I gave the following speech at this morning’s
meeting of the Virginia Board of Medicine.
I am speaking to you today on the topic of licensed midwifery in the Commonwealth. I am a Certified Professional Midwife practicing in the Charlottesville area. I worked on the legislation that was passed in 2005 to license CPMs and I serve as the Policy Coordinator for the Commonwealth Midwives Alliance. I also serve on the Board of Directors for the North American Registry of Midwives, the credentialing agency that administers and issues the CPM credential in all 50 states and Canada.
My intention is to earnestly implore this board to take steps to alter the adversarial tone that has characterized the process of licensure and regulation of CPMs since the Joint Commission on Health first studied direct entry midwifery for the Commonwealth in 1998. For 10 years now, the effort to provide accessibility and accountability for out of hospital midwifery in Virginia has been met with resistance from vocal members of the medical community. This has been in part due undesired intra-partum transfer of care but also from a lack of cultural understanding from both sides of the aisle.
Since the Board of Medicine is the entity charged by the Commonwealth to work to ensure optimal outcomes and public safety, I would like to challenge each of you to strive to become more aware of the culture of home birth and of the women who are seeking out of hospital care from Certified Professional Midwives. Without a better understanding of the public segment that you are seeking to protect, I fear that your actions will only exacerbate the perceived problems you are trying to correct.
Without any kind of licensure or legal status for midwives, home births began increasing in Virginia in the mid 1980s. That increase continues at a steady rate, driven by an increasing population of informed women who seek self directed care. Home birth itself is outside the standard of care to which you are accustomed and despite dire warnings from obstetricians and OB trade organizations, women have and will continue to choose it as the best option for the kind of maternity care they desire. I highly encourage each of you to sit down with a consumer of midwifery services and ask her about her decision to birth at home. You may be surprised by what you hear and it will certainly help to inform you in your decision making as members of this board. I firmly believe that we can only solve problems when we understand the situations that created them.
There are some avenues for better understanding that, to my knowledge, this board has not fully utilized in the past.
The first is to look at solutions that other states have found for ensuring that adequate informed consent is being given to women who choose midwifery care by adopting standardized informed disclosure forms and informed choice documents. Both CA and VT have models that include giving women the full medical viewpoint and require the midwife to provide clear options for referral or transfer of care for conditions that might pose more risk for mother or baby.
The second is to increase your utilization of the Advisory Board on Midwifery. In our short history with the Board of Medicine, the full Board has overturned nearly every public Advisory Board recommendation. This has led to the midwives and their consumers’ beliefs that you do not value the recommendations of the Advisory Board and that midwives have no voice in the process…something the General Assembly and the public very much intended them to have. The Midwifery Advisory Board is composed of very experienced home birth midwives including one who is also a Doctor of Public Health. Please avail yourself of the valuable resource the Governor has provided you in his appointments to this Board.
We have 28 published studies on home birth that have demonstrated its safety. There are zero studies that have shown a significant safety concern for planned home birth, even when the attendant is not certified or licensed. What the studies have shown, however, is that the best way to achieve optimal outcomes for home birth is to develop optimal systems for transfer of care from midwife to medical provider. We are 100% in support of efforts to work collaboratively to develop systems in all parts of the state that will encourage families and the midwives who serve them to utilize medical services when appropriate. This can only be done through a cooperative process that includes bilateral education of the different birth cultures that women must navigate in order to achieve the care they want and need. In order to encourage women to access medical care in a timely fashion, we must create productive discourse among the health professionals.
While some of you have very publicly made your negative sentiments regarding home birth and midwives abundantly clear it is my dearest hope that you will set your personal feelings and anecdotal experiences aside and work with us to develop solutions and better understanding as we strive for our common goals of optimal outcomes for mothers and babies.