HBAC, Twins, Breech in Your State? - Page 2

[wendy1221]

Originally Posted by 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 )

Thank you. I did mean lay midwife when I said DEM. I am not feeling well and haven't been thinking straight for, oh, a month or so (hyperemesis.)

[Doula Dani]

Here's a link to the WA midwifery laws. I'm trying to muddle through it the best I can.

http://apps.leg.wa.gov/RCW/default.aspx?cite=18.50

I will say that I am a vbac client having a homebirth. It is done and it is legal, however I believe that it is frowned upon by many.

[Doula Dani]

Some quotes I found:

It shall be the duty of a midwife to consult with a physician whenever there are significant deviations from normal in either the mother or the infant.

Every licensed midwife shall develop a written plan for consultation with other health care providers, emergency transfer, transport of an infant to a newborn nursery or neonatal intensive care nursery, and transport of a woman to an appropriate obstetrical department or patient care area. The written plan shall be submitted annually together with the license renewal fee to the department.

Here's the standards of practice written up by the midwives association of washington state:

http://www.washingtonmidwives.org/standards.shtml

I don't see anything that says it's 'illegal' per se to do twins or breech, however there are laws stating what can happen to you due to malpractice. If you take on a twin or breech birth and there is a negative outcome, I think you could easily be sued for malpractice because of it being 'risky'. So I think it's up to the midwife really- but I understand why they could be scared away from doing that. I don't happen to personally know any that would do a breech or twin birth on purpose, and only a few that will do vbacs. There's a couple on here, so maybe someone will chime in.

Then there's this:

I. Pre-existing Conditions
The following maternal conditions existing prior to the current pregnancy necessitate physician consultation and may require physician collaboration and/or referral:

Current or any history of significant cardiovascular disease
Pre-existing hypertension
Pulmonary disease/active tuberculosis/asthma if severe or uncontrolled by medication
Current or significant history of renal disease
Current or significant history of hepatic disorders
Current or significant history of endocrine disorders except controlled mild thyroid disorders
Significant hematological disorders
Collagen-vascular diseases
Current or significant history of neurological disorders
Current or significant history of cancer
Current alcoholism or abuse, current drug addiction or abuse (excluding tobacco use)
Current severe psychiatric illness
Isoimmunization with an antibody known to cause hemolytic disease of the newborn
Two or more prior uterine incisions, classical uterine incision, or uterine incision less than 18 months prior to anticipated birth; history of myomectomy Other significant deviations from normal as assessed by the midwife

II. Antepartum Conditions
The following conditions arising during pregnancy necessitate consultation and may require physician collaboration and/or referral:

Labor before the completion of 37 weeks gestation
Premature pre-labor rupture of membranes (PPROM)
Presentation other than cephalic at term
Multiple gestation
Significant vaginal bleeding
Gestational diabetes mellitus
Severe anemia unresponsive to treatment
Evidence of hypertension or pre-eclampsia
Ectopic pregnancy
Molar pregnancy
Significant size/dates discrepancies
Polyhydramnios or oligohydramnios
Documented or suspected intrauterine growth restriction
Thrombophlebitis
Known fetal anomaly or condition affected by site of birth, with an infant compatible with life
Fetal demise after 12 completed weeks gestation
Non-reassuring fetal heart rate
Significant abnormal ultrasound finding
Documented placental abnormalities or placenta previa
Postdates pregnancy > 42 completed weeks
Positive HIV antibody test
Primary herpes past the first trimester
Significant infections, the treatment of which is beyond the midwife's scope of practice
Parent(s) ill-prepared for out-of-hospital birth at 37 weeks
Inability of client and midwife to come to an agreement regarding plan of care
Development of any of the conditions listed previously
Other significant deviations from normal as assessed by the midwife

May require. That's about as clear as mud.

[christyc]

Reading this just has me thinking how nice it would be if HBAC babies didn't have to "accidentally fall out" and twins didn't have to be born "unassisted" (*wink* *wink*).

:

[mwherbs]

Washington is tricky because they don't have many rules - and the folks who now want to limit scope of practice will try either fine you and limit practice or you can go to court and defend-- Breeches are allowed, the judge in a hearing determined it- but not footling breech-- that was one mw's contribution to the legal outlining of practice-- also if you belong to MAWS-- (their association) you will be held to those standards by the state--

[DoomaYula]

I'm moving to NC in a week, and my understanding is that DEM/CPM are illegal. So if we have another baby, I'm sure he or she will accidentally fall out after a precipitous labor attended by friends.

[Peppamint]

Originally Posted by wendy1221

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.

You're right... it's more complicated that just saying it's illegal or not. CNMs are legal but few of them attend homebirths (and we have pockets in the state where there aren't any CNMs). Homebirth itself is legal...

But IMO it's illegal for DEM/CPMs to attend births because I personally know a midwife (CPM) who faced both Class C and Class D felony charges for practicing medicine and midwifery without a license. She wasn't the first, and she won't be the last unless we get this licensure bill passed!

I used to call it an alegal state but Valerie from IL who is a midwife turned attorney set me straight on that!

Are you coming to the rally at the Statehouse on the 24th?


PS- midwives in PA are facing the same difficulties right now unfortunately!

[olive&pimiento]

Here in NJ, licensed midwives are not permitted to do HBAC, breeches or twins at home.

[jljeppson]

MN all 3 are legal, but whether or not they are done depends on the midwife and her comfort level.