Midwifery legislation called for in Idaho

Homebirth midwives in Idaho have asked for legislation that would put in place a licensing mechanism and give homebirth midwives the ability to offer broader services. 

According to the recent Times-News article (2/22/08):

Proponents say midwives have provided safe birthing assistance for centuries and that expanding their privileges when it comes to dispensing medications, including intravenous fluids, antibiotics, painkillers and emergency oxygen, will boost the value of their services. They say this will especially help people in less-populated areas around the state.

The debate, [Connie Wolcott, CNM] said, is especially important given that 40 percent [sic.]* of births in the U.S. are done by cesarean section. Licensing, she said, would make it easier for people to become midwives and ease what she described as a huge backlog of patients.

“As a woman, that terrifies me,” Wolcott said of the cesarean rate. “As a scientist, I am appalled.”

I agree with Wolcott.  It is terrifying to know how easily a woman can end up with a cesarean section even when she thinks she’s done all of the preparation necessary to avoid an unnecessary cesarean.  As a researcher (qualitative) and educator it is appalling to witness it happening every day in my community and across the United frickin’ States. 

And this is what the opponents had to say, according to the article:

Idaho medical doctors and nurses who testified against the bill said creating a licensing system that still allowed uncertified birth assistants to practice could confuse unsuspecting members of the public who wouldn’t know the level of training of their care provider.

Confuse the public?  Because expectant parents aren’t smart enough to check a midwife’s credentials and history of experience?  Moooooooo?

They also said that the rules would allow midwives to do things that registered nurses aren’t allowed to do on their own.

Ah, here we go.  The nurses are mad because they don’t get the same priviledges that would be extended to midwives serving a small portion of the birthing population?  They’re jealous because they’re governed by doctors whereas homebirth midwives operate independently unless obstetric back-up is needed.

I’ll be interested to see how things progress in nearby Idaho.

* The national cesarean rate (projected, 2006) is 31.1% though certain areas of the country have cesarean rates more than double the national rate.  The cesarean rate is not expected to decline any time soon.

Maryland Midwifery Legislation

Thanks to Jen at VBAC Facts for her post bringing attention to current midwifery legislation in Maryland:

(especially those in Maryland)

We have a bill! The Birth Options Preservation Act is House Bill 1407.

This bill proposes to end the requirement that nurse midwives practicing in Maryland have a written agreement with a doctor. This will go a long way to ensuring greater access to nurse midwives throughout the state! Final language is now available on the web site, directly from
http://mlis.state.md.us/2008rs/billfile/hb1407.htm. That page will also throughout the process have up-to-date public information on the bill.

You have all been asking for some time now: what can we do to help ensure that practices like the Takoma Women’s Health Center and the Maternity Center stop closing? Well, here is something you can do right now: We need to all work together to make sure this bill passes! We have the sponsoring Delegates and their staffs all working hard, lobbying not only their colleagues, but
other interested organizations, and things are looking very positive, but without the VISIBLE and AUDIBLE support of midwives and their clients or would-be clients, legislators have no reason to listen.

Below are instructions and driving directions for attending a Nurse-Midwives Rally Night on Monday, February 25th, in Annapolis. Yes, it is a long drive for some of us, but the forecast is for sun and mild temperatures, and we urge you to try your very best to get there, to stand and be counted. This bill could make a huge difference for the women of Maryland ! If this law had been in affect 5 years ago, some of the midwifery practices which were forced to close over the past few years might still be open.

Here’s how you can help:

1. Come to the Rally! We will gather for inspirational speeches from legislators, midwives and clients, then go to visit our legislators, armed with talking points and other materials to make our case. We will try to send a midwife with as many groups of consumers as possible. They love hearing from constituents, and will be very welcoming!

2. Bring your family and friends to the rally! Post this announcement on any listserves you are on, put up a notice up at work, post it at your favorite coffee shop, nursery school, pediatricians, etc.

3. Write to your legislators! Whether you attend the rally or not, it is a good idea to write to your legislator and let them know you support HB 1407. Email your letter to your friends and family and encourage them to write to their legislator, too!

4. Volunteer to help the legislative committee! In the next ten days, we will be doing phone calls to members, and to legislators to set up appointments. We can use all the help we can get! Please contact Mairi Breen Rothman to let her know if you will come to the Rally, and how many friends you hope to bring with you. We can help you identify your legislator, so we can make appointments for you to visit your own delegates when you come to Annapolis . (Don’t worry—you’ll go in a group with a packet of information!) If you can’t come, you can still write to your delegate, and we would be happy to give you sample language, so contact Mairi even if you
can’t come! Please call Mairi or Tina with any questions (Mairi 301-674-9976,
Tina 410-937-5824)

