Louisiana Constituents for Safe Childbirth

ACOG Guidelines ruling Midwifery Rules (Part 2)

Enforcing obstetrician rules on midwives

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Mar 2016

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In 2012 the Midwifery Care Act was passed. For the past 2 years, the Louisiana State Board of Medical Examiners (LSBME) has been working on the Midwifery Rules for those laws. In the next couple days and weeks we will be sharing our thoughts on these rules. This blog is the second of 2 blogs discussing ACOG and Louisiana Midwifery Rules. Click here to read Part 1.

There are two types of Licensed Midwives (LM) in Louisiana, Certified Professional Midwife (CPM) and Certified Nurse-Midwife (CNM). The midwifery rules that we will be discussing affect CPMs, who are governed by the LSBME.

Have you seen the current Midwifery Rules draft? Throughout the document it refers to the rules as being per ACOG’s current guidelines.

 

WHAT IS THE DIFFERENCE BETWEEN OBSTETRICIANS AND MIDWIVES

While there are many similarities in care, there are also differences. Did you know that there are two different care models, Midwifery and Medical Models of Care, concerning maternity care?

Medical Model of Care focuses on preventing, diagnosing, and treating complications that can arise during pregnancy and birth. Prevention of complications is often done through testing and interventions to avoid poor outcomes. Physicians focus mostly on the mother’s physical health. Obstetricians tend to use this care model; and will treat women with all risk levels.

Midwifery Model is based on the premise that pregnancy and childbirth are natural bodily processes that result in healthy moms and babies. As such, midwives tend to perform minimal interventions, and only when necessary. In addition to assessing physical health, midwives also assess spiritual and emotional needs. CPM’s only care for low-risk women and work mostly in out-of-hospital environments.

In addition to the different care models, obstetricians and midwives also have different scopes of practice (legal rules concerning the care they provide).

Did you know that you have the right to choose your care provider, and to accept and decline medical care? Women and their partners need to choose the care providers that best meet their needs. There are many factors that will affect consumer’s choices, but the bottom-line is that it is THEIR DECISION (at least for now).

Some of these draft rules will actually decrease choices, and are also not evidence-based.

 

HOW WILL CHOICES BE TAKEN AWAY FROM CONSUMERS?

Throughout the draft rules it states that the rules will be according to current ACOG practice guidelines. (I do not have a problem with many of ACOG’s guidelines. I actually think that if more practitioners in Louisiana followed them, our cesarean rate would not be almost 40%.) However, I do have an issue with imposing the practice guidelines of one professional group onto another. Midwives are not Obstetricians. They have a different model of care and scope of practice. By forcing midwives to practice by the same guidelines, you are destroying the midwifery model and consumer’s rights to choose a different type of care provider.

This does not mean that midwives should not be regulated. Of course they should! They are a professional body that can greatly affect the health of others. But, instead of forcing the same guidelines of another profession, lets allow the MIDWIVES to regulate their own practice. Let’s let ACOG set the standards for OBGYNs, North American Registry of Midwives (NARM) set the standards for Louisiana Midwives (which is what our midwives are asking for), and let consumers pick their providers. Midwives practice evidence-based care and informed consent. Shouldn’t that be what all providers practice?

 

Supporting Midwifery Care supports Consumer's choices

 

REGULATIONS BY PROFESSIONAL PEERS

The legal system allows us to be judged by a body of our peers, and many professional organizations use a similar set-up. If a lawyer is being investigated for misconduct, they appear in front of their Board to discuss it. This also happens in the medical world. You may think, that because midwives and OB’s are providing care for the same population (pregnant women), that it is fair for both of them to be regulated by the Louisiana Board of Medical Examiners. But, did you know that there are no midwives on this board? Therefore, they are not represented. Additionally, doctors and nurses also care for similar populations, but they are regulated by different Boards. As a nurse, it would be unfair for the Medical Board to rule on my practices because we have different scopes of practices and laws governing us. They are not a body of my peers, and do not understand my perspective like another nurse would. So, why are we allowing this to happen with midwives?

GET INVOLVED

We have almost 1,000 followers on our Facebook page. If each follower only donated $10, the LMA could raise $10,000, their goal for the Midwifery Legal Fund Fundraiser. I realize that there are many fundraisers out there and it is hard to contribute to them all, but every little bit helps! These midwives have already spent thousands of dollars out of their own pockets for this cause. My worry is that if the LMA loses legal representation, then consumers will be the real losers. We need these lawyers to work behind the scenes while the rules are still being drafted. It will be a lot harder to change the rules once they are passed. If you are interested in donating, donate to the LMA’s current fundraiser. They also have some great deals, check them out!

Also, let us know what you think! Comment below! These are only my opinions, and I would love to hear yours. LCSC is a consumer-run group, and as such, we need to hear from consumers!

Also, keep checking our blog. We will be discussing more of the draft rules in the next couple weeks. Is midwifery care a passion of yours? Join our midwifery committee!

 

About the Author

Maryellen Yates is the President of Louisiana Constituents for Safe Childbirth. She is also a doula, childbirth and parenting educator in Acadiana chapter; and has a Bachelor of Science in Nursing. She believes that improving birth options in Louisiana will also improve mother and baby outcomes.

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