MAYD to Birth: At Your Doorstep

Promoting gentle, empowering mother journies…

Something has actually happened:

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Sadly, I couldn’t even be there! The Licensed Direct Entry Midwife Amendments (SB93) was the only thing on the agenda for the House Health and Human Services Committee this morning, but I had to get Roxy to school so I was listening online to the action.

When the committee convened apparently the two parties felt like they just needed a brief meeting to finalize a true compromise bill, so the committee ‘sauntered’ so they could try to finish it. (I love that they use the term ‘saunter’ instead of just taking a break or having a recess). At 8:30 they reconvened and the 7th (!!) substitute bill was entered for the committee to rule on. Both sides testified that this bill was a true compromise and that they would NOT be back to ask for further legislation until 2011 when their had been time for the LDEMs to gather statistics on their births.

With no argument from either side, the bill passed unanimously.

So I waited with baited breath for the new bill to be posted online and in a few minutes it was posted, and well, it is definitely a compromise.

I am very disappointed with what the LDEMs have given up. I don’t know if I can really support this version of the bill. But at the same time I really do believe that if the midwives don’t give up something that the Utah Medical Association will be back at this every legislative session trying to change what they are allowed to do. That is a frustrating idea, it takes such a huge amount of effort to hold our ground at all. Maybe the best thing really is give up a little so that they stop attacking us. I really am not sure what the best thing to do is at this point. (and frankly I’m not in charge anyway)

The one big redeeming factor, in my mind, is that the unlicensed midwives have been removed from the equation and will continue to be able to practice without any meddling from the state. That is all they ever wanted, and I am glad about that.

If you want to read on about my specific issues with the current bill, by all means do so, otherwise stay tuned for more information when it becomes available.

Substitute 7 requires a mandatory transfer when a mother has been pushing for 3 hours and birth is not imminent. I don’t see the problem of continuing to push as long as the mother and baby are tolerating it well. I also think there is the potential for problems if the parents don’t want to transport after three hours, what is the midwife to do? Abandon them? Call 911?

Women with prior c-sections become ineligible after 42 weeks gestation. That could be a real concern as these mothers will then be facing c-sections or inductions, which increase the risks to mother and baby.

It also mandates that women with prior c-sections have an ultrasound to determine the location of the placenta. I don’t exactly disagree with the idea of that, it is something I did in my own pregnancy, but it is a scary concept that they the midwives will have to require the VBAC moms to have ultrasounds. Some people really don’t want an ultrasound, don’t feel it is safe or necessary, and this is just a little too ‘ big brother’ to require tests of people. (they should at least pay for it if they are want to require it!)

It also puts in guidelines saying that VBAC moms must have a prescribed rate of dilation or they have to be transferred, which gets scarier the more I think about it. It isn’t at all uncommon for moms to start labor and progress for a while, then reach a plateau where they need to rest or her baby needs time to rotate and she won’t make progress for awhile. If a midwife checks you at 10 am and you are 5 cm but for whatever reason you haven’t progressed at 2 pm then she has to transport you. Even if there isn’t any real reason to believe something is wrong.

And of course two big restrictions, twins and breech. I have written before on this blog about breech birth, I stand by those statements and feel like it is a real shame that LDEMs are losing the ability to attend those births. The midwife that in my mind has more experience than anyone in this whole state with breech birth (doctors included) is licensed and will no longer be allowed to attend women who choose to stay home.

Twins is another sad thing to lose. I have personally attended a twin birth at home and it was an amazing experience. The mother was very motivated to stay home for her birth and she took seriously the extra risks involved with twins, but she also knew that the risks would not be eliminated by going to the hospital. She met with hospital providers and had arrangements to use their services if at some point she felt that the birth was too risky to be at home (for example if the babies weren’t in good positions when labor came). She was relieved when she carried the babies to term and remained low risk as she really did not agree with the way the hospital providers wanted to handle her birth. The birth was attended by 3 midwives, with 45 years combined experience, and handled with extreme care. In the end it was a beautiful and healthy birth experience for the whole family.

Having sat through enough committee meetings to know full well what the opposition would say to my little anecdote (and that is all it is, hardly scientific, but still an experience to learn from). The opposition would say that this mother got lucky, that it could have turned into a disaster at any moment, she could have needed a c-section that the midwives could not have given her.

Well, the irony is that if she had been in the hospital she would have had a c-section. The midwives monitored her and the babies carefully and waited patiently for her second baby to be born. The hospital never would have been willing to allow nature to take it’s course, not because they are bad people, but because that is how hospitals work. You can’t just sit and let a women nurse and bond with her new baby while you’re occupying an operating room and you have 10 staff members standing by waiting for the other baby to be born. The way the hospital views that birth every minute that you are in that room you are open to liability and it is costing you money.

