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Sunday, July 22, 2012

Big Bill Debate: HB 5070 & SB 1208

Much conversation has circled our state and community in the recent week since Senator Whitmer announced Senate Bill 1208.  A reader asked for a side by side comparison of the two bills.  This chart represents to the best of my knowledge and interpretation what these two bills have to offer.

The bottom line is that something has to be done to make sure Michigan's midwives are educated, licensed, consistently as safe as the can be, and accountable.  The question then is what should that legislation look like?  Just like good writing, authors of bills go through many revisions.  We have two bills that stand on opposite ends of the spectrum, two that will undergo many debates and revisions before a vote can be taken.  Perhaps by discussing the specifics we can find common ground for advocacy that can help our Senators and State Representatives address these issues with specific recommendations from the people they serve.     


Here's more food for thought...if you're feeling conflicted about NARM's credential not being enough (House Bill 5070), but feeling like a RN requirement is not a good fit either (Senate Bill 1208), check out Florida's regulations, where licensed midwives have standards in line with International and National guidelines.  



I'd love feedback on this post, no matter where your perceived allegiance lies because in that conversation is where we will find something that works.  Please be specific.  If you feel your "choice" is threatened, specify how and why.  If you feel there are issues with requiring insurance, specify what those concerns are.  If you feel something is missing or misrepresented, please indicate so in the comments so we can discuss it.  Please don't make an accusation toward either bill without backing up your statement with specifics from that respective bill, or we won't get anywhere here.   Thank you for participating in a conversation aimed at preserving choice and improving safety, one that can leave propaganda at the door.  

12 comments:

  1. From HB 5070:
    (2) A MIDWIFE MAY ADMINISTER A PRESCRIPTION PHARMACOLOGICAL AGENT FOR ANTEPARTUM AND INTRAPARTUM PAIN MANAGEMENT IF THE ADMINISTRATION OF THAT AGENT IS CONSISTENT WITH THE SCOPE OF THE PRACTICE OF MIDWIFERY AND THE MIDWIFE HOLDS A STANDING PRESCRIPTION FOR THAT AGENT FROM AN INDIVIDUAL AUTHORIZED TO PRESCRIBE THAT AGENT UNDER THIS ACT.

    Someone needs to explain this to me. Prescription pharmacological pain medication?
    In labor? At home? Administered by a CPM? For real?

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    1. Wait...but I though home birth was supposed to be natural???

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  2. I realized after I scrutinized SB 1208, I hadn't done the same for HB 5070. I should be fair and take a critical look at the House bill, too.

    SEC. 17111. (1) THE MICHIGAN BOARD OF LICENSED MIDWIFERY IS CREATED IN THE DEPARTMENT. THE BOARD CONSISTS OF THE FOLLOWING 7 MEMBERS WHO MEET THE REQUIREMENTS OF PART 161:
    (A) FIVE MIDWIVES.
    (B) TWO MEMBERS OF THE GENERAL PUBLIC, 1 OF WHOM IS A CONSUMER OF MIDWIFERY CARE.

    A midwifery board that consists of 5 midwives and 2 members of the public?! There will be NO accountability with a board like that. It's almost laughably ridiculous.

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  3. OK - I'm sure a few of you have already torn this to bits - but I'm taking a turn now:

    SEC. 17107. (1) A MIDWIFE SHALL CONSULT WITH OR REFER A PATIENT TO AN APPROPRIATE HEALTH PROFESSIONAL IF THE MIDWIFE DETERMINES THE PATIENT HAS SIGNIFICANT DEVIATIONS FROM NORMAL THAT MAY AFFECT THE PATIENT'S OR NEONATE'S OUTCOME DURING THE ANTEPARTUM, INTRAPARTUM, OR POSTPARTUM PERIODS.

    "Shall consult with or refer" = not mandatory transfer of care

    "appropriate health care provider" Who determines what an 'appropriate health care provider' is for the circumstance? The LM? What if she just calls another LM? Lemme guess - it will be all good. Consult achieved.

    "significant deviations from normal" Again, deviations of normal as defined by whom? We all know what conditions midwives will deem 'variations of normal' = low-risk, high-risk and everything in between.

    What a piece of work!

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    1. I just spoke with McBroom's office about this point exactly. So much gray area. What exactly is a "significant deviation" to a home birth midwife, especially one who thinks nothing is high risk?

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  4. That's what I'm saying, this bill (HB 5070) was written for and by lay midwives who want to keep their loop holes open and stay basically unregulated. They would like a license by the state of MI to continue their VERY DANGEROUS practices. They would like to be governed by a board of midwifery made of only midwives, to be able to prescribe pain medications at home, to have rules set forth by NARM, to have no risking out criteria, to have to report to no one their outcomes, to carry no insurance, on and on and on...

