What are midwives technically required to do in most states? - Page 2

[Charmie981]

In Louisiana, its pretty terrible. Even the newly proposed laws require that a client have all the STD testing and blood work that's required in an OB practice, and...GET THIS: it's required to be performed by a physician. The requirements include "clinical pelvimitry" (don't they know there's no such thing?), a PAP, and a GBS test. That means a MIDWIFERY client has to have two pelvics over the course of her pregnancy and both are required by a DOCTOR, not even by the midwife the client has hired .

[earthmothergypsy]

When I posted before, I posted from the lay mw perspective.

If you decide you want to be licensed (you can choose here) then you DO have rules to follow and protocals you are required to meet. Hence the reason a lot of mw here don't go for the licensure.

[Jenlaana]

I wish that was an option here. I am comfortable with UC, but it still makes me so frustrated that women are forced into the positions they are, and midwives are caused so much grief.

In SC, a midwife who attends a home VBAC will loose her license. No midwife in the state would touch me (that I found last pregnancy and I looked a LOT). Very few hospitals would even allow a VBAC labor even (I love how everyone says "they wont allow it" when its my body : ) Its a very very horrible climate for VBAC mommas in the area I was living in.

*I should state that I am speaking of direct entry midwives, not CNMs

Women should be able to birth safely in the environment that they feel the most comfortable, and not be forced to adhere to the standards of some uptight close minded governmental people who make these decisions for us, with a doctor's "advice" as their reference. (here it was OB reccomendations that made things as bad as they are)

I basically had 2 options (which I was not aware of until I was almost 7 mos pregnant). Have a UC, or have surgery. No OB on my plan would allow me a TOL in the hospital, and no midwife that I got into contact would risk her license in order to attend my birth (I dont blame them, its their livelihood at stake). Oh, or the other option... find the resources to leave the STATE and birth without my husband and live somewhere more VBAC friendly for the last month of my pregnancy plus however long I could possibly go over my due date. :

[AbbieB]

I just wanted to add that do to all the midwives I interviewed here in West Central Florida "requiring" things like glucose tests (the big one not one would budge on) and other things that I would decline (varied from midwife to midwife) I have decided to possible UC and to work with a midwife from out of state (a state with no laws for direct entry midwives - she worked with us for DD's birth).

A PP has a good like for Florida statutes.

I was truly shocked and then very upset that Florida had such strict protocols. I think that the midwives I talked to were definitely unwilling to work with someone like me who would be declining everything unless it was obviously necessary. I got the feeling it was because they wanted to cover themselves to protect there license.

Some of the things that I heard as requirements were (again not all of them for every midwife):
*multiple blood tests (for various things)
*early ultrasound for dating (as someone that practiced fertility awareness and had exact dates I was really surprised that this was pushed so hard)
*late ultrasound for checking the baby's position
*glucose tests
*vaginal exams in labor
*non stress tests after 40-41 weeks
*beta strep test
*antibiotics in labor
*transport for any heavy bleeding after birth
*transport for "retained" placenta (diagnosed if it's not out in 30 minutes)
*transport for ruptured water after 24 hours
*transport for failure to progress after 24 hours
*transfer of care at 42 weeks
*transfer of care if failed glucose test
*transfer of care if breach after 36 weeks

I was left feeling that had I chosen to work with any of these midwives I had a really high chance of being risked out of their practice for declining a test or failing a test and not being willing to follow the recommendations that followed.

Not to mention the fact that DD was 43 weeks, 10lbs, labor lasted 51 hours, had a PPH and a retained placenta had each midwife making assumptions about the state of my health and the "bad midwife" I worked with last time.

[mom3b1?]

Originally Posted by laurashanley

I understand that many midwives ignore the laws. But I'd like to know what the laws are, or where I can find this info. Thanks!
Laura

I have had a conversation about this with a local Midwife. She says I can wave all tests and proceedures here in Georgia. There isn't a single thing she's required to do, which is the only reason I'm thinking about maybe hiring someone.

I UC'd my last one in Michigan. That was great. I've got some other circumstances this time, and since I can hire one and still say "no" to things, I'm considering it.

I'm in Georgia.

Kiley

[attachedmamaof3]

Just an FYI to the above poster...Homebirth MW's are still illegal in GA, so that's why there are no requirements, just be careful who you mention her name to, she could get in trouble!! (I'm from GA and my sister's planning a HB there now, due in Nov...)

As to everyone else...ARE YOU SERIOUS?!?!? I can't believe all the requirements the midwives in your areas are asking for!!! Ultrasounds?!? Glucose tests? Pelvics?? Checking dilation during labor?!? and all those transfers?? ARGH! NO THANK YOU!!

What is happening to normal birth(and all its variations)? :

If I lived in your states and couldn't find a midwife that suited my needs, I'd UC again!! (Accidental UC with DS#2....and we LOVED IT!)

[mom3b1?]

Originally Posted by attachedmamaof3

Just an FYI to the above poster...Homebirth MW's are still illegal in GA, so that's why there are no requirements, just be careful who you mention her name to, she could get in trouble!! (I'm from GA and my sister's planning a HB there now, due in Nov...)
(Accidental UC with DS#2....and we LOVED IT!)