Hope to hear from ALL of you in the next couple of days. If we all work together, we CAN make this happen!
Mairi Breen Rothman & Tina Fisher, Legislative Liaisons
American College of Nurse-Midwives , Maryland Chapter
Nurse-Midwives Lobby Night in Annapolis
Where: Rally @ the Assembly Room (rm. 114) of the Office of the Comptroller
* Enter at the front door on Calvert Street
* All visitors are required to sign in at the front desk with the
Department of General Services Police. Be prepared to show identification
* Parking information listed below! 
* Rally begins @ 6:00 P.M (Please arrive by 5:45!)
* Please plan on being at the Assembly Room by 5:45 P.M. to begin the rally promptly
* Plan on arriving in the Navy-Marine Corps Memorial Stadium parking lot by 5:00 P.M. in order to arrive by shuttle on time
* Park: Navy-Marine Corps Memorial Stadium, 550 Taylor Avenue, Annapolis, MD 21401

Due to severe parking restraints in the area around the Maryland State Government Complex, we recommend that you park in the Navy-Marine Corps Memorial Stadium visitor’s parking lot. A shuttle service will pick you up in the visitor’s lot and bring you to the Complex, which is only a 2-3 minute ride. Please be prepared to pay a maximum of $5 for parking.

Directions (from Washington, D.C. metro area):
Take the Beltway and merge onto US-50 East towarAnnapolis. Get off at Rowe Boulevard South, exit 24, toward Annapolis. Stay in the far right lane as you exit Route 50 onto Rowe Blvd/Md-70 east. Make a right at the second traffic light onto Taylor Avenue/MD-435. The Navy-Marine Corps Memorial Stadium will be on your right before you turn. After turning onto Taylor Avenue, turn at the second entrance to the stadium lot, posted “visitor’s parking.”

Visitors are required to withdraw a ticket from the parking meter machine at the bus stop. If the machine is broken, do not worry about getting a ticket. Depending on when you leave the lot, you will most likely not be required to pay the parking fee. BE PREPARED TO, THOUGH! Take the shuttle bus to the Department of Legislative Services stop, the last one on the loop (do not hesitate to ask the driver for assistance). When you get off, you will be on College Avenue between the Department of Legislative Services Building and the Lowe House Office Building, adjacent to Bladen Street. Proceed down the left side of Bladen Street until you reach the corner of Bladen and Calvert Street. The Office of the Comptroller will be right in front of you! Enter at the front door.

Contact Information

Mairi Breen Rothman – Legislative Liaison, American College of Nurse Midwives Maryland Chapter (301) 674-9976
Patrick Metz – Legislative Director for Delegate Heather R. Mizeur (301) 858-3493

Contrast these homebirth news stories!

I have followed homebirth legislation news in Utah and South Dakota with interest and concern.  I don’t want Montana getting any stupid ideas. 

UtahI blogged about their nonsense recently.  Yesterday, the Utah Senate voted to restrict homebirth practices.  The bill was supposed to have been a compromise, but what resulted was something restrictive and punitive.  Women will be forced to attempt VBACs in hospitals or on their own.  Were this the case in my state, I would have an overwhelminly large chance at “failure” since my hospital’s VBAC rate is a pitiful <1%.  They only had 16 successful VBACs at the hospital in 2006.  Utah legislators have chosen a path that makes homebirth less safe.  To search for Senate Bill 93, click here.

South DakotaI also blogged about their homebirth “situation,” and it appears that both the SD House and Senate have approved a homebirth bill. 

The bill would require midwives to become registered nurses, get master’s degrees in nursing, and pass additional tests. Certified nurse midwives wanting to attend home births would need approval of both the Nursing board and the Board of Medical Examiners.

Allowing certified nurse midwives to attend home births in South Dakota would be allowed on a trial basis until 2013.  (click here for source article)

My concern is that CNMs were previously required to have OB back-up, and evidently no OBs were agreeing to provide back-up services.  What will be different?  And I’m not sure that having a Masters Degree makes anyone particularly qualified to attend labor.  Shouldn’t these homebirth midwives have assisted on “x” number of births before they become licensed?  Why is it always about the piece of paper??

Also, the bill states that CNMs will be able to attend homebirths “under certain circumstances” but doesn’t clarify what those circumstances may be.  I suppose we must find the Board guidelines to find more clear language.  To read the bill, click here.

Thought Provoking

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed – via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed – we treat them. We don’t judge the obese who come in with MI’s. – we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis – we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading – we treat them. We don’t judge many other behaviors which really ARE obviously poor choices – because they are just that – choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .

Bad news for homebirth in Utah

From an article in the Salt Lake Tribune:

    The bill would put new limits on direct-entry midwives, who are licensed and attend home births. By defining a “normal” birth, it bans them from administering to women with a host of medical conditions, from diabetes to hypertension.
    They also would be stopped from assisting women whose babies are breech or who want a vaginal birth after a previous cesarean section (VBAC).

