Our next Midwifery Scope of Practice Advisory Committee meeting will be Monday (January 14th) from 6-8 pm in the Lab conference room. The Agenda is packed with 2 full hours of information and discussion. We’ll be reviewing data from other states, and what scopes of practice they allow, as well as reviewing our own data collected from the midwives’ quarterly reports along with data from AZ birth certificates. This data will give us a better picture of how many Arizona home deliveries had successful outcomes, and how many required transfer to a hospital for delivery or complications. Two of our advisory committee members will be providing a presentation on a successful midwifery home birth model from the State of Washington, called Smooth Transitions.
We’ll also be going over some interim draft regulations (for discussion purposes) that would allow licensed midwives to (under certain circumstances) attend a delivery at home even if the mom is carrying twins, if their baby is in a breech position, and when the mom has had a previous Caesarian-section (also known as vaginal birth after cesarean, or VBAC). For example a midwife could attend a birth at home even if the mom has had a previous C-section if she’s: 1) had a successful vaginal birth since their last C-section; or 2) it’s been more than 18 months since the last C-section and she had a low transverse incision and an ultrasound that shows the placenta in the right place and growing normally.
Because there are higher risks with these types of deliveries… the draft language has certain conditions. For example, the language asks: 1) midwives to develop an emergency action plan for patients with one of these conditions; 2) the patient is to meet with an OB/Gyn to discuss the risks, adverse outcomes, benefits and alternatives of a home birth for their condition (this is known as obtaining informed consent); and 3) midwives to send the patient’s medical records to the hospital listed in the emergency action plan at 32 weeks. Once the patient goes into labor, the midwife would need to call the hospital to let them know her patient is in labor, and then again after the baby is born or if the mother needs to be transferred for delivery or a complication.
Getting ready for this high-profile meeting has been an effort of teamwork from almost every part of the agency. Thanks to staff from IT (Jennifer Tweedy, Gannon Wegner, and Jesse Lewis) and Preparedness (Paul Barbeau, Tim Singleton and Steven Becker) for setting up the meeting so that it can be viewed on Livestream. Fernando Ortega in Facilities has been instrumental in coordinating for after-hours security and parking. Also, thanks go out to Kristin Feelemyer, Shoana Anderson, and Khaleel Hussaini for developing a special database that we’re using to mine our data. Also, thanks to the Rules and Administrative Counsel team (Patti Cordova and Teresa Koehler) for working hard to provide draft rule packages language for the committee to review, as well as researching other states and their rules and regulations for licensed midwives.
This is just one of many examples of the team work and collaboration within our Department. It’ll result in an evidenced based decision that will hopefully improve birthing experiences and outcomes for patients that want to have a planned at-home birth.
Had there been the ability for licensed midwives to attend VBAC births at home when I had my last birth, I would not had to have had an underground VBAC at home. It would have made my birth much safer if I could have had coordination with the hospitals, but still been able to birth where I felt safe and comfortable.
Director Humble,
I have some serious concerns about the content of this blogpost which causes me even greater concern about the proposed changes that are going to be made in favor of M.D.’s over Midwives.
As to the issue of informed consent, do you mean to tell me that only a M.D. (as opposed to a midwife) can explain to me the risks of what an out of hospital birth would be? A licenced midwife is just as capable of informing of those risks as an M.D.. In all reality, my Midwife is actually in a better position to explain the risks due to the fact that out of hospital births are her specialty. Informed consent is obtained by the provider from the patient after the patient has been informed of the potential risks. Why should my wife and I meet with a M.D., who is not our provider, and give them our informed consent for a birth that they are not going to be a part of? Especially, as per your draft rules, the M.D. is absolved of any responsibility for our care? That makes absolutely no sense. Our provider is our midwife, we chose her and and she should be the professional who informs us of the risks and who then obtains our written and informed consent. Being an M.D. does not make one more capable of providing information to a patient than being a licensed midwife. My midwife can explain to me the risks just as well, if not better, than a M.D..
