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Midwifery Scope of Practice, Arizona

Posted on December 18, 2012 at 2:04 PM
I was thrilled to be part of a process in our state by which we as citizens can participate in the legislative process yesterday.  The Arizona Department of Health Services has started an Open Meeting process with the Midwifery Scope of Practice Advisory Committee.  

The stated goal of this committee is to review and update the rules and regulations that govern Lay Midwives and Certified Professional Midwives that practice in the state of Arizona.  As a consumer, am hopeful that they will be modernized to reflect current evidence-based practices. 

Historically, there has been animosity and prejudice between midwives and obstetricians.  When it comes to homebirth advocates, the stance is that birth is safer at home; the other side argues that birth is safer in a hospital.  Both sides are correct.  In healthy, low-risk pregnancies, a birth at home is perfectly safe.  There are circumstances in which a birth at a hospital is the best choice.  And then there is a chasm, a gray area, in which births can go either way.

However, the forgotten component here is: what does the consumer want?  Even if her risks are higher in one place or the other, where does the birthing mother feel the safest?  Where does she want to choose to give birth to her child(ren)?

The truth is that in the “land of the free”, women of Arizona are shackled in their birth choices.  The only option for a mother who has a breech baby, who is carrying multiples, and who has a history of previous cesarean is birth in a hospital setting.  (At least now, in many cases, access to Certified Nurse Midwives is growing, so that a woman can still have midwifery care in a hospital setting.  Even so, they are a considered a threat by some OB's).  In some places, women with previous cesareans are not even allowed a trial of labor.  They are forced to have repeat cesareans, despite evidence that best practice should be to allow women to labor for a vaginal birth.

Is every birth outcome going to be perfect? No.  That is unrealistic.  However, each woman should have the option to approach the care provider of her choice to have the conversation about the possibility of having her birth wishes honored and come to fruition.  If a woman is willing to assume the risk of any of these births at home, and if she can find a homebirth midwife who is willing to travel that path with her, then they, as two consenting adults, should have the right to enter into that contract together without fear of repercussion from the state in which they live.

What I suspect is missing from the discussion is the understanding that no mother and no care provider would knowingly and willingly endanger the life of a child.  A mother knows her mind.  A care provider knows their abilities.  If the two do not mesh, then a different choice will be made, a choice that ensures the safety of the child.

Here is my speech from yesterday during the “Call to Public” portion of the meeting.  As a mother who carried a breech baby, I felt that I could speak to that aspect of the law:

My name is Krystyna Bowman.  I am the mother of four children.  Three were born in the hospital, and our last was born at home.  I am here to address you today to ask you to consider the choices that are available to women in Arizona today.

Anything other than a uterus intact, head-down, singleton pregnancy at the time of labor is considered high-risk under the medical model.  There is rarely any assessment of the mother or the child as individuals, nor is there any belief that any other variation of labor can tolerate a natural labor and birth.

We had a breech presentation with our third child.  We had two options under Arizona state law since trained midwives are not allowed to deliver breeches at home and our obstetricians were not willing to share the names of any doctors trained in breech birth.

1.  We could have a cesarean birth after a trial of labor.

2.  We could drive to Tennessee, where there is a group of midwives who are trained and legally allowed to deliver breech babies. 

Are these reasonable choices in this day and age?  I could agree to undergo major abdominal surgery fraught with it’s own risks and complications; or I could load up my entire family of four and drive 1,600 miles, hoping not to go into labor along the way, so that I could have legal and professional care.

We are asking you to recognize that educated, informed healthy women want to have the choice to approach other trained, educated women about their care.  It is up to a woman to decide if she wants midwifery care in a home setting, and it is up to the licensed midwife to decide if she will accept a patient into her practice.

The beauty of the midwifery model is that skilled people, trained under a time-honored model of education know how to recognize the difference between a low-risk pregnancy and labor and one that needs a more medical approach.  The one-to-one care during labor allows a midwife to assess when it might be time transfer a patient for medical observation much sooner than the impersonal, ticker-tape of a fetal monitor.  Take under consideration that the fetal monitor is being watched on a screen by a nurse who is caring for two to four women, it’s feasible that a distress signal would be missed. 

We would like the opportunity to show the personalization of the midwifery model works for women outside of the paradigm of healthy, low-risk mothers with vertex presentations and intact uteruses.  Mothers with breech, multiples pregnancy, and previous cesareans should also have the choice to seek care within the home midwifery model. 

If two parties can come to an agreement, then care should be able to proceed in such a manner that our intelligence and our choices are honored by the state and the country in which we are supposed to be free citizens.  Freedom to choose, and sometimes to choose differently, should not be legislated.  When a state starts to “protect” instead of endow, we enter a slippery slope of rules and regulations that slowly strip away our freedoms.

We ask for the freedom to choose our birth as long as we can find a midwife who is willing to travel that journey with us because she can do so without fear of repercussions from the state in which we live.

I hope that you will do some reading, visit the Rights for Homebirth webpage and Facebook page.  Get involved.  You have a voice.  The Arizona Department of Health is listening.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Categories: Breech presentation, Cesarean Birth, Rights for Homebirth

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