Tuesday, June 12, 2012

Why Licensing CPMs Will Not Make Out of Hospital Birth Safe

Licensing CPMs is not a quick fix to improving the safety of out of hospital birth.  Proponents would have you focus on the fact that if licensed, the state is looking after midwives, thereby making out of hospital birth safer. At our own birth, we had two CNMs and two CPMs present and it was still a disaster.  Why?  Becasue the license didn't matter, it was the absence of several other safety guidelines and the actions of the individual midwives that enabled this to happen.  While licensing is part of the picture, there is so much more that MUST be included in any legislation that truly aims at offering women safer options.

House Bill 5070 is a bill that intends to license CPMs in the state of MI.  Not only are there glaring gaps throughout this bill, there are also many self serving elements written into this bill that would actually make out of hospital birth more dangerous for mothers and babies. 

To read about the pitfalls of this bill, you can visit:  Top 10 Reasons HB 5070 Will do More Harm Than Good 

In addition to the absence of critical elements that would actually improve safety of out of hospital birth, this bill proposes two obviously self-serving notions.  The first is the proposal of establishing a new board within the department of Licensing and Regulatory Affairs to serve as oversight for midwives.  This proposed board would be made of only midwives and one citizen.  Other states who have regulations for midwives do have boards, but they are balanced boards, comprised of Obstetricians, Nurses, Pediatricians, and a majority are midwives.  Creating a board of only midwives reeks of the same appalling practices of NARM who claims accountability, but does more to protect themselves than the people they serve.  

The second self-serving notion comes from the words of State Representative Ed McBroom himself as the primary sponsor of this bill.  He claims that the bill will, "Authorize creation of licensing process for midwives, including creation of licensing exam, rules, and standards."   He fails to disclose that ALL of the licensing processes, exams, rules, and standards would be set forth by NARM and NARM alone.  This is an institution that is notorious for protecting themselves and their midwives, with little to no accountability to the families they serve.  This is also the organization that has accepted mail order study and a 350 question multiple choice test as a means to "certification".  Choosing NARM as the lone source in establishing exams, rules, and standards for practice has no place in state legislation.

A more subtle advantage that this bill brings is that the newly licensed midwives would be eligible for insurance reimbursement.  Let's not confuse that with thinking they would carry malpractice insurance as a means to better protect their clients.  It means they'd get paid for the work they do by insurance companies, but wouldn't be bothered by having to adhere to any guidelines or specific scope of practice.

I've heard ridiculous arguments to support this bill, one being that it would serve rural communities in MI.  While the need may be present in rural communities, why would people living there be subject to sub standard care?  Don't wives and daughters of farmers and miners deserve to have highly educated, licensed, insured, accountable midwives too?  If we're truly talking about reforming out of hospital birth, with the goal being to improve safety, then let's get serious about the standards to which we hold all midwives.  A license should stand for something no matter where you live. 

Another argument I recently read on the Greenhouse Birth Center's face book page, was a letter writing campaign that asked supporters to write a letter to their legislators.  The post was explicitly explaining that if we licensed our CPMs it would somehow protect them from criminal charges and prosecution.  Since when does a state license prevent criminal prosecution?  The argument doesn't even make sense.  Anyone can still press charges against a licensed midwife if her actions warrant such action.  How does licensing a CPM prevent her from being prosecuted should she break the law?  This argument makes no sense. 

The critical question we should be asking is who are we proposing that we license and what do we know about their safety and outcomes?  How can we license CPMs without having collected ANY data about their safety record, a thorough analysis of outcomes, why/how these outcomes happened, and furthermore how to improve upon them?  Wouldn't it make more sense to do the homework first before handing CPMs a license?  CPMs could be the most educated, well intentioned people on the planet...or not.  The point is that without specific definition of scope of practice, educational standards, and safety guidelines for out of hospital birth, and actually knowing their outcomes with certainty, what does licensing matter? 

Do women deserve a choice in where to have their babies?

Do women deserve for those choices to be as safe as possible, educated, insured, responsible, and accountable...no matter where in MI they live?

Is that the case now?

Would HB 5070 improve safety?

How then could we improve the safety of out of hospital birth and the practices of the midwives attending them?  What action steps will truly improve safety for mothers who choose out of hospital birth?

* Set Educational Standards allowing only the most highly trained midwives available, with 
   a solid education behind them, clinical practice in handling emergency care, & neonatal   
   resuscitation certification to practice midwifery.
* Allow only licensed midwives to practice.  Licensing is based upon aforementioned 
   educational standards and nothing less.  (Not set forth by NARM).
* Require all midwives to carry malpractice insurance.
* Define a clear scope of practice and limitations for midwives.
* Identify screening measures and "risk out" criteria so that midwives are appropriately 
   assessing risk factors and risking out the clients that would not be good candidates for out 
   of hospital birth, thereby minimizing risk.
* Define protocols for transfer of care and physician consultation.
* Establish consistent informed consent documents to be used state wide.
* Mandate reporting of all outcomes for every midwife so that clear assessments of safety 
   can be determined. 
* Work to develop a system of collaboration between doctors and midwives. 
* Only allow "birth centers" that are licensed facilities through Licensing and Regulatory 
   Affairs and staffed with midwives that meet all of the above criteria. 

I am weary of the deceiving notions proponents of this bill are using to advance their own agenda.  It's time to start having honest, detailed conversations about the fact that out of hospital birth DOES take on an amount of added risk, what those risks are, and what they mean in the end.  It's time to start evaluating outcomes, analyzing preventative measures, and taking action that will actually improve the safety of out of hospital birth.  This bill needs a great deal of revision if it is to be effective and actually serve the mothers and babies of this state well.  Simply handing CPMs a license and cushioning them with a false board and standards set forth by NARM will NOT make out of hospital birth safer, it will make it inherently more dangerous than it already is.

If this post resonates with you, PLEASE take the time to write to your State Representative and Senator to express your concern for HB5070 and the ways it needs to be improved. Legislators listen to their constituents. 

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