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Open Letter to The Arizona Department of Health Services
Posted on January 15, 2013 at 4:45 PM |
HERE is a link to the meeting - ADHS is taping them for public record. First of all, I want to thank Will Humble, Director of Health Services, for
facilitating the Midwifery Scope of Practice Meetings. I have never been prouder of our state than
in the last two meetings I attended. Director Humble is truly committed
to a transparent process. I can only imagine how wonderful government
could be if all agencies and government operated out in the open and in full
view of the public that they are supposed to serve.
Secondly, I want to say that I appreciate the perspective of the hospital-based
practitioners on the board and in the audience. I know that you feel
passionately about the safety of the mothers and the babies. Some
homebirth transfers that happen are critical, and I understand why you feel
that homebirth is not safe. You only get to see, and you only get
involved, when a labor and delivery has passed out of the realm of what a
midwife’s training has prepared her for in the home setting.
I have a couple of points I want to make based on the proceedings of January
14, 2013. The first one is directed at Dr. Manriquez. The second
one is directed at the hospital-based providers that want the public to believe
that the hospital is the safest place to give birth for all mothers, regardless
of their own risk level.
Point 1.) People having homebirth are informed about the risks and benefits.
Dr. Manriquez made a couple of statements that to my mind betray her bias.
Her first statement was about the ability of the homebirth mother to
assess the information that is available to her so that she can make an
informed consent decision. She pointed out the education level of the two
consumers sitting on the panel, and her own educational level. Later, she
brought up the high percentage of women who were self-pay on a document that
was being passed around with homebirth statistics across North America.
I have news for the panel: A woman’s level of education does not necessarily
impact her ability to read. It does not affect her ability to listen.
It does not affect her ability to feel. Although I do not have a master’s
degree, or a jurisdoctorate, or a medical degree, I am capable of researching
on the Internet. I can find the sites that impartially collect
information. I can attend meetings with my peers to hear their anecdotal
information. I can consult with doctors and licensed midwives when I am
pregnant. I can listen to their information and process it to make the
best decision for our particular situation. My formal level of education
has no bearing on my ability to educate myself on a topic that impacts the well-being
of my unborn child. My first priority as
a mother is to choose what I feel is best based on all the information I have
evaluated.
It is a fact – a large majority of homebirth families are self-pay. There
are several reasons. Here are five that I am aware of:
Point 2.) The safety of homebirth versus the safety of hospital birth is
debatable.
Every midwife licensed through the state of Arizona is
required to prepare and submit quarterly reports. By the states own
admission, the Department of Health has failed to do anything with those statistics
until this Midwifery Scope of Practice Advisory Committee was formed.
Presenting statistics with over 2000 empty fields is irresponsible.
With so much at stake, it is absolutely imperative that every “text
field” is read and recorded electronically in such a manner that can be used to
report the true picture of homebirth.
What the state and the medical community are patently
unaware of is all the homebirths that go smoothly and beautifully at home with Healthy
Mother, Healthy Baby outcomes. I echo the sentiment that the state is not
ready to have this discussion until a clear picture is received. You must
complete the homebirth statistics without empty fields. The state must
pull the records from the family doctors, naturopaths, and the certified
nurse-midwives that are allowed to attend VBAC, multiple and breech births at
home, as well as the unassisted births at home. We in the community know
that these things happen safely at home because we are the ones witnessing them
and holding these women up through their birth journey. It is time for a wider
audience to become aware of the real picture of birth in the home setting.
Going forward, we have to consider the consumer. The
piece that was missing from the discussion last evening was the piece about a consumer
having the right to choose her care provider. We all seem to be making
the blanket assumption that if the State of Arizona expands a midwife’s scope
of practice, then all midwives across the state will be taking VBAC, multiples
and breech deliveries.
I believe a truer statement
is that those who feel qualified to attend those births will make themselves
available to do so. I also believe that mothers will choose providers
that have the skill set to support them at home. We have to try to give
the midwives credit for making the best practice choices for their abilities,
and the mothers and babies they serve; and consumers credit for making the
safest choice for the babies that they carry.
If we remove egos and simply look at care providers as providing a skill set
for birth, the paradigm can start to shift. A licensed midwife is trained
to serve low-risk women in a home setting. A certified-nurse midwife is a
great option for a woman who regardless of her risk category, and who wants to
birth under the midwifery model of care in a hospital setting.
Obstetricians are trained surgeons, whose level of training and expertise
is exactly what a mother in a higher risk category needs.
However, in a country where we live and die by our freedom to choose, there has
to be an effort made to provide choices for all women to access care in spite
of their risk category. As Director Humble so eloquently stated last
evening, this is an opportunity to rise to the occasion and make a real effort
for the women in the State of Arizona to effect Real Change.
I propose that Arizona becomes the first state to provide true informed consent
and a collaborative model of care that other states can use as their midwifery
model. We could be the first state that has a way for midwives to confirm
on record that they have provided the risks and benefits of a homebirth and
offers the option to speak to an obstetrician. We could be the first
state that has mothers under obstetrical care consult with licensed midwives
before consenting to a hospital birth.
I implore the Midwifery Scope of Practice Advisory Committee do the hard work
to establish a collaborative model of care. Let us remember that this is
a consumer-driven movement – women want the freedom to choose. Consumers
are demanding access to homebirth midwives regardless of their risk status.
In closing, I ask you all consider the babies. I believe that every provider
wants what is best for the babies. Consumers are asking that licensed
midwives be available to legally serve a population that is choosing unassisted
births at home. In which way, shape or forms can it possibly be safe for untrained
consumers to intentionally birth outside of any care model? I think we can all
agree that it is a situation to which a solution must be found.
There is no way to quantify the empowerment, the rite of passage, the growth in
a woman that happens when she is allowed to labor away from the smell, the
noise, the pinging and the intrusion of a hospital. It is our duty to
rise to the occasion and allow them legal access to the care they want and the
choice they deserve.
Sincerely,
Krystyna Robles-Bowman
LINK LIST Video of January 14, 2013 meeting http://www.youtube.com/watch?v=QacwYdrvp5g&feature=youtu.be
Disclaimer:
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: Rights for Homebirth
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