Routine Care During Pregnancy

Now that the holidays have settled into a nice new year, we're back on track for talking about the serious issues families are facing with the current state of midwifery in MI.  We'll start the year with a series of posts related to assessments, testing, and their relationship to safety.  We hope you find them thoughtful, and useful.   

What do you get when a group of professionals have no practice standards?

A crap-shoot as to what kind of care a client gets. 

A group of us were discussing creating a list of routine prenatal assessments and cares that should be offered by all maternity care providers - specifically CPMs and OOH midwives. There is such a variation of practice, training and skill among these "professional" midwives that it is difficult for a client to know if she is getting appropriate care or not during her the course of her care. Former apprentices have voiced concerns numerous times about the lack of safe care they'd witnessed -and the complicated nature of the problem. A point we keep coming back to is that CPMs have no professional guidelines. There is no document or position statement by an OOH midwifery organization that lays out appropriate care (routine tests, follow up, labor assessments, timing of FHTs in labor, etc). There just are no standards. And that is the root of the problem.

But it sure seems like midwives should be breaking down the issues surrounding what constitutes appropriate care and assessment during pregnancy and birth.  You know, like writing actual professional practice guidelines. Midwives are the ones who keep asserting that they are "professionals." THEY should be sitting down together and writing these standards and disseminating this information to each and every CPM out there saying: "These are our professional standards." "This assures safe and competent care." But instead they know that CPMs do whatever the Hell they want [homeopathic streptococcus, anyone?] and they don't do anything about it except cower behind the tenet of "informed consent."

Our group advocates for professional practice standards. This means each mother who hires a CPM should be assured that she is receiving appropriate, competent and thorough care based on clear and concise professional practice guidelines.

There are a number of places one can look for a list of routine prenatal tests and screenings: 

US National Library of Medicine: Prenatal Testing

American College of Nurse Midwives: Trimester by Trimester
  
But where is the list for OOH midwives? Routine prenatal assessments? And how often is this list reviewed and revised? Which professional organization is doing this? The answer is no professional group of CPMs is doing this. And CPMs do whatever they want. Or don't want to do. 

Peruse this document:

NACPM standards of practice

Does it say anything about routine prenatal care?
Does it say anything about routine labor assessments?
Does it say anything about standard procedures for women planning an out-of-hospital birth? 
Does it say anything about use of unproven, potentially unsafe, ineffective treatment modalities such as herbs or homeopathy?
Does it say anything about safety - and which situations and circumstances enhance the safety of birth in the out-of-hospital setting? 
Does it describe the process of risk-screening?
Is it anything more than a bucket of fluff left for each and every CPM to interpret as she sees fit?

CPMs need clear practice guidelines even more than other health care professionals - because they're working on their own - and not under medical practice guidelines or hospital policies.  NACPM (or MANA) should have regularly-updated, concise, evidence-based practice guidelines for routine prenatal testing in pregnancy, postpartum and for newborns.   
**Every mother reading this should clearly understand that without these guidelines in place for assessments that protect your safety, you are at great risk under a CPM's care.