As to VBAC, Twins, and Breech, you are putting these options in your rules but are making it impossible to achieve. These “conditions” you require, render these options unobtainable. Either you trust the Midwives to attend these births, or you don’t. For example, in your draft rules, requiring that Consumers meet with an OB/GYN before being able to pursue these options, virtually shuts these options down. Additioanlly, the draft rules go on to state that if the OB/GYN does not recommend these options, that a consumer can proceed with it against their advice. But nowhere does it state that in that event, a midwife is still authorized to attend these births. This ommission is extremely important and potentially devestating to a consumer. Regardless of whether a consumer can continue on care with their midwife without the recommendation of the OB/GYN, it is totally unneccesary to force consumers to meet with the OB/GYN. Nothing will be achieved and it will actually cost consumers more, especially those without insurance, to have to meet with the OB/GYN for a birth the OB/GYN was not solicited to be a part of in the first place.
On that same line, as a licensed attorney, I find it hard to believe that any midwife or consumer will find an OB/GYN that will sign the physician consult out of fear of legal liability. While the draft rules seem to attempt to protect them from liability, we all know that it will not stop law suits from arising. In addition, it is very likely that the OB/GYN will need to consult with their malpractice insurance provider to determine if signing that type of consult will increase their premiums or if the insurer will even cover the M.D. in those situations. M.D.’s and medical facilities so often operate and create policies and procedures out of fear of legal liability that it his hard to imagine that this consult will be smoothly implemented or even a viable option. The liklihood of a M.D. taking on more (or any) liability for a consumer to utilize a midwife for an out of hospital birth is beyond imagination.
You state that you are relying on your committee and their recommendations and that you are specifically going to make decisions based on evidence based practices. Please read what the Midwives and Consumers have presented you thus far and compare it to what has been provided in opposition. By and large, their proposals are not rebutted by any research based information that has been documented and provided to you by your medical professional panel members. Just because a M.D. expresses an opinion, it does not mean that it is backed by research. It seems that the burden only lies on the midwives and consumers in this case and that is simply not appropriate.
As a sidenote, having attended some of these past committee meetings, I take extreme personal offense to those statements made by members on your committee that imply that my wife and I, as consumers, are inacapable of understanding the risks of an out of hospital birth, especially after having successfully accomplished one already. It appears from their statements that you apparently need to hold a medical degree in order to make an informed decision. That is ludicrous. Informed consent obtained by my midwife from my wife and I should absolutely end any objection ANY other party should have over our birthing choices (and I am not agreeing that anyone other than my midwife and my spouse should have any ability to object to our personal medical choices). If I want an OB/GYN opinion, I will go seek it out myself.
It is my sincere hope that these rule revisions do not further restrict midwives from providing my family with the care that they are already limited in providing. I am not proposing that medically unsafe measures be approved, but I am proposing that when someone says something IS unsafe, that you look at the research and the comparitive risks of the other options being proposed and determine whether or not the alternative risks are any safer. Midwives should not be relegated to a subordinate of a M.D.. They are seperate professions in their own right and deserve autonomy and mutual exclusivity. The professions should work together, not with one overseeing the other.
Thank you for your consideration,
-Justin
Justin, as licensed attorney you should know the evidence and statistics of home birth maternal and neonatal complications , they are both higher. ( if you read evidence based publications not “experts” opinions – which are the lowest in medical evidence because are susceptible to haevy personal bias.
There is a very good reason to not have this registration and records given to the hospital before hand and it has to do with a recent statute limiting liability. Given the nature of this statute i think it would not be possible to find a doctor or hospital that would agree to these conditions——
Here is the Arizona Statute—–
12-573. Limited liability for treatment related to delivery of infants; exception; definition
A. Unless the elements of proof contained in section 12-563 are established by clear and convincing evidence, a physician licensed to practice pursuant to title 32, chapter 13 or 17 is not liable to the pregnant female patient, the child or children delivered or their families for medical malpractice related to labor or delivery rendered on an emergency basis if the patient was not previously treated for the pregnancy by the physician, by a physician in a group practice with the physician or by a physician, physician assistant or certified nurse midwife with whom the physician has an agreement to attend the labor and delivery of the patient.
B. Unless the elements of proof contained in section 12-563 are established by clear and convincing evidence regarding the acts or omissions of a licensed health care facility or its employees in cases that are covered by subsection A of this section, the health care facility is not liable to the female patient, the child or children delivered or their families for medical malpractice related to labor or delivery.
C. This section does not apply to treatment that is rendered in connection with labor and delivery if the patient has been seen regularly by or under the direction of a licensed health care provider or a licensed physician from whom the patient’s medical information is immediately available to the physicians attending the patient during labor and delivery.
D. For the purposes of this section, “emergency” means when labor has begun or a condition exists requiring the delivery of the child or children.
