Update on Midwifery and Medications

The 4th Workgroup on Midwifery and Medications was held on May 5th. While some were celebrating International Midwives Day with picnics, parties, and fundraisers, some VA licensed midwives were engaged in the ongoing dialogue at the Board of Medicine regarding access to medications for women birthing out of hospital.

The challenge of the cultural divide continues to be an obstacle to resolution, with both “sides” feeling conflicted. While there are distinct moments of mutual agreement about issues and concerns that come at each meeting, this feeling of movement is tempered by the untenable areas related to patient autonomy and physician supervision. Following the meeting, for which minutes are not yet available, Deren and I sent the following letter to Board of Medicine Executive Director, Dr. William Harp:

Dr. William Harp
Executive Director
Virginia Board of Medicine
Perimeter Center 9960
Mayland Drive, Suite 300.
Henrico Virginia 23233-1463

Date 5/8/11

Dear Dr. Harp,
After our fourth meeting last week it is clear to us, as representatives of the midwifery and home birth community for the Workgroup that an impasse has been reached between medicine and midwifery. There is an obvious and immoveable sentiment among members of the Workgroup who represent the full Board that there will be no endorsement of a plan to allow access to medications for midwifery clients without agreement to restrict access to home birth. Additionally, there is resolute resistance to the concept of drafting model language that would allow the use of medications by any providers who are not supervised by physicians.

Though there was some tentative discussion at the last meeting of issues directly related to access to medications such as protocols and training, the vast majority of our time was spent revisiting the conflicts over standard of care and physician/midwife relationships. Persisting in this dialogue is not productive toward the goal of the Workgroup. As the representatives of Virginia midwives on the workgroup we do not have the blessing or the authority to negotiate issues of midwife autonomy and risk screening. The suggestion by Workgroup members that midwives give up the right to care for women with potential risk factors would likely lead to an increase in unlicensed midwifery practice or unassisted birth. To close one gap in care by opening another one would simply compromise safety in a different way. We cannot see the point in continuing to respond to requests for research. There is no amount of data available that can justify the continued lack of access to basic medications for clients in midwifery care. Neither can we agree that restricting risk factors for home birth will impact the suitability for the use of these medications by well-trained midwives attending births outside the hospital environment.

In order to move forward in a way that justifies the public cost and respects the time and energy of the Workgroup members, we feel that the staff at the Board of Medicine should be directed to draft model statutory language which would outline a mechanism for obtaining, carrying, and administering medications by Licensed Midwives that does not include physician supervision. All of the members of the Workgroup have agreed that supervision is not tenable at this time. Physicians are unwilling to assume liability for the actions of midwives, and therefore midwives are unable to find physicians to supervise them. An autonomous mechanism seems to be the only remaining solution.

As Brynne stated during our last meeting, the midwifery community accepted licensure without access to medications because we knew that practicing with a legal status would increase the safety of home birth and the accountability of the midwife providers in the Commonwealth.

We continue to believe that access to basic emergency and newborn medications would make home birth safer for mothers and babies, but we cannot continue our participation in the workgroup without action and input from staff expertise at the Board of Medicine and an indication that our fellow Workgroup members are committed to helping us solve this problem.

We respect the effort and intention put forth by the Board of Medicine in the creation of this Workgroup. But until a will exists among members of the group and of the full Board to acknowledge the need to move forward with a mechanism for medications without an agreement for practice restriction, we do not believe our efforts are serving the public and we respectfully request that the effort be tabled.

Sincerely yours,

Brynne Potter, CPM and Deren Bader, CPM, DrPH

At this time, we have had no response and a next meeting has not been scheduled.  What are your thoughts on next steps for Virginia midwifery?