In summary, this bill is a disaster in the making.
According to Kate Mazzara, CPM and President for the Michigan Midwives Association:
“The purpose of licensure is to protect the public's safety by providing a mechanism
for consumers to verify that their midwives have appropriate training, proficiency
and accountability, as determined by the state,” said Kate Mazzara, president of the
Michigan Midwives Association. "Licensed health care providers are subject to
oversight by state boards that are responsible for determining standards of practice
as well as hearing consumer grievances and carrying out disciplinary measures
when necessary.” ~ Quoted from recent LSJ Article
All sounds good right? "Appropriate Training ~ Proficiency ~ Accountability ~ Oversight ~ and Standards of Practice"... so what's the problem? Isn't this precisely what Safer Midwifery for Michigan is all about?
The problem is that Ms. Mazzara's statement is a carefully crafted PR move, with absolutely no meaning or intention behind it. Anyone who takes the time to read this bill will see glaring discrepancies between what she claims to support, and what is actually being proposed in this bill. It's almost as if the small number of midwives supporting this bill are counting on the fact that the public won't read it for themselves.
Well, we did read it, and in a nutshell here is what this bill proposes for MI families:
- A body of licensed midwives whose minimum standard for education is a high school diploma or a GED, hold a CPM certification, and pass the NARM exam.
- Just a reminder here that the minimum standard for education in every other first world country is 3-5 years of UNIVERSITY education. The educational standards for CPMs in the US would not qualify them to be employable in any other first world country. Is this "appropriate training and proficiency?" Not by anyone's standards but their own. This level of educational training is no where near a university level education, in fact there is literally NO university level training required whatsoever to earn a "CPM" credential.
- Midwives who carry prescription medications and administer IV fluids with NO MEDICAL TRAINING or even so much as a course in Pharmacology.
- No, they don't want to bother with jumping through the hoops of earning prescriptive authority, instead they propose to work under the prescriptive authority of other "health care providers". Other "health care providers" is purposefully defined as Physicians, Nurse Midwives, or any other licensed, registered, or authorized health care professional.
- The bill further states:
authority of a midwife to administer prescription drugs or
medication or prohibit the administration of medication."
- A strategically biased board of "midwifery" that consists of 5 midwives and 2 members of the public.
- Note that this bill also defines "midwifery" as being completely separate from Nurse Midwifery. Therefore, there are no Nurse Midwives that will participate on this board, no physicians, no balance. It's a sneaky little way to avoid accountability by protecting the sisterhood, just as is done now with "peer review".
- A "board" that promises to promulgate rules about regulating, limiting, prohibiting, the tasks, acts, or functions of midwives, yet in the same bill states:
section that limit or restrict the scope of practice of midwifery
as established under this article."
- In other words, there will be no risking out criteria, no defined scope of practice that ensures families will be properly assessed and appropriately limited to low-risk births. The bill specifically states that no one can limit a midwife's scope of practice except for themselves.
- Collaborative care will be determined by the "board" with the "appropriate health care providers".
- So an unbalanced board will determine when, if ever, a client would need to consult with a "health care provider." For example, a woman with a breech presenting baby might be referred to a local chiropractor in lieu of consulting with an actual OBGYN. (Yep, that happened.) We all know that high risk birth is considered, "just a variation of normal" anyway.
a) Highly educated care providers (In the US that means a CNM or a CM)
b) Clear screening guidelines and risking out criteria that ensure homebirth is an
option for only low-risk women
c) Truly collaborative care between midwives and medical personnel
ACOG has issued a statement on Planned Homebirth explaining the critical factors in achieving favorable outcomes:
"Importantly, women should be informed that the appropriate selection of candidates
for home birth; the availability of a certified nurse–midwife, certified midwife, or
physician practicing within an integrated and regulated health system; ready access
to consultation; and assurance of safe and timely transport to nearby hospitals are
critical to reducing perinatal mortality rates and achieving favorable home birth
Licensing CPMs wouldn't come close to meeting educational standards for "highly educated care providers", and dangerous bills like SB 292 work intentionally against appropriately defining a scope of practice as being for low-risk pregnancies in the OOH sector. The notion that this bill is about accountability, proficiency, oversight, or safety is an absolute lie.
There is no doubt that our options in MI are limited, and that licensing is part of a bigger picture that can potentially offer safer options, but it MUST be done responsibly, including all of the factors that impact safety. Handing out a license to those who haven't earned them according to educational & safety standards, will undoubtedly cause more harm than good. Women in MI deserve to have safe, reliable options, and this bill will not provide them with that.
Please read the bill for yourself and contact your Senator and State Representative immediately to share your concerns for the safety and well being of mothers and babies in MI.
* Tell them that people with a high school diploma, & no medical or university level training, have NO business administering drugs or IVs, let alone delivering babies.
* Let them know you value options surrounding birth, but that MI women deserve for those options to be safe and reliable...this bill won't get them there.
What would improve the safety of OOH birth?
- Licensing only the most educated to serve as midwives, those with a university level education
- A clearly defined scope of practice and risking out protocols that ensure only low-risk births are taken on outside the hospital
- Appropriate transfer of care and Collaborative Care guidelines
- A balanced board of midwifery, including a majority of highly educated midwives, doctors, and citizens
Check out this link for more reading about Educational Standards for Midwives Around the World.
(Part II in the 3 part series on Education of Midwives Around the world, coming on Monday.)