Why would you contemplate increasing homebirth midwives’ scope of practice when there isn’t a single scientific paper that demonstrates that VBAC, breech or twins can be safely delivered by a homebirth midwife?
Consider the verdict of Marc J. N. C. Keirse MD, DPhil, DPH, FRCOG, FRANZCOG, one of the leading exponents of breech vaginal birth:
“Home birth is a well-established recipe for disaster for a baby in breech presentation and contrary to any sensible guidelines that have ever been developed.”
If an expert on breech vaginal birth says that homebirth for breech is contrary to any sensible guidelines, why are you thinking of allowing it?
I think this is a horrifying idea to allowe CPMs to attend twin, VBAC and breech births. In my state (Michigan), there are zero scope of practice guidelines for CPMs, and we’ve had horrifying results.
This has to be the worst idea I’ve ever heard. Allowing midwives to attend VBACS, twins and breeches is a recipe for disaster. These are serious complications and are better left to professionals who have the training to properly deal with them. Homebirth midwives only have enough training to take on low risk pregnancies, and even that is risky should a complication arise during labor. Women and babies are not well served by this proposal. Please rethink it.
Sure lets have some more neonatal mortality everyone! What a ridiculous idea to allow an expansion of something that is already putting childrens lives at risk.
see: Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Presented at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010. Joseph R. Wax, et al. Am J Obstet Gynecol 2010.
Listen folks; if the argument is about womens autonomy, well lets just keep it that and make decisions on that basis; FUNNY, how this state government wants to deny the ability of a women to terminate the lethally affected malformed fetus, but now is leaning to allow women to gamble with 100 potential years of life expectancy of a perfectly healthy fetus; quite bizzare. Over 20 years of Ob practice in AZ, I’ve lost count of these so called lay midwife attended births gone bad; I hear there’s a baby now with a cooling cap on at a local childrens hospital in the hopes of preventing cerebral palsy because someone decided better to deliver a breech at home. So as far as I am concerned, if the argument is for a womens right to delivery at home, thats one thing. If the argument is about the safety of home birth, well I’m all for it; provided there is a blood bank, an operating room, a surgeon and pediatric providers all assembled in the kitchen!
strongly agree with you.
How long has the human species been giving birth, good thing we had hospitals and surgeons the whole time. At what point did birth become a sickness that needed so many doctors.
Oh; AND an anesthesiologist!
This is from the current American Journal of Obstetrics and Gynecology; the official journal of the Society for Maternal and Fetal Medicine:
Planned home birth: the professional responsibility response: Chevernak F, et al. American Journal of Obstetrics & Gynecology Volume 208, Issue 1 , Pages 31-38, January 2013
SUMMARY:
This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women’s rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth. We start with patient safety and show that planned home birth has unnecessary, preventable, irremediable increased risk of harm for pregnant, fetal, and neonatal patients. We document that the persistently high rates of emergency transport undermines patient safety and satisfaction, the raison d’etre of planned home birth, and that a comprehensive analysis undermines claims about the cost-effectiveness of planned home birth. We then argue that obstetricians and other concerned physicians should understand, identify, and correct the root causes of the recrudescence of planned home birth; respond to expressions of interest in planned home birth by women with evidence-based recommendations against it; refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth. We explain why obstetricians should not participate in or refer to randomized clinical trials of planned home vs planned hospital birth. We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital.
I AGREE.
That statement is disturbing. Women have the right to choose birthing at home without such demeaning language in regard to their decisions. What is a doctor for, except to be there in true need? To treat patients with compassion…with equality and respect, even if there is a disagreement of “safety”.
There are a huge amount of reasons why home is a “safer” option than hospitals. Even so, that is not the issue. The choice of the mother needs to be respected.
It is unfortunate that some midwives view themselves as “wannabe” mini-doctors and hospitals (whether they acknowledge that or not). That particular involvement in birth would, in fact, make it risky and less “safe”.
I have birthed at home twice, alone. I have fear that my right to do so, even without a midwife, will be gone if this attitude of control continues. Doctors and midwives do not own, nor have the right to make decisions about childbirth-the mothers do. That is a concept that needs to…recrudesce
I am writing on behalf of the OB-Gyn Committee of Scottsdale Healthcare. It was recently brought to our attention that the Department of Health Services was reviewing the Scope of Practice for lay midwives and that there is a desire to allow breech, vaginal birth after-section (VBAC) and multiple gestation deliveries. In our opinion this would be a significant disservice to the public and especially to unborn children.
