MIDWIFE & CLIENT RIGHTS AND RESPONSIBILITIES
The licensed midwife provides accurate information regarding the standards of care and scope of midwifery practice, professional fees, medical consultation arrangements, and the rights and responsibilities of the client.
I. CLIENT RIGHTS & RESPONSIBILITIES SPECIFIED
The client shall receive complete, relevant, objective and, where appropriate, evidence-based information regarding community-based midwifery as a form of care that is separate from the practice of obstetrics as a medical-surgical specialty. This information can be provided verbally, in writing, or any combination of both. It should include but is not limited to the following topics: ^O^ fg
- The risks and benefits associated with midwifery services provided in the client’s home or freestanding birth center
- The right of the client to change her mind and seek out obstetrical services or hospitalization
- A written or verbal description of the responsibilities for the client and her family, relative to choosing community-based maternity care
- The client’s right to receive full information, including risks, benefits, options, and alternatives, and to provide permission or informed consent prior to the performance of routine procedures of midwifery care or other treatments, procedures, or administration of any drug to mother or newborn
- The client’s right to decline standard protocols or recommended midwifery care. The client’s decision to decline recommended care will be noted in the chart and signed or initialed by the client and kept as a part of the client’s official record.
- Birth-related legal requirements for California residents include newborn screening for inborn errors of metabolism (PKU/newborn genetic screening), eye prophylaxis, registration of birth and death certificates, and reporting requirements for emergency transports involving mortality or serious complications. Some but not all of these can be declined by the parents under informed consent/decline protocols.
- Information regarding the client’s medical conditions and other concerns for which a licensed midwife may need to consult with a physician, refer client to a physician, and/or transfer the client to a physician’s care
- Information and referral of the client to other providers and services whenever requested or if the care required by the client is outside the scope of practice for midwifery or the protocols of the individual licensed midwife
- The grievance process for client complaints to the Medical Board of California regarding unsatisfactory or unethical care; (Medical Interface form per SB 1479 – see Section I-D)
- The client’s right to have pertinent records in her chart forwarded to other professionals when requested, to obtain copies of her midwifery records and those of her baby
- The licensed midwife’s expectations of the client and the licensed midwife’s right to discontinue care
II. MIDWIFE’S ETHICAL RESPONSIBILITIES TO CHILDBEARING FAMILIES
A. The principal objective of the midwifery profession is to render service to healthy women and their infants with full respect for human life and human dignity.
Licensed midwives should merit the confidence of women entrusted to their care, rendering to each a full measure of service and devotion.
Each licensed midwife should uphold the dignity and honor of the profession and accept its self-imposed disciplines. Such disciplines include a responsibility to uphold professional standards, to avoid compromise based on personal or institutional expediency, and to adhere to professional rather than commercial standards in making known the availability of their services.
Client Disclosure and Informed Consent for Community-based Midwifery Services
B. The licensed midwife shall provide a professional disclosure to each client that includes a brief description of the following information in verbal or in written form, or by reading on-line sources, including access to this Standard of Care document if the parents express an interest:
- The licensed midwife’s practice standards, guidelines, protocols and policies
- The licensed midwife’s training and years of experience
- The licensed midwife’s compliance with adult and infant cardiopulmonary resuscitation and neonatal resuscitation certification, continuing and/or special education
- The licensed midwife’s practice statistics, noting the number of clients served annually and the percentage of NSVD at home, of hospital transfers and subsequent Cesarean or instrumental deliveries, and the perinatal mortality rate for her practice (LMAR)
- Any limitations on the skill, practice, or other special requirements specific to the licensed midwife
- Care and equipment available and supplies provided
- How to contact the licensed midwife for routine communication
- How to reach the licensed midwife in an emergency, including phone numbers for a second-call midwife or backup arrangements if the licensed midwife cannot be reached
C. The client shall attest, by either checking off the appropriate box on the midwife’s “Consent for Care” form, or adding a handwritten notation signed by the client, that she has read and/or received complete, relevant, objective information on Client Rights and Responsibilities and Midwife Responsibilities as listed above.
D. All Disclosure and Consent forms shall include the date, name and signature of the client and, if appropriate, her partner, and become an official part of the client’s records.
E. Mandated disclosure forms
The “Medical Interface for Community-Based Maternity Services & Plans for Emergency Response” is required by SB 1479 (2000) and additional client information, client disclosures and client consent have been mandated by AB 1308 (2013).
Each licensed midwife shall disclose to a client, in oral and/or written form:
- The legal scope of practice for licensed midwives under the LMPA, including 2014 amendment (AB 1308) which specifically restricted the Ca LM’s practice and expanded the midwife’s obligation to provide legally specific information, disclosures and client consent.
- The specific arrangements for the client to access medical services including consultation and transfer of care during the prenatal period, hospital transfer during labor, birth and the immediate postpartum
- How to obtain appropriate emergency medical services for mother and baby when necessary
- The professional liability insurance status of the licensed midwife
- How to inquire about the midwife’s licensure status from the Medical Board of California
- Methods to report unsatisfactory or unethical care to the Medical Board of California
The Medical Interface “Plan for Routine and Emergent Care” form shall include the date, name and signature of the client and, if appropriate her partner, and become an official part of the client’s records. The Medical Interface Form, as developed by the California College of Midwives, is accepted by the MBC as satisfying the requirements of the 2000 amendment to the LMPA.
However, any licensed midwife may develop her own version as long as it includes the same six areas of mandated information.
F. Midwife Responsibilities & Client Informed Consent Documents ~ Sample forms
NOTE TO ROSANNA ~ access to these document should be via internet links, rather than being a specific aspect of the Standard itself.
This allows Ca LMs who use other forms can continue to do so. However, the Standard of Care as posted on the Internet should include the list of these links, with bookmarks to any specific form required by a specific section/topic (like GBS info included in routine prenatal care.
Sample forms as developed by California midwives are available on-line ~ at www.collegeofmidwives.org or in Section 4 of this web document. Midwives may use or develop their own version for each form as long as each one includes the necessary information.
- Professional Disclosure and Informed Consent for routine care
- Medical Interface and Plans for Emergency Care per SB 1479
- Information on Group B Strep and Consent/Decline of prenatal GBS cultures
- Information and Consent /Decline ~ Routine Newborn Ophthalmic Prophylaxis
- Information and Consent /Decline ~ Routine Administration of Vitamin K
- Consent for Out Of Hospital Intrapartum Care
- Information relative to special circumstances