Mothers with twins will still choose to stay home and they will be forced to use unlicensed midwives for their births. Some of those women will experience bleeding that could easily be managed with a shot of Pitocin, but because the unlicensed midwives can’t carry Pitocin those moms will have to go the hospital after the birth just for one shot.

Part of me wants to say just screw licensure, just be midwives and skip the medications and the hassles. But another part of me thinks that licensure has been such a wonderful thing. Having just a few medications available can save women a lot of hassle. Some women really do have completely normal pregnancies and labor but need just a shot of RhoGam. It has been so wonderful with LDEM care that women in that situation don’t have to give birth at home and then make the trek into a doctor just to receive that one medication that a midwife can very safely give her. The midwives really only use a very short list of medications, it is a shame that licensure is the only way to legally have acces to those medications. (none of the medications are ‘controlled substances’ by the way, just a few things for controlling bleeding, antibiotics, etc)

In case you care, here is the exact language for mandatory transfers in the bill:

(a) failure to deliver the infant after three hours of pushing unless birth is imminent;
158 (b) gestation beyond 42 weeks without consultation with a licensed health care
159 provider or with non-reassuring surveillance;
160 (c) gestation beyond 43 weeks;
161 (d) moderate, thick, or particulate meconium in the amniotic fluid unless birth is
162 imminent;
163 (e) non-reassuring fetal heart rate pattern indicative of fetal distress that does not
164 immediately respond to the licensed Direct-entry midwife’s treatment, unless birth is imminent;
165 (f) a fetus in the breech presentation during labor unless birth is imminent;
166 (g) multiple gestation unless birth is imminent;
167 (h) more than two prior c-sections;
168 (i) prior c-section with a known classical or inverted-T or J incision;
169 (j) prior c-section without an ultrasound that rules out placental implantation over the
170 uterine scar;
171 (k) prior c-section without a signed informed consent document detailing the risks of
172 vaginal birth after caesarean;
173 (l) prior c-section with cervical dilation progress in the current labor of less than 1 cm
174 in three hours once labor is active;
175 (m) prior c-section with a gestation greater than 42 weeks; and
176 (n) Rh isoimmunization with an antibody titre of greater than 1:8 in a mother carrying
177 an Rh positive baby or a baby of unknown Rh type.

Read the whole bill here:

http://le.utah.gov/~2008/bills/sbillint/sb0093s07.pdf

Thursday nights action plan

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Hang on folks this is where it gets bumpy. The legislators who are on our side are helping us to find a solution:

A timeline to hopefully make this clear.

So this all began with SB93 – new and insanely restrictive laws to regulate midwives attending births at home (commonly called direct-entry midwives).

We say NO, don’t vote for that will make it against the law for many of us to have our right to have a midwife at home.

The legislators say midwives you and the Utah Medical Association (UMA) need to go and negotiate this, we don’ want to hear about this issue again so let’s solve it once and for all.

(we all roll our eyes because we agree and thought it was solved in 2005 when we got the midwives legal and licensed)

The representative midwives and the UMA meet for many hours and start making headway pinning down the details.

The UMA says we will work on a new version of the bill and we’ll show it to you before we put it back out for a vote.

Without telling the midwives they enter a new bill, we’ll call it Sub1 (technically SB93S001). This bill does remove some of the insane restrictions but still has vague language and some unacceptable restrictions (including me, a mom with a prior c-section)

The bill sails through the Senate.

We work hard to get the bill killed in the House.

That brings us to now. The savvy people who know the best way to do things at the capital have a new strategy.

Tomorrow, our friend, Representative Jackie Biskupski will enter a new substitute bill. This bill was written by Representative Lockhart during the negotions between the UMA and midwives. Sub 2 will have a reasonable scope of practice for the midwives, similar to what they have now (that is working so well).

There are lots of things that can still happen, we just have to wait and see, but tomorrow we need to get a new message to the Representatives. Tell them that you have been asking them to vote against SB93 because it unfairly restricted women’s rights, but now Representatives Biskupski and Lockhart have come up with a more reasonable bill and you would like them to support Sub 2.

Phew, I know this is painfully complicated. Isn’t politics fun?

A poorly written article…

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But I’ll share it anyway:

http://www.deseretnews.com/article/1,5143,695254580,00.html

I commented on it over on the Des News website, but I’ll elaborate a little more here addressing some of the errors and agendas:

1st paragraph:
The bill does not affect only 16 midwives, it affects all the midwives and all of the women that they serve. The bill’s sponsors are telling people that this bill only affects licensed midwives and they asked for it by licensing, but in reality the language of the bill is such that all midwives are affected.