The medical literature is clear that multiple gestations, breech deliveries and vaginal births after caesarians pose increased risks to patients and their pregnancies. The Term Breech Trial (TBT), published in 2000, was an international randomized multi center study which compared 941 planned elective c-sections with 591 vaginal breech deliveries. The conclusions, which were published in The Lancet, revealed a 5.0% risk of neonatal morbity or mortality in the vaginal delivery group versus a 1.6% risk in the planned c-sections group.
The risk of the uterus rupturing in labor after having undergone a prior c-section is 0.7%. Though it may seem like a low figure 1 out of 140 VBAC deliveries will result in a potentially life-threatening condition for both the mother and the unborn infant. It is for that reason that the American College of Obstetrics and Gynecology defines the obstetrical standard of care of having an obstetrician and c-section personnel immediately available to ensure the delivery of the infant within 30 minutes.
In regard to multiple gestations it is a well known that position of the second twin is often unstable and a vertex presentation can quickly flip to that of a breech. Cord prolapses can occur as well. This is an obstetrical emergency in which the umbilical cord comes out before the baby. The results is the compression of the cord by the fetus’s head which prevents blood from reaching the fetus. The only treatment to prevent permanent injury to the fetus is an immediate c-section.
Though we fully recognize the preference for a home birth some women may have there are situations in which the risks far outweigh the benefits of a home birth. In the aforementioned examples this is the case and the welfare of mothers and unborn children needs to be paramount. As practicing ObGyns we have all taken care of patients brought into the Emergency Department after having labored at home … unsuccessfully. When complications arise (as they eventually always do) the resources available in a hospital setting are what will make the difference between a healthy good outcome and permanent injury or death. It is with this in mind that we ask the committee to exclude multiple gestations, malpresentation and VBACs from the scope of practice of lay midwifery.
Respectfully,
Eric Reuss MD MPH
Chairman, Department of Obstetrics and Gynecology
Scottsdale Healthcare – Osborn
Well said, Dr Reuss.
Do you really feel comfortable with the statement “as they eventually always do?” Maybe you should talk with women that have had a vbac or 3 and hear that no, complications do not always arise. Even in the event of twins and breech, complications are a possibility not an inevitability!
I do not want to be cared for by a provider who believes that complications eventually always arise. That is the cause of much over-intervention in childbirth.
As a parent of an attempted breech delivery outside the hospital that ended in disaster, please leave the high risk births to the doctors who have gone to medical school. Or at least to the midwives who appreciate the risks and can attempt these deliveries with their clients IN a hospital where emergency services are immediately available. Please also consider the recommendations of SOGC (Society of Obstetrics and Gynecology of Canada) on the subject of appropriate setting, providers, and criteria for a high risk breech birth. CPMs and out of hospital midwives are not trained adequately to handle these deliveries safely, nor do they have immediate access to the emergency services that are often needed in an instant. CPMs would not be qualified to delivery babies in any other first world country by their current “educational” standards. They claim to attend low risk birth, but now you’re proposing to cross that line. If you notice, many countries who successfully support home birth, are those who have very detailed risking out protocols for the very purpose of keeping high risk mothers and babies safe, i.e. in the hospital for their care. Home birth is not safe for everyone. Should a woman have the right to birth outside the hospital? Yes, but ONLY when she has been fully informed, and that doesn’t mean just by her midwife.
As a consumer I want the choice to choose for myself. I can read, I have an education and I can think for myself. I do not need a “Dr” to tell me what is good for me because many times they do NOT. I have had 2 babies in the hospital and with both of those babies interventions were suggested and encouraged without giving me any information on possible risks. In my opinion that is not informed consent. With my 3rd baby I opted to have a baby at home because I didn’t want to be pushed into something that I didn’t understand the risks of. I did the research, I grilled my midwife and NEVER did she treat me as if I should just take her word for how safe everything was. She was very up front about possible risks and what would happen if difficulties should arise. As a consumer if you want to keep babies safe, allow women to make educated choices. Just because a Dr is a specialist on breech births doesn’t mean he is a specialist on breech homebirths, he cannot be because he has never attended one. Many consumers, like myself, would rather labor at home than be forced to go into a situation where we know we will not be treated like an individual but we will be put on the time schedule of the nurses and staff and be pushed around by “liability.” Our country was founded on freedom, allowing women to choose and have the benefit of a back up team at the hospital IF things go wrong provides for the best possible outcome.