I won't mention her name unless she says it's OK. She is actually legal. After working as a DEM for many years she got her CNM. She's never done hospital births. So, she's liscensed AND does only homebirths. She's got no OB over her shoulder requiring stuff. Pretty good deal.

Kiley

[mom3b1?]

Originally Posted by tie-dyed

In MI, nothing. Unregulated state. One of the main reasons I'll have a midwife at my birth. If I were in a regulated state I would probably not want one.

How interesting. When I was in Michigan I couldn't find a MW who didn't have a list of requirements as long as her arm. I guess just because the law doesn't require something, doesn't mean the MW doesn't. That was 6-7 years ago. Also, the PKU was an issue.

I UC'd.

Kiley

[Snowdrift]

Originally Posted by mom3b1?

How interesting. When I was in Michigan I couldn't find a MW who didn't have a list of requirements as long as her arm. I guess just because the law doesn't require something, doesn't mean the MW doesn't. That was 6-7 years ago. Also, the PKU was an issue.

Wow. I interviewed with three midwives this pg. One practice "required" bloodwork, is "uncomfortable" with prenatals more than six weeks apart, and a few other things. The other two had no requirements. One suggested that I follow the "schedule" many of her Mennonite clients go by--call her to get on her calendar around 8-12 weeks, meet around 8 months to ascertain position, and call her when they go into labor.

Maybe the birth culture has changed a lot locally in the past few years? I dunno. All three midwives agreed to only monitor HB in labor/birth at my request and to wait in the other room while I catch my baby if I so desire. Not sure how much less regimented than that it is possible to get. I'm glad I can get a midwife who will serve as a labor support rather than as a manager or coach.

I havent' discussed PKU with this birth, but with DD she offered it and told up about the fee waiver. She never indicated it was necessary at all.

[cottonwood]

I'll add that even here in Oregon where midwives can get around a lot of this stuff, many still practice defensively. My first midwife (a CPM with nurse's training) was monitoring the baby frequently during labor (never any indication of distress) and did several cervical checks, with the frequency increasing the closer we got to the birth. She led me to believe that this was standard and necessary in order to assess the progress of labor and therefore the appropriateness of continuing to stay at home. When I went to interview midwives for my second birth, I went through a string of them (I think there were six or seven) none of whom felt comfortable attending me under the conditions that there would be no cervical checks, no timing of contractions, limited monitoring of FHT, no coaching, etc. I did eventually find a "hands-off" midwife who I was pretty happy with, but it took some doing to find her. I think the issue is not that all midwives have to do these things, but that it is so hard to find midwives who won't (regardless of whether they're legally bound to do so or not.)

[JustKiya]

Bumping as this relates to the UC'ers wanting to become Midwives/Doula's thread......

[mnearthmomma]

Originally Posted by earthmothergypsy

In MN there are no requirements. Unregulated here too.

However, most mw are way too hands on for my comfort.
Most things they do don't provide any info anyway, it is all just to cover the attendant's butt. ~smiling~ The mama knows best and if you listen to her and her dh you can know all you need to know.

I guess I am just way to layed back as a birth attendant. Imho a good midwife helps/encourages the family to educate themselves enough so they don't need her, and if she IS there then she needs to sit on her hands and let the family birth in peace. I promote UC the whole time I am with a family. They have to realize that no one may be there for the birth and that they need to be ready on their own. Most don't even think about it and just assume the attendant will be there, but it isn't true. One has to be prepared.

Actually MN does have regulations, but should you feel the need to practice as a lay midwife, you can, but you cannot promote yourself or use a great number of verbiage as your title. Fun little loophole.
http://mana.org/laws/laws_mn.htm
http://www.state.mn.us/portal/mn/jsp...ency=BMP&sp2=y

[Full Heart]

http://www.azsos.gov/public_services...9-16.htm#pgfid

Thats AZs state laws. However most mws um interpret them differently.

[onetwoten]

This was from a while ago, but I'll add in my two cents. I'm in Manitoba, Canada, wehre midwifery is legal and even publicly funded. Our midwives have a fairly long list of "should do..." "have to do..." BUT there's a clause at everything stating that if the midwife believes it's in the patients best interests, then she doesn't have to transfer care. ie They can't do breech- but if I were to say I refused to transfer care and I would just birth the baby myself instead- she is within her limits to say ok she'll attend me anyways. I've heard one or two of the midwives make sure their clients are very aware of these guidelines "just in case" so they know to 'make a fuss'.

[laurashanley]

Last week I went to see the play "Birth." Overall I thought it was very good! Afterwards a midwife, a doula and my friend Raquel (of consciouswoman.org) sat on the stage and answered questions. I asked the midwife (who must have known who I was because if looks could kill I wouldn't be writing this) how restrictive the homebirth (with a midwife) laws are in Colorado. I told her I seemed to remember a law stating that a woman had to be transferred to the hospital if second stage lasted longer than an hour. She said in a condescending tone that I was wrong, it could last two hours, and that the laws weren't retrictive at all.

