May 7th Medical Board Meeting ~ my request to extend postpartum scope of practice to 12 months

by faithgibson on May 8, 2020

in 21st Century Healthcare in US, Practice Issues - Safety & Cost

Public Comment ~ Virtual Medical Board Meeting, May 7th 2020

My name is Faith Gibson. I’m a Cal licensed midwife and was a member of the Midwifery Advisory Council from 2007 to 2013.

I’m requesting support by the Medical Board for an amendment to the Licensed Midwifery Practice Act of 1993 to expand the postpartum scope of practice of licensed midwives from 6 weeks to 12 months. This is consistent with definitions used by the CDC and World Health Organization for assessing maternal health and tracking maternal morbidity and mortality.

We generally think of maternal deaths as primarily a ‘childbirth’ issue, but actually only 17% of these deaths occur during the labor, birth or immediate recovery phase. However, a whooping 52% occur during the 12 months after a new mother gives birth, and this number does not include suicide, which is three times greater than deaths from medical complications.

For the last century, maternity care in the US has focused intensely on pregnancy and childbirth. As a result, healthy new mothers and their neonates are discharged from the hospital after 48 hours with no scheduled follow up for the new mother until the traditional 6-week check up.

ACOG recently recommended that new mothers be first seen in the office at 3 weeks, but currently there is no formal mechanism for home visits during the first week after hospital discharge and no regular follow up after the 6 weeks visit.

The most common medical reasons for postpartum deaths include hypertension, pulmonary embolisms, infection and increasing rate of undiagnosed *cardiopathy (*car-de-op-oh-thy, i.e. seriously weakened heart muscles). Even more disturbing is the suicide rate from postpartum depression during the first year, which as I mentioned is 3 times higher than medical complications.

According to a CDC spokesperson, some of these new mothers died because they lacked access to good health care, resulting in delayed or missed diagnoses of crucial medical problems. Serious racial disparities also exist. Black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women. Officials said this data suggests that the majority of deaths, regardless of when they occurred, could have been prevented by tackling these key problems.

Dr. Wanda Barfield, director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention, noted that the CDC’s new analysis underscored the need for access to high-quality services, risk awareness and early diagnosis and preventing future pregnancy-related deaths. She said that by identifying and promptly responding to warning signs not just during pregnancy, but up to a year after delivery, we can save lives …”.

Postpartum care currently provided by Cal LMs:

California licensed midwives make 2 postpartum-neonatal house calls in the first few days after the birth, with scheduled office visits to see the new mother and baby at 2 and 6 weeks.

Proposal for expanding postpartum scope of practice and adding a relevant educational module to the LMPA

I’m proposing to extend the formal scope of practice for licensed midwives to include the first 12 months postpartum and to add an education module for recognizing the signs and symptoms of pulmonary embolism, cardiopathy and postpartum depression to the educational criteria for LMs.

Many midwives, myself included, already provide expanded postpartum care or what we call Second Nine-Month Care. At the 6 weeks visit, I offer to see the new mother at 3, 6, and 9 months. This could easily be expanded to include a one-year visit.

An additional benefit of extending midwifery care to one year postpartum is that healthcare organization like Kaiser, community clinics and obstetrical groups could formally employ LMs to provide extended postpartum care as home visits for new mothers just released from the hospital and 30-minute offices at 3, 6, 9 and 12 months.

Thank you for your time and I hope you will favorably consider my proposal.


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