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Purpose, Definitions & General Provisions:
A. Standards of Care, policies, protocols, guidelines, technical bulletins and published opinions provide a framework to proactively guide and retroactively evaluate the California licensed midwife’s practice. This is to ensure that midwifery care provided by LMs is safe, ethical, and consistent with physiologically-based principles, scientific evidence and the professional practice of midwifery as defined by the international, national and state organizations identified below. ^O^ fg
The professionally licensed midwife who conforms to the standards, policies, and guidelines associated with these practice requirements is judged to be competent. Sources and documentation for practice standards and guidelines requirements include, but are not limited to, the following:
- The International Definition of a Midwife (International Confederation of Midwives) and international scope of practice (see page# ?)
- Customary definitions of the midwifery model of care by state and national midwifery organizations, including the LMPA of 1993 and its four amendments, including SB 1479 in 2000 (see its Legislative Intent language at end of this section), SB 1950 in 2002, SB 1638 in 2006 and AB 1308 in 2013. ^O^ fg
- Standards of practice for community midwives published in the English language by state and national midwifery organizations in the US, Canada and Europe (Alaska, British Columbia, Colorado, England, Netherlands, New Mexico, Texas, Tennessee, Washington State, Vermont)
- Philosophy of Care, Code of Ethics, and Informed Consent Policy published by state and national midwifery organizations in the US
- Educational competencies published by state and national midwifery organizations in the US
B. The California licensed midwife is a professional health care practitioner who maintains all requirements of state certification, keeps current with safe and ethical midwifery practice and who practices in accordance with:
- The body of knowledge, clinical skills, and clinical judgments described in the Midwives Alliance of North America (MANA) Core Competencies for Basic Midwifery Practice
- The statutory requirements as set forth in the Licensed Midwifery Practice Act of 1993, all current and future amendments to LMPA and the Health and Safety Code on Birth Registration ^O^ fg
- The standards, guidelines for community-based midwifery practice
- The protocols of the individual midwifery service/practice
C. The California licensed midwife provides care in clinics, physician offices, hospitals, birth centers and the family’s residence. The licensed midwife provides well-woman services pre- and inter-conceptually and maternity services to essentially healthy women who are experiencing a normal pregnancy. ^O^ fg
An essentially healthy woman is without serious pre-existing medical or mental conditions affecting major body organs, biological systems, or competent mental function. An essentially normal pregnancy is without serious medical conditions or complications affecting either mother or fetus.
D. The California licensed midwife must be able to give the necessary supervision, care and advice to women prior to and during pregnancy, labor, and the postpartum period, to conduct normal spontaneous deliveries in all settings, and care for the healthy neonate. This includes preventative measures, policies and protocols for the management of variations, detection of clinically-significant deviations from norm and complications in mother or neonate, and the procurement of medical assistance when necessary.
Maternal-neonatal safety also requires that licensed midwives sometimes provide emergency measures as a ‘first-responder’. Use of emergency medical methods is appropriate while arranging emergency transport and when medical care is unavailable due to prolonged travel time, geographical barriers, inclimate weather, and civil disasters of any type. ^O^ fg
E. The California licensed midwife’s primary ethical accountability is to the women in her care within the context of the midwife’s responsibility to uphold professional standards and avoid compromise based on personal or institutional expediency.
F. The California licensed midwife is also accountable to peers, the regulatory body (MBC), and to the public for safe, competent, ethical practice. It is the responsibility of the licensed midwife to incorporate an evaluation process into her practice, such as soliciting feedback from client families and community groups concerned with improving childbirth practices and maternity care services. Monitoring the safety of licensed midwifery practice in California requires that each midwife participation in mortality and morbidity reporting and on-going review processes. This is satisfied by filing the Licensed Midwives’ Annual Report. The CCM encourages the use of data from the LMAR whenever professional policies, education, and practice standards are being developed or amended. ^O^ fg
G. The California licensed midwife is accountable to the client, the community, and the midwifery profession for evidence-based practice. Evidence-based care is generally defined as a combination of (a) the best research evidence available at the time; (b) the clinical experience of its practitioners and {c} the informed choice of childbearing women and their families. Evidence-based care and “best practices” includes but is not limited to continuing education and ongoing evaluation of the scientific literature. This may include sharing midwifery knowledge and participating in research regarding midwifery outcomes. ^O^ fg
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