Do Midwives Provide Too Much Information?

Not in the opinion of the Commonwealth of Virginia.
As a follow up to last year’s passage of legislation that would require evidence-based informed consent for all women seeking home birth Evidence Based-It’s Now the Law, the Virginia Regulatory Townhall posted the first of two public comment opportunities.
Please read the following open letter to Midwifery Advocates and take a moment to post a comment to the Commonwealth of Virginia regarding your thoughts on informed choice in maternity care.

Dear Midwifery Advocates, Researchers, and Educators -

I am writing on behalf of the Certified Professional Midwives licensed in Virginia to ask for your support involving establishment of regulatory precedent for evidenced-based informed consent for women seeking maternity care.  As some of you may already know, last year the VA General Assembly passed a bill that required CPMs to provided evidenced-based informed disclosure to all women seeking home birth. You can read the history of how this happened here:  http://midwifemonologues.com/making-lemonade-a-recipe-to-support-hb-2163/

Risk factors that were listed in the law included vbac, twins, and breech presentation but also allowed for “other high risk pregnancies”.  The law does not state that these conditions would prohibit CPMs from attending a woman at home, just that the CPM will be required to provide clear, evidence-based informed consent before doing so.

The process that follows a statutory mandate for regulatory change in Virginia is open to the public and participation is simple.  The notice of intended regulatory action (NOIRA) has recently been posted to the Virginia Townhall Website.  The summary and details of the guidelines for this regulatory change are listed in a pdf (here) and there is now a 30 day public comment period.  Comments can be submitted by any member of the public, both in Virginia and outside of the state.

After the comment period ends (11/25/09), a Work Group consisting of members of the Board of Medicine and the midwifery community will convene to come up with a list of conditions that require additional informed choice, and draft specific informed choice documents that will be included in the regulations for CPMs.  These documents will then be presented to the Advisory Board on Midwifery and the full Board of Medicine for review.  There will be a public hearing and then another 30 day public comment period before final approval.

The midwifery community in Virginia believes that even though this requirement is redundant to our existing statutory requirement to practice the Midwives Model of Care, which is based on informed choice, the opportunity to establish once and for all that women are choosing midwifery care and home birth of their own free and informed will, is worthy of our close attention and support.  We believe that if we can engage the Board of Medicine in an unprecedented process of looking at evidence-based criteria for competent practice, we will widen the narrow band of understanding that is forming between medical and midwifery based maternity providers.  In addition, we need to be vigilant during the process to make sure that any guidelines or rules established do not create unforeseen obstacles to care for women who may fall into gray areas regarding relative risk of home or hospital birth based on current standard of practice in many hospital settings.  Mandated c-sections for VBAC, twins, and breech are good examples of the conundrum many midwives and their clients face when providing and making informed decisions for care.

We ask that you review and consider this outlined process and then post a comment to the Townhall Web site.

For those of you with a background or expertise in evidenced-based maternity care, please include your credentials and give citations to your work or other relevant resources that you can provide to the Work Group.  The NOIRA specifically states that the department plans to look to other states with various models of reviewing and determining risk. Item number 3 under “Substance” is especially interesting and invites response:

“If the factors or criteria have been identified that may indicate health risks associated with birth of a child outside a hospital, a requirement for the midwife to provide evidence based information on such risks. Such information would be specified by the Board for certain conditions and would include statements and evidence from both the medical and midwifery models of care.”

It appears that the agency believes that “evidence” is a subjective term and that is why we need evidence from both sides.  While I commend the Agency in its efforts to be fair and balanced, I believe this statement shows how imperative it is that we provide them with clear and objective evidence (research) from which to draft their documents.

For those of you who have used, are utilizing, or intend to use maternity services in Virginia, please tell the Agency what you would like the documents to include.  It is up to you to remind them that you want your informed choice to include the risks and benefits of home birth and that you want your “evidence” to be based on research, not opinion.  It is up to you to ask for information on the risks of hospital or caesarean delivery in certain situations as part of complete informed decision making. It is also up to you to review the current midwifery regulations and comment on any other aspect or restriction involving access to care that you believe should or could be improved.  They are asking for your opinions and this is a great opportunity to give them.

By providing  your comments, you support and engage the process.  You also remind everyone involved that the process is being carefully watched.  Most importantly, your comments may have a ripple effect in creating a future where ALL maternity providers are required to give evidenced-based informed choice to their clients.

Thank you for your time and attention. Please forward this request to anyone in your contact list that you believe would want to have this opportunity to participate in this process. Feel free to contact me with any questions or concerns.

Brynne Potter, CPM

Legislative Policy Coordinator, Commonwealth Midwives Alliance

brynne@mountainviewmidwives.com

www.mountainviewmidwives.com

o: 434-962-0148

m:434-962-5453