Section I-J ~ Identifying the crucial role of midwife’s clinical judgement attempting to distinguish between a ‘variation’ and ‘deviation’ per AB 1308
The possible opportunities for some aspect of biology or physiology to in the moment present a variation/deviation spans the entire course of midwifery care, from first prenatal appointment to the last postpartum-neonatal appointment, and all stages and phases of labor and birth. A list of these possible variation-deviation would number in the thousands. As a result, there is no way to determine, prior to the facts of each situation, whether a possible variation is in fact a deviation legally requiring immediate obstetrical evaluation by a physician.
As stated in STANDARD # SIX: “The category of deviations differs from variations in that deviations are clinically significant conditions likely to have a detrimental affect on the health of the childbearing woman and/or unborn or newborn baby. The midwife employs clinical judgment to distinguish a ‘variation’ from a ‘deviation’ in each individual circumstance, taking into account all other relevant aspects of the situation.
While members of the CCM may prefer this document to include a such a list, it is impractical as to be impossible. Unless there is a legal ruling by a judge, or case law precedent in relation to particular situations or circumstances some time in the future, the issue of variation versus deviation will remain, per the CCM’s published Standard of Care, a part of the Ca LM’s on-going process of clinical judgment.
To assist that process, a functional definition of normal childbirth is provided below.
Normal Birth Defined: The word normal, as used in the LMPA and the four amendments, equates with a natural or spontaneous birth process, that is, one not requiring the use of any “artificial, forcible or mechanical means.” Thus normal would encompass all spontaneous physiological processes characteristic of healthy reproductive biology in healthy childbearing women that can reasonably be expected to lead to normal, healthy conclusions that include essential wellbeing for both mother and baby.