HBAC, Twins, Breech in Your State?

[crescentmoonmama]

I am collecting information about midwifery (homebirth) practice, state by state.

I would like to know if Homebirth After Cesarean, Twins, or Breech are allowed in your state AT HOME.

I realize some states will be dealing with "alegalities," but I would like to hear from as many states as possible. If you are able to point me to practice guidelines or policies, that would be helpful.

I will be compiling this information to make available to the public. If I get a good response here, I will post a link to the final product - hopefully very soon.

Thanks For Your Help!

[cathicog]

I admire your willingness to gather these statistics to share, but I doubt very seriously that very many midwives are going to be able to say whether they do VBACs, twins etc. There are too many docs watching, who would love to take that away from the birthing momma..My guess is that most midwives do all that, but don't usually tell...after all, we end up here on MDC! and we would like to continue to be of service to birthing moms for many years hence.

[crescentmoonmama]

No, no, I am not looking for folks to spell out how they might be bending rules or doing things they shouldn't.

I am looking for sanctioned births. I think California mw's, for example, are able to attend HBAC, twins, and breech births - maybe Tennessee too, possibly Texas.

LOL, I am an ICAN Chapter leader and well aware of the importance of privacy.
My own HBAC baby accidentally fell out in SC

Thanks and let me know if you have any info about LEGAL births or general info about states where the rules are fuzzy, i.e, GA, NC, etc..........

[crescentmoonmama]

P.S.

I appreciate your generosity about assuming most midwives do all that. I wish it were actually so........

[Reha]

Here in Oregon, we can do breech, VBAC and twins all at home.

[alegna]

Not a professional, but my understanding is that all 3 are legal in TX.

-Angela

[mwherbs]

AZ--
not legal for a licensed mw to attend any of the 3 intentionally -- and accidental breech I have heard of. written right in the rules
Naturopaths could legally do this as could CNMs but there is the question of very small numbers of professionals able to provide this service and 1 maybe 2 homebirth CNMs in the state that I know of and the one I know well would not do breech or twins and only select vbac clients

[KariM]

Not a professional - just a consumer

But here is a link to the Rules for the State of Wisconsin:

http://www.legis.state.wi.us/cr_final/06-096.pdf

[Peppamint]

Indiana is an illegal state.... so none of it is legal. Whether or not they do breech, twins, vbac just depends on the midwife's personal comfort zone.

[cfiddlinmama]

Here's for NH:

http://www.mana.org/laws/laws_nh.htm

VBAC after one section with some pretty strict requirements...

Transfer to the care of an OB or CNM if malpresentation occurs including breech or multiple fetuses.


So looks like we can't do breech or twins and VBAC only if meets strict requirements.

ETA: guess I'll move to OR!

[wendy1221]

Originally Posted by busybusymomma

Indiana is an illegal state.... so none of it is legal. Whether or not they do breech, twins, vbac just depends on the midwife's personal comfort zone.

It's not illegal in Indiana. It's more complicated than that. Homebirths are very legal in IN. It's just that the law says that midwives must be licensed, but there is no agency to license them. Very different from being illegal. So midwives can be prosecuted for practicing without a license, but that's not the same as saying midwives attending homebirths is illegal.

I do believe midwives who have had no formal training and have not taken tests to be a CPM, etc, are illegal, but as for CPMs and CNMs practicing homebirth, this is the case, at least according to my midwife.

It's funny b/c I moved here from PA and DEMs are the only midwives who are legally allowed to practice there. I think this concession was made for the Amish, but hey, it works.

[Reha]

Originally Posted by wendy1221

, but it's unfortunate that CPM's probably have to claim to be DEMs.

But most CPMs are DEMs (unless they are a CNM as well, then they aren't a DEM). DEM just means that they have gone directly to midwifery rather than becoming a nurse first, (as a CNM is). CPM simply means that they have passed the NARM exam and met NARM's minimum experience requirements. For example, here in Oregon, to be a licensed midwife, you are a LDEM: licensed direct entry midwife. In order to qualify for the license you must have passed the NARM, in other words, be a CPM.