3rd paragraph:
The writer says it is a veiled effort by the licensing division, but it actually has nothing to do with them. They are satisified with the rules that are already in place. He is right about the tacit approval of the medical establishment, since the Utah Medical Association is behind the bill.

4th paragraph:
Opponents say lots of things, but the fact that they are following pioneer-era traditions is not really the most important. More importantly opponents say that the bill eliminates women’s rights.

7th paragraph:
Senator Dayton says she wishes that the midwives had never asked for licensing, which is a true statement. She fought the bill that made midwifery legal and gave them licensing 3 years ago, because she doesn’t think direct-entry midwives deserve licensure. She is a labor and delivery nurse and her husband is an OB/GYN, hospital birth is all she knows. Home birth and the midwives who attend them are something that she doesn’t understand and doesn’t believe in.
Also in that paragraph it says that the bill doesn’t affect “certified midwives” which is an incorrect term. The writer means Certified Nurse Midwives, and he is right they are unaffected. Actually the licensed direct-entry midwives are also certified by their own organization.

12th paragraph:
Dayton says that licensed professionals must have practice parameters, which is true and it is why the midwives had a Rules process that determined their parameters 2 years ago. The UMedA had the opportunity to give input during this time, the midwives had more public hearings than any other profession has had before.

13th paragraph:
Yes, if this bill goes through I do have choices. I can go to the hospital, a place that they are right, I don’t want to be. Or I can stay home alone. This bill takes away my preferred choice, which is to stay at home with a Certified Professional Midwife who was trained by both apprenticeship and study, and who passed a very rigorous exam proving her competence.

Begging via Email

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This is the email I sent out today:

I am asking for a favor on behalf of a cause that I feel very passionate about, the rights of women, specifically their right to choose how they want handle their births. I believe this is a deeply personal issue and the decisions about where to give birth and what care provider to use belong in the hands of the woman giving birth.

Right now there is a bill in the Utah House of Representatives that, if passed, would eliminate the choice of giving birth at home for myself and many women like me. This bill is sponsored by Senator Margaret Dayton of Provo and backed by the Utah Medical Association, who feel it is their duty to protect women and babies by making it illegal for midwives to attend certain births at home, even though the home birth outcomes are already excellent and there is not any scientific evidence to support their views.

One type of birth that will be illegal for midwives to attend are the births of women like me who have had a prior caesarean section. The bill’s sponsors have decided on my behalf that I am too ‘high risk’ to have my baby at home. I do not share their view (because the science does not support it) and I believe it should be up to each woman to make these decisions based on their own personal situation and medical risk factors.

I believe that it is a slippery slope when we allow our government to make laws dictating how we must handle what should be personal medical/life decisions.

You can help me by taking just a moment to contact your own representative and ask them to oppose this bill and protect women’s rights!

Go to this website to find your districts if you don’t already know them – enter your address into the left hand side:

http://www.le.state.ut.us/maps/amap.html

If you don’t like that one try this one:
http://www.le.state.ut.us/house/DistrictInfo/NewMaps/State.htm

You can send them just a one line email asking them to oppose SB93S1 the Licensed Direct Entry Midwife Amendments. Tell them to protect women’s rights to make their own decisions!

I wouldn’t ask if I didn’t believe that every single email matters, the representative are listening and they take constituents requests seriously. I have been told by my own legislator that just a few emails have made the difference in how he votes. Please forward my request on to anyone that you think might help.

Through the Senate

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The bill went through the senate with only 3 nays. ***insert swearing here***

Time to stop it in the house. Contact your representatives!!!

Here is what I sent to mine:

Dear Representative Hughes,

I am emailing you in regards to SB 93 Sub1 the Direct Entry Midwives bill. I am extremely angry about this bill and the audacious way in which it violates my right to choose where and with whom I can give birth. This bill would make it against the law for any midwife to attend my birth at home because I have had a prior caesarean section. Senator Dayton and the Utah Medical Association have no right to make the important personal and private decision of where to give birth on my behalf.

The bill’s sponsors are claiming to be protecting the citizens of Utah, but that is a false claim that they cannot back up with any solid evidence. The reality is that both hospital and home are basically safe places to give birth, but life is never risk free and there are some very real risks that exist only in the hospital (life threatening antibiotic-resistant bacteria are one very good example). It should be up to the woman who faces the risks of giving birth to decide which ones she chooses to assume.

Please fight this unjust bill by holding it in Rules committee. As my representative I am asking you to please protect my rights!

Sincerely,

Heidi Sylvester

Another article

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Right to the point:

http://www.heraldextra.com/content/view/255734/155/