THIS ISN’T LITTLE HOUSE ON THE PRAIRIE BIRTHIN’
This is a guest post from a “Post Modern Midwife.”
21st century midwives who provide out of hospital maternity services are trained, educated primary care providers who often have relationships with physicians and other care providers to offer full scope care. A post modern midwife accesses technology as appropriate and consults in an independent fashion as necessary to provide evidence based care with great outcomes.
As the Big Push garners more and more visibility on a national mainstream level, and OFSB becomes more visible on a state level, there will be more citizens who see our publicity and legislative efforts and have visions of what I call “Little House on the Prairie birthin’”. We need to make clear that midwifery is not tribal woo woo, nor the practice of medicine, but its own independent field grounded in evidence-based practice.
Women with major health problems such as heart disease and type I diabetes which can cause serious complications in pregnancy and labor are not good candidates for out-of-hospital birth and will either self screen out or a midwife would screen them as too high risk for an out-of-hospital birth.
As well, every prenatal visit with a midwife is in fact a screening visit, looking for potential problems that could risk a women out of home birth. Because of this very intense screening process and preventative model of care, families with major problems or risk factors are not tossing the dice on a birth outside of a hospital.
Midwives monitor mother and baby via intermittent fetal monitoring and other assessment means, just as a hospital does. Problems do not fall out of the sky, they develop with plenty of time for response. The Obstetrical Standard of Care is “Thirty minutes from Decision to Incision”. Out-of-hospital birth with a qualified attendant in relationship with her community health services provides the ability to adhere to this standard.
It is important for the general citizenry to understand that the way to protect families is to provide regulation and mandate minimum standards of training and experience for midwives to ensure public safety. No one is trying to convince anyone who doesn’t want to have a home birth, we are just trying to show policy makers that the best way to protect families who choose out-of-hospital birth is to ensure that their providers are in a regulatory framework.
If Oregon decides to mandate regulation of all forms of midwifery it will have crossed the line from protector to police state. That might not be a problem
if we could assume that the standards are and will remain appropriate for all people. But it’s a slippery slope. The regulatory board will change over time and it’s quite possible that it will become more restrictive. I’m sure you’re aware that in Washington and California, despite these being relatively progressive states, standards for licensure and laws regarding birth practices in general are far more restrictive than they are here. And in most other states, they are even more so (even to the extent of homebirth midwifery being illegal.)
Oregon is in a leadership position in this respect, representative of the fact that birth cannot be objectively defined in only one way, with one set of beliefs governing how an autonomic bodily process should be handled. Oregon has so far refused to define birth as inherently a medical event necessitating management by a medical professional. Mandating licensure would negate that.
Women already have the option of selecting a state-sanctioned care provider, if they agree with the beliefs of those people the state has appointed to determine how licensed care providers must operate. We also have the option to select a support person outside of that closed system, in accordance with other beliefs. In a moral society, that option would remain available.
Yes, this is emotional, and that’s because it matters. Many have been harmed by the obstetric model of care, which unfortunately informs much of modern midwifery. This model is not wholly evidence-based and is not the objective pinnacle of birth wisdom. It makes no sense, then, to give it the ultimate right to dictate that all births and types of midwifery must fall under its rule. The state should not be able to tell anyone that they cannot step outside of that model and self-tailor their care in the interest of a better outcome. If the state decides to regulate midwifery, it will be doing so ostensibly to protect me and others like me from ourselves. This is arrogant and demeaning. It assumes
that the midwifery regulatory board knows better than any individual what is best for them.
I am sure that those who are pushing for mandatory licensure are well-meaning. And I agree that it is important to advocate for consumers. But this is simply not a case in which we can say without question that one set of standards is right and all others are wrong, and to not only insist that this is so, but to *force* others to abide by it is *not* in the best interest of consumers. Allowing all of us to make our own informed choices, even if they are different from the norm, is.”
Definitely anytime you have midwives carrying medications, oxygen, sutures, etc., you need accountability regarding safety and knowledge of these meds, their administration, etc. For that, I agree that licensure offers safety for both the midwife and the consumer.
For midwives that do NOT carry such medications or supplies, there has to be a distinction about it not being the practice of medicine. But, I understand that the lines are blurry for many people (including myself at times!).
I wrote a comment in the original post that spurred this post on which also addressed a bit what you brought up.
In the post, Midwifery - The Practice of Medicine? there are a couple papers written from perspectives that include legal POV.
I know that it’s not an easy distinction. I recognize this. I also recognize that to many people, anyone that attends births is automatically a ‘medical provider’ and, as such, practicing medicine. However, for me, the difference really comes down to the use of medications or supplies that require prescriptive effort to obtain.
from :http://sagefemme.blogspot.com/2008/02/oregons-voluntary-licensure.html
for those interested
Well, Oregon and the rest of the country are very different creatures.
I would also point to the fact that the states with voluntary licensure situations are very, very vulnerable and unstable in regards to definition of scope of practice- look at the stew Utah is in right now with unfriendly legislators determining midwives scope of practice and eliminating VBACs from the scope of practice, not to mention a whole host of other things. This is not about medication that midwives carry, this is about the medical establishment and the Scope of Practice Partnership of the AMA attempting to either control, limit or eradicate practitioners who are not physicians.
What it boils down to is this, do you want to choose philosophical purity in theory, i.e. keep your laws off my body, self determination for a privileged, educated primarily white population, which is who is typically choosing homebirth services?