[wendy1221]

Originally Posted by Reha

But most CPMs are DEMs (unless they are a CNM as well, then they aren't a DEM). DEM just means that they have gone directly to midwifery rather than becoming a nurse first, (as a CNM is). CPM simply means that they have passed the NARM exam and met NARM's minimum experience requirements. For example, here in Oregon, to be a licensed midwife, you are a LDEM: licensed direct entry midwife. In order to qualify for the license you must have passed the NARM, in other words, be a CPM.

yeah, I corrected my post as you were posting this, I think. To clarify, if they've had any formal training, they can't claim it. CNMs are not allowed to attend homebirth in PA afaik. At least that's what I was told when I was pg w/ my firs there. It's odd. Odd in that it seems more likely that the medical community would allow a CNM than a DEM.

[wendy1221]

ANd not all CPMs are either DEMs or CNMs only. My widwife went to a midewifery school in Canada, but never went to nursing school.

[nashvillemidwife]

That makes her a DEM, as in she entered her profession directly as a midwife without becoming a nurse first.

I'm not aware that "DEM" is a credential?

Some people also make a distinction between the terms "direct entry" and "lay" midwife. By definition, "layperson" means someone who doesn't have the qualifications to be a professional in their field of interest. As in you may have heard of church congregations referred to as "the laity", meaning although they are Christians they are not considered qualified to "lead the flock". (JUST AN EXAMPLE, NOT A SPARK OF DISCUSSING RELIGION)

These terms would describe the difference between a professionally trained midwife (despite route of education or letters behind their name), and the Amish midwives.

(Reha, you might want to remove your "yeah that!" if you don't agree )

[Reha]

Originally Posted by nashvillemidwife

That makes her a DEM, as in she entered her profession directly as a midwife without becoming a nurse first.

:

[KLPeanut]

FL
In Florida we are licensed midwives. The NARM is used as our state exam so we are CPM's as well.

Twins & Breech are definitely against our rules. We have a risk assessment score that we work with. A VBAC is a three which means we have to consult with a physician. Finding one willing to sign off for a home birth is difficult. I believe that VBAC's at this time are not allowed in birth centers. If a woman is a proven VBAC then the risk score goes down to 2 and hopefully she does not have any other risk factors which would raise her risk to 3.

If you go to the NARM website they will link you to a web site (Concerned Citizens for Midwifery - I think) that will give you the breakdown of which states are legal, etc.

[nashvillemidwife]

In Tennessee, the short answer to your question is yes, those things are allowed.

The longer answer is... it's complicated.

CPMs in Tennessee are licensed and regulated. The law says:

The CPM-TN shall form a collaborative care plan with a physician for all clients....

The emergency plan shall include documentation of the initial consultation with the physician previously referenced in subsection (a). The documentation shall also include referral and transfer plans for the patient in the event of an emergency. A copy of the plan shall be sent to the named physicians.

So for every client you name the doctor you plan to call if needed and send and let them know about it.

The law refers to the protocols that were created by the midwives themselves. Those protocols say:

The following conditions require physician consultation and require physician referral and/or transfer of care.

Pre-existing conditions:
13. previous Cesarean section with classical incision
14. three or more previous Cesarean sections
15. previous Cesarean section within one year of current EDD

Prenatal conditions:
2. lie other than vertex at term
3. multiple gestations

Of course she's not likely to find a physician who will support them, but nothing states the midwife is actually bound to take the doctor's advice, only to ask for it. Of course if the doctor finds out you did it anyway there's a risk they won't agree to help you again, so in the end it comes down whether the midwife is willing to go out on a limb.

There are 2 important things here to notice about VBACs: consultation is only required for a high-risk VBAC, and the requirement to have a consulting physician does not require that you tell them about a VBA1C or VBA2C. Of course some midwives already know their doctors wouldn't support it and if they find out you're just as screwed.

[nashvillemidwife]

Originally Posted by wendy1221

Homebirths are very legal in IN. It's just that the law says that midwives must be licensed, but there is no agency to license them.

I don't want to get off topic, but that's restriction of trade and a federal offense. If you want to talk about it please pm me.

[crescentmoonmama]

Thank you , thank you all for posting with what you know. I hope to hear from or about more states!

There are some agencies out there, Citizens for Midwifery being one, that have great info on licensing and credentialing and legal status, but not much about basic scope of practice. MANA has some links for various states, but the information is incomplete. I wasn't able to tell, with some of them, what the scope of practice is.

If I am able to track down more specific info, I will surely pass it along.