Pennsylvania is the sole remaining state to bar certified nurse-midwives from writing prescriptions for their patients. Now, that barrier is about to fall.

Tomorrow morning, Gov. Ed Rendell is scheduled to sign the first laws to come out of his health care reform package, all aimed at making high-quality, low-cost health care available to as many people as possible.

The package, known as Prescription for Pennsylvania, is designed to ensure that all licensed health care providers are able to practice medicine to the fullest extent of their education and training, including advanced nurse practitioners and certified nurse-midwives. The authority to write prescriptions is part of that. (It does not apply to lay midwives, who are trained mostly through apprenticeship and are not licensed by the state.)

The changes in so-called "scope of practice" issues have been a major focus of groups representing non-physician medical professionals. That includes the Pennsylvania Association of Licensed Midwives -- www.pamidwives.org -- and the Pennsylvania State Nurses Association -- www.panurses.org.

"We've been working on this since 1985, when new regulations were written by the state Board of Medicine," said Vivian Lowenstein, a certified nurse-midwife from suburban Philadelphia and president of the midwives association.

The Board of Medicine is comprised almost entirely of doctors, who long have opposed letting non-physicians write prescriptions. Ms. Lowenstein was the first and only nurse-midwife to hold a seat on the board, which occurred from 1997 to 2002.

"We tried to negotiate for prescriptive authority, but the board wouldn't allow it," she said.

"Without Gov. Rendell, the Office of Health Care Reform and our supporters in the Legislature, this change would not have happened."

Amy Kelchner, spokeswoman for the governor's health care reform office, said "Nurses and doctors have been at odds for 40 years on this issue. Coming up with a plan everyone can agree to is very significant. It's also a sign of the times -- everyone knew the governor was serious about Prescription for Pennsylvania and this is a common-sense change."

Most nurse-midwives practice in hospitals such as Magee-Womens Hospital in Oakland because that's where most women choose to have their babies, said Ms. Lowenstein. But Pennsylvania also has five free-standing birthing centers, one in Pittsburgh.

Christine Haas, executive director of The Midwife Center for Birth & Women's Health in the Strip District, said state regulations have been out of step with the education that certified nurse-midwives receive.

"Advanced pharmacology is a core requirement in every nurse-midwifery educational program accredited by the American College of Nurse-Midwives," said Ms. Haas.

Every other state lets them use that training.

"It's been an issue for us in recruiting nurse-midwives to our practice," she said. "When they've had prescriptive authority in other places and find out they would not have that here, it's a strike against us. This really gets us on par with the rest of the country."

Nurse-midwives contribute to higher health standards by delivering lower cost care to women and children, she said -- something the governor wanted to emphasize in his health care reform package.

"Birth centers consistently have fewer C-sections, epidurals, episiotomies and low birth-weight babes," Ms. Haas said. "We have lower incidences of induced labor and premature birth compared to the national average."

That's partly because birthing center clients must be healthy and low-risk. But it's also because the midwifery model of care emphasizes educating women and their partners, prevention, wellness and the use of medical technology only when necessary, not as routine care for normal, healthy labor and birth.

The governor's overall health care plan was introduced as a single bill but the Legislature broke it up by profession into eight pieces. Six of them have passed, concerning nurses, nurse practitioners, clinical nurse specialists, midwives, dental hygienists and physician assistants. Bills dealing with nurse anesthetists and pharmacists are still pending.

The laws don't go into effect until their regulations are written by the Board of Medicine. That will be a yearlong process, and Ms. Lowenstein said members of the nurse-midwife profession will be involved in crafting the language.

"The question is whether the Board of Medicine will follow the legislative mandate of writing regulations that are not restrictive," said Ms. Lowenstein. "Many of us will be going to Harrisburg to work on this," to make sure they do, she said.