, who cited concern about potential abuses.
Don McCoy, a Pennsylvania Medical Society vice president who helped draft the rules to implement the law, said the final version of the bill responded to that concern by requiring that agreements between nurse-midwives and their collaborating physicians be in writing and filed with the Board of Medicine.
Lowenstein said the concerns about potential abuses are exaggerated and that the new requirement that the collaborative agreements be filed with the board amounts to needless red tape.
"This is not about unlicensed midwives," she said. "This is about nurse-midwives."
Lowenstein, a nonpracticing nurse-midwife who still works in women's health care in Philadelphia, said the governor's advocacy of expanding authority for certain non-physician medical professionals was crucial to the bill's passage.
Rendell and his Office of Health Care Reform "were the catalyst to make this happen," she said.
McCoy said the exodus of obstetricians and gynecologists from the state because of rising medical malpractice insurance costs also helped build support for the bill.
"Someone has to fill that void" for pregnant women, he said.
Even though the law is in effect, the actual writing of prescriptions by nurse-midwives won't occur until after the Board of Medicine develops an application for those who want that authority.
"It's still going to take a little bit of time," Lowenstein said.