I am outraged that the Dr and medical professionals are only looking at the stats!! You guys have great points but none of then have made a case for me? Home birth is an amazing choice for a family to choose and it would be a sad day if that choice was taken away from them. If a family or myself wants to have a Midwife and a birth at home, that is my choice! I am not stupid or uneducated because I want that, just means I have researched and came to the right choice for me! I have the freedom to choose and I wish Dr and insurance companies would stop picking the best care for me while I am pregnant! If I am healthy and baby too, then let me be! High risk should be seen by OB or Perinatal specialist, and deliver in the hospital! Everyone else should have the choice, where and with who
A few things…
1) Medical professionals referring to all non-CNM midwives as “lay midwives” instead of acknowledging the CPM credential or licensing is a political ploy. Lay midwives are those who have learned exclusively through apprenticing. CPMs and Licensed Midwives have completed formal training in midwifery that meets the criteria for the North American Registry of Midwives or their state, respectively. They are not “lay midwives.”
2) So much of medical practice is dictated lately by either malpractice fear or other non-medical factors. This is not a criticism of doctors; mainly a statement of fact. Because of this, however, women are often subjected to unnecessary interventions that can impede the natural progression of labor and have ill effects on the newborn baby. These are not usually seen as crises, as the hospital also provides ways to “fix” the problems caused by their interventions. In no other field of medicine have I heard of doctors intentionally impeding healthy care simply because they can fix it later. Mothers deserve choices.
3) Much of the VBAC hysteria came from a time when overuse of inductions in VBAC labors, particularly via Cytotec (which is not even approved for use in labor induction), caused ruptures. Additionally, given that most of the research today on VBAC is conducted in hospitals in which continuous fetal monitoring, limited movement, induction, pitocin augmentation, and other interventions are the norm, it is difficult to get good numbers on the actual safety of VBAC in situations in which interventions are not the norm.
4) In many places, particularly in small-town hospitals, women are flat-out denied TOL for VBAC or twins, no matter what the research says. If hospitals are not going to truly give birthing women (even VBAC and twin moms) options and choices about their own care (ever heard of “informed consent”?), they deserve the right to seek out care elsewhere. To deprive them of the one chance they may actually have to avoid unnecessary interventions (including major surgery) is unethical.
5) In situations where the OB backup provider works professionally with the midwife providing homebirth care, the transfer to the hospital need not be stressful and antagonistic. Working positively with the midwife ensures that the OB is up-to-date on the woman’s health before magically seeing her in the ER.
6) Banning midwife care at twin and VBAC homebirths will no more stop twin and VBAC homebirths from happening than banning abortion means that women will not terminate their pregnancies. It simply means that they’ll be doing it alone at home without appropriate care to deal with potential complications, and CPMs are trained in how to deal with most major complications that can arise in a homebirth setting, as well as in how to recognize when a transfer to hospital care is the right course of action.
7) When I was planning my own birth for my last pregnancy (twins and VBAC), I called EVERY doctor in an hour drive radius. Without even meeting me, all confirmed that they would not even consider attending a twin VBAC in the hospital, even though there is research indicating that twin VBACs should be allowed a trial of labor provided certain conditions are met. Even with 2 prior vaginal births, a lower transverse uterine incision, 4 years since my cesarean, 2 vertex babies, etc., nobody would give me a chance. During my prior cesarean I experienced a medication reaction that caused it to be extremely traumatic and dealt with 2 years of PTSD, so I was not willing to submit to unnecessary surgery (though I was willing to do it again if there were any medically-indicated reason to). Luckily, I ended up finding a skilled midwife in another state who had extensive experience with both twins and VBAC as well as extensive clinical skills, and I was able to travel to another state at 36 weeks pregnant to have my birth there. Had I not found a midwife and been able to use my tax refund to pay for her services, I would have considered an unassisted birth. These are not choices women should be forced into. As it turned out, I had a safe homebirth of my twins at 38+2 gestation, and my midwife skillfully handled the few complications that arose (including a postpartum hemorrhage and manually removing clots from the uterus) at home.
The language of this proposal has built into it conditions for ensuring smooth transfer of care should it become necessary. Although, asking an OB to explain the risks and benefits of home birth to a patient is sort of like asking an orthopedist to explain the risks and benefits of chiropractic care– they are two separate, distinct, and different fields of practice that should each be entitled to self-regulate.