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  5. So sad that people are being so critical of midwifery in MI. There was ONE infant death that caused this big flurry. As a woman who has had prenatal care with a midwife and an OB (two separate pregnancies), I can tell you that midwives are WAY more thorough, and WAY more likely to catch sketchy stuff ahead of time. My OB barely even detected a fetal heartbeat. My appointments with him were 10 minutes long vs. an hour minimum with a midwife! My midwife gave me a packet of info, including how to deliver a baby in an emergency, optional fetal/infant testing, healthy pregnancy diet, and fetal development, as well a thorough page listing her schooling/credentials/experience, and information and reasons for transfer and the importance of being kind and receptive to doctors and nurses in such a situation at my FIRST appointment. I got NOTHING like that from my OB. He literally never gave me a single piece of advice or pamphlets or anything. Didn't even tell me how to know I was in labor until I pressed him and even then, it was VERY generic (contractions 5 min apart or water breaking... thanks! got that from reading what to expect!) I wish more people knew how much time effort, and CARE midwives put into their work and how truly safe it is to deliver with them!

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    1. Veggegurl
      I really appreciate your post. Your experience with your midwife is very true of most midwives most of the time. For me as a former apprentice midwife, I'm a bit frustrated with the profession of midwifery not adequately addressing the problems with many midwives' lack of regard of risk-status of their clients, and not referring women to medical care when it is appropriate.

      One of the reasons I was so moved by the story of Sara and Jarad Snyder - was because the things they'd described happening to them were behaviors I'd witnessed in my own apprenticeship with CPMs - and I was always silently questioning whether these high-risk situations were truly safe in an OOH setting. High-risk does not mean absolute or 100% risk, so the most likely outcome is usually not death or injury.

      Midwives do a lot of things very well. And they do a lot of things right. And they provide a model of care that is personalized and caring and wonderful. (I had a wham-bam-thank-you-ma'am 3 minute prenatal appointment with a 'holistic midwife-friendly' OB that made me cry for all the women who only get to experience THAT in their pregnancies.) But somewhere along the line midwives - as a profession - appear to have lost sight of safety.

      Sara and Jarad and Magnus' story confirms for me that when I thought something was 'risky' during my apprenticeship - it was.

      I have felt the other-worldly 'calling' to become a midwife. I love birth. I love women. I love witnessing birth unfold. I love providing space for women and their babies to bond in the first hours after birth. I love it when the most prominent people in the room are the mother and her partner and their chosen support people - and the midwives seem like shadowy bystanders. I love home birth. I love what midwives do.

      But I don't love these things more than I love healthy, vibrant, breathing babies. What incredible heartbreak - that I cannot begin fathom - to lose a child.

      And what an incredible reckoning this should be for the profession of midwifery. So I may seem frustrated - I AM - I believe somewhere midwifery has neglected the most important aspect of their practice, SAFETY, in their relentless effort to achieve licensure for CPMs in all 50 states.

      I will argue and fight for women to have the right to birth at home. But I will not argue and fight for lax standards and licensing requirements that permit substandard, negligent and injurious midwifery practices to flourish.

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  6. Thank you for the perspective veggeygurl. I just have to say that Safer Midwifery for MI represents many families who have had losses in MI, who have experienced sub standard care with midwives, midwife apprentices who have see the dangerous practices first hand, and midwives who are advocating for better, more consistent standards of care and practice in their own profession. This is far more than ONE infant death.

    I do agree that midwives offer far more personalized care than do OBs and docs in my experience. There are midwives out there practicing safely, risking out, taking on only low risk pregnancies, giving accurate information, etc. There are also those who are not. This is not an attack on midwifery, rather a call to action. A call for all those to support it to a) recognize the problems (even if that wasn't the case for you) and b) help us work to improve the safety of out of hospital births so that we can preserve it as an option for women in our state. I don't think advocating for higher standards of care and ethical practice is anti-midwife.

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    1. Veggeygurl: I'm very glad you had such a good experience with your midwife. OB's are like all professionals: there are some that are good and some that are not so good. Most fall in between. My OB gave me a thick packet of lots and lots of info about all things that he deemed relevant to a healthy pregnancy and postpartum period. This blog is not an indictment or witch hunt on all midwives - just ones that endanger the reputation and ability to practice for really qualified ones like yours. And it is REALLY, really important, for the sake of being sensitive and kind, NOT to dismiss the deaths and disabilities of babies (more than one) born under the "care" of inferior midwives.

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  7. Does FL require reporting of outcomes?

    I think this is essential for any bill licensing midwives.

    http://www.coloradomidwives.org/about/about-homebirth/45

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    1. Yes they do. Here's the link: http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0467/Sections/0467.019.html

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