Today I decided to check the CO laws to see who was right. Ha! Unless it's your first baby, second stage of labor (without steady progress) can only last one hour - http://www.dora.state.co.us/Midwives/Rules.pdf - page 8 (and how can they know when you're in the second stage of labor unless they've done vaginal exams - another intervention). Also, the placenta must be delivered within an hour of the birth, your water cannot be broken for more than 12 hours without labor, you cannot go more than 42 weeks, fetal heart tones must be taken every 5-10 minutes during second stage, etc. No thanks.
Laura

[JustKiya]

The mere fact that there are laws regulating how any woman's birth progresses is restrictive - how sad that she couldn't (or wouldn't) see that simple fact.

[Full Heart]

Originally Posted by laurashanley

Last week I went to see the play "Birth." Overall I thought it was very good! Afterwards a midwife, a doula and my friend Raquel (of consciouswoman.org) sat on the stage and answered questions. I asked the midwife (who must have known who I was because if looks could kill I wouldn't be writing this) how restrictive the homebirth (with a midwife) laws are in Colorado. I told her I seemed to remember a law stating that a woman had to be transferred to the hospital if second stage lasted longer than an hour. She said in a condescending tone that I was wrong, it could last two hours, and that the laws weren't retrictive at all.

Today I decided to check the CO laws to see who was right. Ha! Unless it's your first baby, second stage of labor (without steady progress) can only last one hour - http://www.dora.state.co.us/Midwives/Rules.pdf - page 8 (and how can they know when you're in the second stage of labor unless they've done vaginal exams - another intervention). Also, the placenta must be delivered within an hour of the birth, your water cannot be broken for more than 12 hours without labor, you cannot go more than 42 weeks, fetal heart tones must be taken every 5-10 minutes during second stage, etc. No thanks.
Laura

While those are very similar to the laws in az I will tell you from fact almost no mws actually do transfer for do all those things. Do I believe there should be laws? No. But just saying just cause there aren't doesn't mean there aren't women out there finding a way around them.

[laurashanley]

Originally Posted by Full Heart

http://www.azsos.gov/public_services...9-16.htm#pgfid

Thats AZs state laws. However most mws um interpret them differently.

It looks like AZ laws are fairly similar to CO - other than the placenta needing to be out in 40 minutes. Also, they define what "normal progress" means (ridiculous). I'm fine with 2g, but that's about it!

2. During labor, the condition of the mother and fetus shall be assessed upon initial contact, every half hour in active labor until completely dilated, and every 15 to 20 minutes during pushing, after the bag of water has ruptured or until the newborn is delivered. Care shall include the following:

a. Checking of vital signs every 2 to 4 hours and an initial physical assessment of the mother;

b. Assessment of fetal heart tones every 30 minutes in active first stage labor, and every 15 minutes during second stage, following rupture of the amniotic bag or with any significant change in labor patterns;

c. Periodic assessment of contractions, fetal presentation, dilation, effacement, and position by vaginal examination;

d. Determination of the progress of active labor for primiparas by determining if dilation occurs at an average of 1 cm/hr until completely dilated, and a second stage not to exceed 2 hours;

e. Determination of a normal progress of active labor for multigravidas by determining if dilation occurs at an average of 1.5 to 2 cm/hr until completely dilated, and a second stage not to exceed 1 hour;

f. Maintenance of proper fluid balance for the mother throughout labor as determined by urinary output and monitoring urine for presence of ketones, at least every 2 hours; and

g. Assisting in support and comfort measures to the mother and family.

3. After delivery of the newborn, care shall include the following:

a. Assessment of the newborn at 1 minute and 5 minutes to determine the Apgar scores;

b. Physical assessment of the newborn for any abnormalities;

c. Inspection of the mother's perineum for lacerations; and

d. Delivery of the placenta within 40 minutes during which time the midwife shall assess for signs of separation, frank or occult bleeding, examine for intactness, and determine the number of umbilical cord vessels.
Laura

[laurashanley]

Originally Posted by Full Heart

While those are very similar to the laws in az I will tell you from fact almost no mws actually do transfer for do all those things. Do I believe there should be laws? No. But just saying just cause there aren't doesn't mean there aren't women out there finding a way around them.

I understand that many midwives (and certainly the good ones) find a way around the laws (and isn't this just a creative way of saying they break them?). But why should they have to? And how much do the laws interfere with a midwife's ability to TRULY assist a woman in labor? Surely somewhere in the back of her mind, she must be aware of the fact that the woman she's caring for isn't having a labor that would be approved of by the state. In many cases I'm sure it is an added stress.
Laura

[mnearthmomma]

Originally Posted by laurashanley

I understand that many midwives (and certainly the good ones) find a way around the laws (and isn't this just a creative way of saying they break them?). But why should they have to?

I don't think it's a creative euphemism, I think that we are simply smart enough to find the loopholes, and loopholes are legal! Just like here in MN. I assist mothers in a loophole in that I am not licensed, but I just don't call myself anything but a midwife. I'm not committing any sort of crime at all.

in answer to the second question, no, we shouldn't have to side step the law to be able to help a mother have the birth she is most comfortable with, but this is the status of our very invasive government. sad, really, that the knowledge of women to help other women is so completely undervalued.