How is it that people who never see “normal” birth (a term that is easily usurped and unfortunately true of augmented birth in this day and age) are able to determine normalcy.  If they can determine “normal”, then perhaps they should start overtly forcing more women into induction, augmentation, and other interventions.  Medically-managed labor & delivery is certainly most common in a hospital setting.  In fact, why don’t we just get rid of the mother’s (and other vested persons’) desires altogether?  Many – if not most – OBs are contemptuous towards mothers with birth plans anyway.

I can tell you that “normal” should equate to “natural”, but it doesn’t any more.  And really the only venue for assuring natural birth is home.  Sure “natural” might not happen for everyone.  I’m not even trying to suggest that all women should give birth at home.  But these restrictions . . . why not ensure that direct-entry midwives are well-trained for breech, twin, and VBAC scenarios.  How do you ensure this?  By keeping it legal and supporting midwives who feel confident in their skill level with breech, twin, and VBAC labor.  Just as an OB should know if s/he is the appropriate person to deliver a breech baby or perform an amniocentesis (and lemme tell you, some simply are NOT), so should a CNM or direct-entry midwife.

I’ve written about “normal” and “natural” before – click here to read!

Trust Birth or Don’t?

I can’t resist.  You would think that since I am new to homebirth and haven’t had a VBAC yet that I wouldn’t bother myself with polemics regarding homebirth.  I’m obviously not that bright.  My homebirth google alert today included a post about the power of positive thinking and the homebirth movement.  I had to check it out. 

I won’t link to this weblog out of principle, but if you search for the quote using your favorite search engine, you’ll find it easily enough . . .

“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

I’d like to play with the words a bit:

“If you refuse to trust birth and insist that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

Some people, practitioners and women, simply refuse to trust birth.  Some will insist that birth is inherently dangerous.  They will likely achieve the birth experience that they desire, and it will likely be overly-managed, overly-medicated, potentially surgical, and definitely exorbitantly expensive.

“If you don’t trust birth and accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

And somewhat similarly:

“If you don’t trust birth even though you don’t believe that birth is inherently dangerous, you will likely have trouble achieving the birth experience that you desire.”

Some people don’t trust birth and have accepted the “fact” that birth is inherently dangerous.  They will likely create that reality in their birth experiences.  If women engage practitioners with this guiding philosophy, they will likely lose faith in the natural processes of life and end up dissatisfied with their birth experience even if the outcome is positive.

Some women know that birth isn’t dangerous most of the time but lack the trust needed to achieve particular outcomes.  Perhaps this was me once upon a time.  I never really considered that birth might be dangerous.  Why would I be created for a particular skill if it were inherently dangerous to me or my offspring?  However, I’m not sure that I trusted myself enough last time.  I didn’t trust my body.  I didn’t trust my instincts.  That’s probably the worst part of it . . . I didn’t listen to my inner voice.

“If you trust birth and acknowledge that birth is inherently natural to our species, you will likely achieve the birth experience that you desire.”

If you trust birth you are fortunate enough to understand that certain life events are natural and far less risky than some of the every day activities in which we engage.  Things like riding in cars.  That single activity is far more risky (statistically speaking) than giving birth.  If you trust birth you may not be “rewarded” with a particular birth outcome but understand that complications and poor outcomes are possible.  Trusting birth is not about sticking your head in the sand.  It’s about understanding that most of the time women can achieve normal birth when given appropriate support, time, and space.

Going back to the original quote:
“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

“Trust” – in the original text, the blogger puts the word “trust” in quotes; this diminishes the validity of “trust” in relation to childbirth
“Refuse to accept” – ultimatum . . . polemic
“Inherently dangerous” – emotional scare tactic
“Reward” – as if there’s a prize involved???
“Desire” – as if all that matters for homebirthers is what the woman desires

Do you see yourself anywhere in my “play on words” section?  Where do you want to be?  Do you want to be afraid to be pregnant?  Do you really want to go into labor and delivery afraid?  Do you really want to go into labor and delivery lacking trust?  What is positive and proactive about being fearful and lacking trust?  What do you as a pregnant and/or laboring woman gain from that perspective?  I would say nothing.  You have lost your power and are no longer an active participant in your care when you are afraid and can’t trust.  Perhaps you (and your birth experience) are more manageable that way.  How do you feel about that?  Do you want to be managed?

I can’t really define homebirth for you.  Everyone comes to homebirth from different paths.  Some women always know that they’ll have their babies at home.  Some women are involved in social structures that are more inclined to promote homebirth, homeschool, extended breastfeeding, attachment parenting, and the like.  Some women are disgruntled consumers.  Some women aren’t given the choice to have a vaginal hospital birth and turn to homebirth as their only choice.  Some women who give birth at home don’t fall into any of these generalized categories.

For me homebirth is about safety, sanctity, Faith, Trust, natural life processes, achieving physiologic birth, what’s best for me and baby, avoiding an unnecessary cut, vaginal birth after cesarean, comfort, family, community, and a whole host of other things that I haven’t even discovered yet!