When thinking about the ‘relationship between midwives and physician’s as defineMPA’s mandated supervision requirement in the 1993 LMPA’s, I’d like to ask legislators and other policy-makers one important question:
“Does classifying the legacy (traditional, non-nurse) practice of midwifery as a medically-supervised discipline carry out the plainly stated Legislative Intent of the LMPA (SB 350) and Senator Figueroa’s amendment (SB 1479), or does it get in the way?
After reading the Legislature’s Intent for the LMPA and its firs amendment passed in the year 2000, I think you’ll agree with me that it does not help and it does create considerable harm.
faith gibson, LM ^O^
The Licensed Midwifery Practice Act of 1993
SECTION 1. The Legislature finds and declares all of the following:
(a) Over 40,000 babies die every year in the United States, many of them as a result of being born severely underweight. That rate, among the worst in the developed world, has been condemned by health experts as a preventable tragedy and a national disgrace.
(b) Research has shown for every dollar society might spend to reduce the number of underweight births, three dollars ($3) in medical-care costs could be saved.
(c) The increasing state budget deficit limits the amounts of state funds available to subsidize public health care.
(d) It is in agreement with the principle stated by the World Health Organization that each woman has a fundamental right to receive proper prenatal care, that the woman has a central role in all aspects of this care, including participation in the planning, carrying out, and evaluation of the care, and that social, emotional, and psychological factors are decisive in the understanding and implementation of proper prenatal care
(e) Prenatal care reduces the incidence of low birth weights.
(f) The number of available physicians and surgeons to serve low-income pregnant women has sharply decreased.
(g) Five nations with the lowest prenatal mortality rates have 70 percent of all births attended by midwives.
(h) In a 1982 report by the Department of Consumer Affairs, recommendations were made to actively promote nurse and non-nurse midwifery services as one means of providing cost-effective, comprehensive perinatal services which have been shown to be effective in lowering perinatal morbidity and mortality rates.
(i) The Office of Statewide Health Planning and Development (OSHPD) recommended in its 1986 study of Alternative Birthing Methods that a separate category of licensed midwives should be established in the Department of Consumer Affairs.
(j) The OSHPD further recommended that competencies for this new category should be comparable to those of nurse-midwives and physician assistant-midwives, although licensure as a registered nurse or physician assistant should not be required to become a licensed midwife.
(k) The Legislature supports a multifaceted, cost-effective approach which includes licensed midwives providing prenatal, delivery and necessary followup care to families.
SB 1479 ~ THE LEGISLATURE FINDS AND DECLARES THAT:
(a) Childbirth is a normal process of the human body and not a disease.
(b) Every woman has a right to choose her birth setting from the full range of safe options available in her community.
(c) The midwifery model of care emphasizes a commitment to informed choice, continuity of individualized care, and sensitivity to the emotional and spiritual aspects of childbearing, and includes monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and identifying and referring women who require obstetrical attention.
(d) Numerous studies have associated professional midwifery care with safety, good outcomes, and cost-effectiveness in the United States and in other countries. California studies suggest that low-risk women who choose a natural childbirth approach in an out-of-hospital setting will experience as low a perinatal mortality as low-risk women who choose a hospital birth under management of an obstetrician, including unfavorable results for transfer from the home to the hospital.
(e) The midwifery model of care is an important option within comprehensive health care for women and their families and should be a choice made available to all women who are appropriate for and interested in home birth.