I have recently been reading up on the scope of practice changes in Arizona and found it to be both sad and outrageous. This is an issue that will affect all the women of Arizona, not just those who choose to birth at home with a midwife. I have become part of a few Facebook groups where there are many concerned citizens, many of whom have birthed at home, and want to again with their next children. There are so many great points. The biggest issue right now is that the restrictions upon midwives will be so enormous as to endanger women and babies, which is totally backwards of how medical care should be.
"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has." -Margaret Mead
"If it is to be, it's up to me." -Bradley Method teacher training materials
I wanted to put all the great links to information in one place, which will be easy to find for someone just coming into this discussion, or those who may just find it helpful to have everything in one place. So, to that end, here are the links:
Here is a direct link to post public comment about the scope of practice. http://www.surveymonkey.com/s/
Proposed draft to the scope of practice for midwifery: http://www.azdhs.gov/diro/admin_rules/documents/midwifery/licensing-of-midwifery-draft-rules-may-2013.pdf
"The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.
"The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center." http://www.acog.org/
"Although The College does not support planned home births given the published medical data, it emphasizes that women who decide to deliver at home should be offered standard components of prenatal care, including Group B Strep screening and treatment, genetic screening, and HIV screening. It also is important for women thinking about a planned home birth to consider whether they are healthy and considered low-risk and to work with a Certified Nurse Midwife, Certified Midwife, or physician that practices in an integrated and regulated health system; have ready access to consultation; and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency." http://www.acog.org/About_ACOG/News_Room/News_Releases/2011/The_American_College_of_Obstetricians_and_Gynecologists_Issues_Opinion_on_Planned_Home_Births
"Pregnancy does not obviate or limit the requirement to obtain informed consent. Intervention on behalf of the fetus must be undertaken through the body and within the context of the life of the pregnant woman, and therefore her consent for medical treatment is required, regardless of the treatment indication. However, pregnancy presents a special set of issues. The issues associated with informed refusal of care by pregnant women are addressed in the January 2004 opinion "Patient Choice in the Maternal–Fetal Relationship" (20). This opinion states that in cases of maternal refusal of treatment for the sake of the fetus, "court-ordered intervention against the wishes of a pregnant woman is rarely if ever acceptable." The document presents a review of general ethical considerations applicable to pregnant women who do not follow the advice of their physicians or do not seem to make decisions in the best interest of their fetuses. Although the possibility of a justifiable court-ordered intervention is not completely ruled out, the document presents several recommendations that strongly discourage coercive measures:
•"The obstetrician's response to a patient's unwillingness to cooperate with medical advice . . . should be to convey clearly the reasons for the recommendations to the pregnant woman, examine the barriers to change along with her, and encourage the development of health-promoting behavior."
•"[Even if] a woman's autonomous decision [seems] not to promote beneficence-based obligations (of the woman or the physician) to the fetus, . . . the obstetrician must respect the patient's autonomy, continue to care for the pregnant woman, and not intervene against the patient's wishes, regardless of the consequences."
•"The obstetrician must keep in mind that medical knowledge has limitations and medical judgment is fallible" and should therefore take great care "to present a balanced evaluation of expected outcomes for both [the woman and the fetus]." •"Obstetricians should consider the social and cultural context in which these decisions are made and question whether their ethical judgments reinforce gender, class, or racial inequality." http://www.acog.org/
"In honor of Mother's Day, Jan Crawford introduces viewers to Ina May Gaskin, an Iowa farm woman who is helping to revive a natural childbirth process used by more and more American mothers." http://www.cbsnews.com/video/watch/?id=50146659n&tag=api
Official link to email Governor Janice K. Brewer (appoints head of AZDHS) http://www.azgovernor.gov/
Midwifery community upset over new DHS guidelines
Arizona State Representatives roster
http://azleg.gov/MemberRoster.asp?Body=H&SortBy=1
Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. (PubMed)
"The practice of medicine is as much an art as it is a science. There are subtleties that demand one’s attention as well as an appreciation of the risks, benefits and alternatives to treatments that confront every patient and physician. The practice of medicine is never black and white.
The Arizona Legislature is pushing several bills under the guise of “protecting” the health of Arizona’s women. Though the social impact may superficially appear laudable, these are not just simple anti- abortion bills. They are weighted down with many entanglements that violate standard obstetric practice, interfere with the doctor-patient relationship and are adverse to women’s health.
As obstetrician/gynecologists, we are at the forefront of caring for the women of Arizona. We are deeply troubled by lawmakers’ attempt to legislate the practice of medicine against the standard of care set by the American Congress of Obstetrics & Gynecology (ACOG), our national organization."
Read more: http://azcapitoltimes.com/news/2012/04/06/abortion-bills-out-of-line-with-accepted-standards-of-prenatal-care/#ixzz2TZWbwXkV
The European Court of Human Rights held both that women are the ones with legal authority to make the decisions of childbirth, and that the state cannot use the force of law to take away their options. The basic options that the court discussed in the Ternovszky case were the choice between giving birth at home or in the hospital, and also the choice to be attended during childbirth by a medical doctor or a midwife.
http://www.humanrightsinchildbirth.com/blog/125-welcometohricblog
Arizona American Civil Liberties Union
http://www.aclu.org/affiliate/arizona
Pre-hospital Emergency Medication Policy Statement
"BACKGROUND: From the beginning of paramedic systems in this state, pre-hospital care providers have
used prescription and non-prescription drugs to provide lifesaving care. In spite of the widespread use of
drugs by prehospital care providers, no rule has ever been written specifically devoted to the distribution,
possession, storage, security, administration and replacement of these drugs and controlled substances.
As a result, important policy questions have arisen from time to time concerning the supply and resupply
of drugs in prehospital care. This policy guide is based on the Arizona Board of Pharmacy interpretation
of existing statutes and rules related to drug distribution by Arizona hospital pharmacies."
http://www.azpharmacy.gov/substantive_policies/pdfs/sps4.pdf
This seems to cover quite a bit. What information should be available to those asking for changes, as well as parents who will need to be informed about the care they are to receive around the time of pregnancy and birth? Please comment with any suggestions or new information!