Or do you want to support a major, fundamental overhaul of our failed maternity care system which is cutting open women for birth and loosing babies, particularly babies in minority and underserved populations at a rate comparable to a developing country? Do you want to put into place a system where midwives, CPMs, CMs, CNMs, will be the normative providers of maternity care, no matter the location of practice?
The right to self determination of body, politic and otherwise, is a fundamental value of being an American Citizen. But we loose the vision of our founders when we are willing to sacrifice the many for the well being of the few. In this instance it is the sacrifice and scarring of many mothers and babies by denying the larger population as a whole access to the Midwives Model of Care by keeping it secret, underground or unregulated and out of sync with existing care structures in our country.
The debate of mandatory regulation of Midwives is a 20th century debate. Families committed to off the grid and libertarian lifestyles will always have unregulated midwives to choose from, that privileged will not be revoked and is not what is at issue here. The 21st century midwifery issues is one framed by a failed maternity care system with astronomical cesarean rates and rising death rates for babies and mothers in this country. The 21st century midwifery debate is looking at how to integrate the purveyors of normative maternity care into the broader health care arena in this country to improve outcomes and reconfigure the systems as a whole.
Do not be tricked into thinking that some how this independent midwife is kow towing to the authority of big government or big medicine by moving toward regulation. Rather see it as the first step to the truly radical notion of a maternity care system where midwife are the policy makers and first line providers of normative maternity care.
There is the true revolution.
You stated: “do you want to choose philosophical purity in theory” and stated what can be taken as a nonsensical accusation of selfishness and privilege.
No one is talking philosophical. That speak is nothing but a twisting ploy to try and force a dismissal of the essay of a thinking woman (she’s pretty respected by the way of telling through how many link to her blog! ) http://sagefemme.blogspot.com/2008/02/oregons-voluntary-licensure.html
Voluntary licensure is a reality. It could be gained for Ohio citizens. As a midwife, I have assisted umteam numbers who do not fit your cookie cutter accusation of Ohio midwifery only reaching a privileged, educated primarily white population. But the worst thing is, the twist of fallacy took the focus away from what voluntary licensure could accomplish. Just how would voluntary licensure withold the populations you have in mind from accessing midwifery care ??? More than anything, it will be cultural orientation about childbirth & pain, and notions of efficiency, control, & modernity that will hinder them.
You state: “voluntary licensure situations are very, very vulnerable and unstable in regards to definition of scope of practice- look at the stew Utah is in right now with unfriendly legislators determining midwives scope of practice and eliminating VBACs from the scope of practice, not to mention a whole host of other things”.
** Nothing unexpected: it sounds just like some other States ~~that have mandatory licensure…and, for instance, can’t do VBAC (only 8 can do VBAC out of the touted “24″ licensed states; and 6 out of 24 ~breech and twins).
I say, consider that Idaho (voluntary lic) sits rather new with her law, just like Virginia (mandatory lic). They are both having trouble, and truth of the matter be, it’d be a miracle if they were basking peacefully. That’s how it is.
Integrity commits itself to character over personal gain,
to people over things,
to services over power,
to principle over convenience ,
to the long view over the immediate.”
-John C. Maxwell
Worrying does not empty tomorrow of its troubles…it empties today of its Strength!
(unknown)
This State has strength for voluntary licensure ! It will peg down midwifery on what will become a slippery slope with State (med-tech & litigatory fears)regulation.
You state:
“this is about the medical establishment and the Scope of Practice Partnership of the AMA attempting to either control, limit or eradicate practitioners who are not physicians”.
Where is the evidence of that in Ohio ? You’ll find Freida busier than ever. You may say that’s an anomaly…and I will say the other case clearly is, from start to finish.
If this state was troubled, we would not have midwifery services in the yellow pages or with hanging banners and promotion tables at public mass-attended fairs. We have midwives starting up services (and I know of one that chose to move to this state recently). I know of several mothers whom traveled INTO this state to have their babies born here with Ohio midwives because they could not get care where they were.
Licensing is not necessarily the golden ring to sit in (protection, to get medicaid, or about drugs) ~~ and this state does need voluntary licensure. Know enough Ohio homebirth parents, or enough about Ohio midwifery among the rural communities and this can not be dismissed. It isn’t about “the priveleged”. It is about being able to think and consider ‘outside the box’.
Confucius said:
“To put the world right in order,
we must first put the nation in order; to put the nation in order,
we must first put the family in order; to put the family in order,
we must first cultivate our personal life;
we must first set our hearts right.”
Would you deny mother’s their midwife ?
“Rats and roaches live by competition under the laws of supply and demand; it is the privilege of human beings to live under the laws of justice and mercy”.
“The price of liberty is eternal vigilance”
Thomas Jefferson
and Just in Case confidence in our State Legislature lags: “The probability that we may fail in the struggle ought not to deter us from the support of a cause we believe to be just”.
— Abraham Lincoln
It is the only way to not dismiss Great Matters.
“In matters of style, swim with the current; in matters of principles, stand like a rock”. Thomas Jefferson
“Nothing in the world can take the place of persistance.
Talent will not; nothing is more common than unsucessful [Wo]men with talent.
Genius will not; unrewarded genius is almost a proverb.
Education will not; the world is full of educated failures.
Persistance and determination alone are omnipotent.”
–Calvin Coolidge