Making Lemonade-a recipe to support HB 2163

Start with two lemons: Two bills introduced by a freshman Delegate from Harrisonburg who “loves midwives” but lends his ear to obstetricians in his community who feel quite differently.

Throw out the rotten fruit: HB 2167- a bill intended to eliminate VBAC births at home but written in a way that singled out low-income women from accessing midwives for normal birth after cesarean birth.  Happily, the strong surge of consitituent phone calls, emails, and letters to the Delegates of the General Assembly put a prompt end to this bill in the Health, Welfare, and Institutions (HWI) committee.

Re-examine remaining fruit: HB 2163- a bill that requires the regulations of Certified Professional Midwives in Virginia to include discussing information about risks associated with VBAC, twins, breech, and “other high risk pregnancies” was upheld by the HWI committee on the same day.  The lesser of two evils, this bill is redundant and sets a higher standard for informed choice for midwives than any other profession.

Slice through the skin and squeeze the juice: “Higher standard of informed choice for the profession of midwifery”.  Isn’t this what we have been trying to say all along?  Informed Choice is the hallmark of midwifery care.  How can we oppose a bill that clarifies that for us?  The concern is that the Board of Medicine will get to oversee the development of standardized documents…what will they require us to say?

Add Sugar: How about making the bill better, stronger, and able to leap tall buildings?  Why not clarify that the information the CPM gives her client be “evidence-based“? If accepted, this phrase would be precedent setting in VA statute. Imagine if ALL informed choice were evidenced-based?  Imagine if the Board of Medicine reviewed all practitioners based on evidenced-based practice rather than community standard of care, which is often driven by defensive medicine and convienience. The bill then changes from redundant to strenthening of the Midwives Model of Care.

Add water, and maybe a few other fruits: While we’re at it, let’s try to fix another problem that the Board of Medicine is having with the practice of midwifery.  Our statue specifies that a woman cannot be required to seek the care of another health care professional during her care with a midwife.  This was included by wise individuals who knew that in other states that license midwives, a requirement for a woman to be evaluated by physician in order to have a home birth was an obstacle to practice as no physician would be willing to assume liablity for the outcome of his/her “approval”.  This phrase in the statute, however, prevented the Board of Medicine (BOM) from moving forward with its NOIRA request last February  (scroll to 2008 action alerts at this link) to set limits on the scope of practice for CPMs. This came up at last Friday’s Midwifery Advisory Board meeting.  The BOM has a lengthy process for determining that a change in statute is necessary, but an end result of a recommendation for removal of the phrase that blocked their NOIRA is not something that we want.  The midwives think a better solution is to use the bill that is before us to give a compromise to the Board.  How about if we clarify what we already do in situations that involve potential risks in  pregnancy and birth: offer options for consultation or referral to a physician as part of our informed choice?  This gets at the heart of the cultural divide between physicians and the midwifery community.  The opponents of home birth genuinely believe that midwives can’t possibly be giving women informed choice that includes risks and we are potentially even keeping them from seeing physicians in a timely manner by not offering or facilitating consultation or transfer of care.  Midwives say they get little or no support in some communities in Virginia (Charlottesville is not in that category, UVA is a FABULOUS model for good collaborative relationships) when they do try to consult.  Many OBs don’t want our clients and they refuse our calls for appointments. Something needs to change and while we don’t want to fix our problems through legislation, this bill is moving forward and there is an opportunity to offer a gesture towards a peace process by reiterating consultation and referral as part of informed choice.

Stir and serve: A draft amendment (which would technically be called a “substitute”) has been offered to Delegate Lohr.  Along with lobbyists from the Medical Society and VA ACOG, Delegate Lohr has agreed to amend his bill at the request of the Commonwealth Midwives Alliance.  The VABirthPAC Board of Directors has also reviewed and approved the new language.  Now, we offer it to the rest of the Commonwealth in the hopes that you will also agree that this is a worthy bill.  We have the opportunity to have an historic precedent….medicine and midwifery on the same side of a bill.  We hope that this gesture will move us forward to the necessary place of problem solving, rather than fighting at the Board of Medicine and in Virginia communities.

The proposed substitute language will be voted and (hopefully) adopted this Thursday by the Senate Health Licensing Subcommittee.

Please contact Delegate Lohr today to let him know that you support the substitute amendment for HB 2163 and to thank him for listening to midwives.
You can also contact the members of the Senate Health and Education Committee to let them know that they should support HB 2163, with the substitute.

Thanks for all you do for birth-

Brynne

UPDATE: HB 2163 passesd the Senate Health Licensing Subcommittee with a unanimous vote on Thursday, February 12.