Thoughts on the newly amended LMPA & providing the care based on “best practices to health childbearing women

by faithgibson on December 18, 2013

in AB1308, new regs & new legislative efforts

Now that the stumbling block of prerequisite supervision has gone away, we have a chance —  for the first time in 39 year — to eliminate the undue influence that special interest groups have had over mfry licensing laws (1974 and 1993).

This provides the first opportunity since passage of the CNM law in 1974 to see that midwifery practice acts is a flexible instrument that reflects the public interest (as contrasted with those of special interests!) by being organized around the dynamic biological of normal childbirth and the physical, psychological and social needs of healthy childbearing families. 

Laws developed in the public interest and designed to serve childbearing women must always provide for the informed consent/decline of the childbearing woman and the voluntary participation of the parents in all non-emergent medical care during normal pregnancy, childbirth and the care of their newly-born  baby.

This including protocols that address the inevitable  ‘exceptions, emergencies and extenuating circumstances in a manner that acknowledges the realities of the situation and  balances the needs and of all parties.

The facts are clear: Obstetrical medicine is an inexact science. Obstetrical providers do not as a general rule do a better job of making decisions for families than those families do for them selves when fully informed of the options.

Midwives and consumer groups need to talk more about how to facilitate a win-win for all parties — childbearing families, midwives, medical providers, and hospitals.

Since 1962 I have worked to protect the right of healthy woman to choose normal, physiologically-based childbirth practices and to be able to say “no” to involuntary medicalization of a normal labor and birth. Unfortunately medical schools in the US stopped teaching physiological management in the early 1900s. At this point in time, the professional trained, experienced and skilled in physiological management is midwifery. Only its practitioners can reliably provide an alternative to industrialized childbirth practices.

Constitutional laws in the United States need to recognize the right of healthy women women normal pregnancies to make this common-sense choice and for that choice to continue to have complementary relationship with obstetrical medicine so women who develop complication care receive appropriate medical care.

Unattended childbirth — with its 2- to 40-fold increase in neonatal deaths — is NOT an option, its an emergency.

I (and i hope the majority of other Ca LMs) identify safe and accessible maternity care for healthy women to include zero purposefully UNATTENDED labors. In conjunction with the general (or public) oversight of the mfry profession, we expect a logical system of  accountability of individual midwives for competent and ethical practice.

As founder of the California College of Midwives (state chapter of the Am. College of Community Midwives), I am 100% committed (along with all the other CAM and non-CAM activists) to keeping and/or transforming the LMPA so it always mirrors the dynamic (changing and changeable) needs of essentially healthy childbearing women with normal pregnancies.
This requires that our licensing law be a flexible instrument that structures the mfry profession so Ca LMs can meet the practical needs of women economically, safely and satisfactorily to all parties.
Many countries of the world that have hundreds of years of history with midwifery as an independent profession. In these countries, mfry licensing laws are structured in the public interest as a flexible instrument. They are designed to meet the practice realities of a normally dynamic biological, psychological and sociological process.  That is our goal as well.
In addition to formal mfry training, a professional scope of practice and standards that define safe and ethical care, laws developed in the public interest and designed to serve childbearing women must always provide for the informed consent/decline of the childbearing woman and the voluntary participation of the parents in all non-emergent medical care during normal pregnancy, childbirth and the care of their newborn.
One of the ways this is achieved is by including protocols that address the inevitable ‘exceptions, emergencies and extenuating circumstances in a manner that balances the needs and realities of all parties.

AB 1308 removed supervision from the LMPA, the licensed practice of midwifery in California will be restored as to an independent discipline.

Its obvious that all modern mfry legislation (1974 and 1993) was been heavily influenced by special interests. As a result, the modern nurse-midwifery law (1974) re-classified midwifery in California as a medicalized discipline under the control of the medical profession.

The CMA/ACOG authors of both mfry bills crafted them to provide a new type of physician-extenders practitioners — CNMs and LMs — that were expected to function under medical supervision as the employees of physicians. The 1993 LMPA copied the CNM law verbatim, also putting direct-entry into the category of a physician-supervised medicalized discipline.

The reason both CNM and LM laws did not contain a professional standard of midwifery practice is that both were designed to create the category know as “physician extender” in the arena of obstetrical medicine.
As a medically supportive role, an individual midwife’s practice was to be determined by her supervising OB. In those instances, care provided by each individual midwife is based on the dynamic needs and preferences of a specific individual physician.
However, this has never been the norm for the discipline of midwifery. In those areas of the world where it’s practice was historically a part of mainstream health care, its modern practice was an independent profession
We are all working now to see that new midwifery laws neutralize the undue influence of special interest groups by being configured in the public interest.

We all hope and pray that AB 1308 will return  to the historic or ‘legacy’ practice of midwifery as an independent profession after 6 decades of being lost in the desert.

The immediate issue is how to structure midwifery as an independent discipline.

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