Ultimately, though, women deserve choices about their own care. Allowing them choices about their VBAC and multiple pregnancies should be no different.
Over the years, I’ve talked with many people about homebirth and there is one thing that really stands out. The vast majority of people, whether laypeople, journalists, legislators or even homebirth advocates themselves, don’t realize that homebirth midwives aren’t real midwives.
They don’t know that homebirth midwives (certified professional midwives or CPMs) are a second, inferior class of midwife that exists in no other country than the US. CPMs lack the education and training required of ALL other midwives in the industrialized world.
The CPM was made up by lay midwives to award to themselves. The requirements are so lax that it was only within the past few months that a high school degree became a requirement. No education and no training is required, just attending a few deliveries, taking a test and paying a fee.
CPMs lack the education and training required of midwives in the Netherlands, the UK, Australia, Canada and other first world country that incorporates homebirth into midwifery practice.
If no other country licenses a second, inferior class of midwife, why should we?
You really shouldn’t lie. ” . . . just attending a few deliveries, taking a test and paying a fee” is a lie. How many births do they really need to attend? Do you know the answer?
I find it appauling that you as a professional would write in a manner degrading a practice that is based off of liberties and freedoms for mothers and families to make a decision on how they want to birth their child. This is a country thats foundation was built upon giving its citizens the right to choose. You sit here and spread lies about the education process of a midwife and their knowledge within this scope of practice. I would love for you to compare statistics from home births and hospital births and I would also like for you to explain the differences in conditions that a mother goes through between the two. For you to blatantly demish the knowledge of one person to make yourself superior shows a lack of respect for not only the midwives but OBs also. If it is your opinion that home births are more dangerous and have negative side effects please enlighten us on the stats and how your experience in both areas makes you an expert to make a judgement for both sides. I am for a free society that this nation was built upon and with that a mother should have the proper knowledge of the choices that she can make. With someone like you and your statements you are makeing it difficult for some women to be able to make an informed decision on their health and the childs health. I think you need to really rethink your stance on why you became a doctor, because I know why I do what I do and it is not to make my life better or my name bigger, but it is to ensure those that I take care of get all of the information from an unbiased source to ensure that my patient/client can make the best decision to ensure the best health for families, it is about the mother and child not your name or the hospital or the pocket book. I hope that we can rise above the negativity that is brought by those to ensure their agenda is met. Remember the beautiful babies that we want to raise for our future.
I read through your blog and once again I am floored that you are a professional and speak of one of the most amazing gifts that god has given us like it is a disease. I will keep this one short, and as the professional that you are I hope to actually recieve an answer from my questions. Why is it that you show pictures of babies that have died from homebirth but are not showing those from a hospital birth? How long has modern medicine been around for pregnancy and how long has the human race been giving birth to children? Why do you treat a birth like it is a sickness? If midwives are uneducated and know nothing of birth than why is it not your stance to teach? You state that medical professionals are against home births, is this based off of feeling or statistics? As a doctor is it not your obligation to inform your patient from an unbiased stance and give them the right to make their own choices about their own bodies? What makes your education and training far superior to midwives? Thank you for taking the time to listen and hopefully answer what I feel to be legitimate questions, I will leave with a quote by a doctor who took care of my child who was a NICU baby ” A mothers intuition far outweighs any doctors degree”
I strongly agree with point 5 and 6. There needs to be a mutual respect between midwives and OBs so that women can truly be cared for.
Dr. Reuss,
The fact that many OBs have seen women brought in after attempting to give birth at home is a sign of a responsible, caring midwife who knows her limitations. That should certainly not be used in an argument against expanding their scope of practice.
-Melinda
Exactly! In addition to my homebirth experience, I have had a homebirth transfer that ended in cesarean. The fact that my midwife immediately took me to the hospital indicates that the backup plan works, not that homebirth fails.
Now would we call a transfer from a regular hospital birth to a c-section a failure on the doctor because if so statistic wise hospital births are failing.
By taking away choices for mothers in AZ, the state is effectively guaranteeing some of these mothers will seek out care with unlicensed midwives or put themselves in less-than-ideal situations.
I live in a town in AZ that only has a small hospital that does not allow any VBACs for any reason. A licensed midwife can’t attend my birth, even though there is a midwife just down the road from me. The next closest hospital is a 90 mile drive (and they do allow VBAC.) The closest birth center can’t allow me to give birth there. Am I expected to consent to an unnecessary surgery because I can’t use a midwife for the birth I want? Some women will do that but others will find an alternative, such as an unassisted birth or using unlicensed midwives.
I can not for the life of me figure out why a woman that chooses to VBAC at home, give birth to multiples at home, or birth a breech baby at home has to obtain informed consent from an OB/Gyn in order the have a midwife attend her birth. Midwives are the experts in home birth, not OB/Gyn’s
This says to me that the state trusts midwives to attend these types of births, but not to inform their clients properly???
Director Humble,
As part of these discussions, it is imperative to remember the rights of individuals to make decisions based upon their own risk-benefit analysis. No doctor, of any profession, is allowed to force their wishes of care upon a person. The health care provider, instead, is obligated to give informed consent to the individual directly in their care, and must step back to allow the individual freedom of choice. Mothers birthing children should NOT be subject to any other conditions or requirements-it is their SOLE decision, and they must live with the outcomes of their choices as anyone else is expected to.
A doctor who is interested in forcing their way of care onto a patient, I would argue, has ulterior motives, financial or otherwise, and their bias must be considered. A mother should have her freedom of choice in healthcare options and that right should be unequivocally protected by law, regardless of her birthing circumstances. By placing undue restrictions on mothers, they are left with poor choices and can not seek proper care.
I am a mother of two, middle- to upper-income, college educated, who birthed my first, and will birth my second at home in March. Please do not allow me to be classified as a “dirty”, “uneducated”, “poor” woman who must be saved from herself. I assure you my choice of home birth was a well-educated decision. Please, Director Humble, protect my rights to make these decisions for myself in the future!
Thank you for your time and consideration
I should not need a waiver from ANYONE to have a home birth. What happened to a woman’s right to choose? We always talk about a woman’s right to choose regarding her pregnancy; why is her birthing any different?
Give Women their choice!
Or you probably will have many lawsuits on your hands! :/
I believe in a woman’s right to choose.
As someone who has had both a hospital and a home birth I have seen both sides. I’m not here to bash hospitals (as I do feel they serve a purpose when needed), instead I’m here to stand up for women and what should be their right to chose- not only where they birth but also who attends that birth.
Licensed midwives provide consumers such as myself not only the ability but the safety of their training and knowledge to allow women to have the birth experience of their choosing. We’ve done our research. We’ve decided what risks we are willing to take. You’re essentially trying to take away our freedom to choose.
Some of these rules and regulation changes you are trying to implement would take away a midwife’s ability to provide this service that so many of us women desire. You can’t tell a midwife she needs a doctor to sign up to provide back up care, if necessary, without making the doctors provide that signature.
Also, If a woman wants to have a VBAC, birth muliples, or a breech baby in the comfort of her own home with the care and security a midwife provides… that’s our right to. Don’t take away our freedom over our bodies and our births!
Many times it has been said or implied that women/families choose home birth because it is the less expensive option. While I don’t know any families who have birthed at home for this reason. (I know over 200 home birth families.) I do know families who have either excellent insurance (50$copay for a hospital birth) or whose income qualified them for a state-aid birth and yet they will pinch pennies, barter and go into debt to birth at home with an LM.
I am also all for a women to have the right to choose. I too have had both a hospital and home/water birth and I do understand the potential problems that may arise in the event of a breeched baby or VBAC, however, we also need to understand that the licensed midwife is trained to attend these types of births which is why the state has approved a license to perform such procedures.
Maybe one of the things that should be included within the State licensing is that the midwife must attend a “safe” amount of these procedures prior to acquiring her license.
Of course, there should always be an emergency plan of action as you stated in the conditions you have. All home births should have these conditions regardless of her condition. This will only provide a safer outcome to the mother and child in case of ANY minor or major emergency.
Wow. Look at all these people who believe they have more authority over my body than I do. Normally I don’t stoop to ad hominim, but I think it’s important that those on this committee realize that these kinds of statements are misogynistic. The ONLY person who should be making the decision about where, how, and with whom a woman gives birth is THAT woman. Because SHE is the one who has to live with the consequences of the decision 100% of the time. As someone who’s had to suffer the consequences of someone making a medical decision on my behalf and against my will, I’m terrified the the committee will listen to these misogynists in favor of protecting women’s rights. Please alleviate my fears.
And by the way, most midwives I know will refuse a client who’s only choosing homebirth to save money.