Proposed rule changes to Az midwifery taking away mother's rigth to informed concent - Mothering Forums
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#1 of 17 Old 05-17-2013, 01:16 PM - Thread Starter
 
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A step back to the 1800's for midwifery, the improvements proposed by the department of health is to strip midwives of medicines that they have been administering to mothers and babies , at the same striping mothers rights to refuse any and all testing and treatments required by midwifery rules. And this all in a package to be data captured as an informal study of midwifery and its safety. The new rules apply by July this year expand scope by July 2014 and by 2015 the expectation is there will be "rich data". Oh yea what are they truly studying.
Parents successfully lobbied the state to open Arizona rules to allow for increased scope of practice, parents wanted midwives to be able to attend twins, breeches and vbac at home. So It is the end of that rule making process and in the most recent draft of the rules , they removed the administration of any and all meds and administration of vitamin K to newborns. In addition they are requiring 1 ultrasound and several tests including HIV - if any of the tests are refused we cannot provide care. Basically there is no informed concent, and coercion to agree to all tests in order to have a midwife attended homebirth.
The rules allowing us to administer meds has been there since the 90's .
Also the new assistant director of the health department is an OB, so they should know better .
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#2 of 17 Old 05-17-2013, 05:37 PM
 
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That includes PPH meds? Pitocin, cytotec?


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#3 of 17 Old 05-17-2013, 05:44 PM
 
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This is horrible! greensad.gif Do you have a link to the proposed rules?

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#4 of 17 Old 05-17-2013, 06:28 PM - Thread Starter
 
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yes the are removing administration of all meds including ones for hemorrhage, rhogam shots, vitamin k for babies...

 

here is the page that has links to the newest draft and a link to the current rules- that have been in place since the 90s

 

http://www.azdhs.gov/diro/admin_rules/midwifery-licensing.htm

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#5 of 17 Old 05-17-2013, 07:00 PM - Thread Starter
 
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in looking over the draft rules is isnt quite as clear, when the committee met and clarification was asked for- it was said the intent is going in clients know what are rules are and that if they refuse testing that we are not allowed to care for them--- they will allow refusal for chlymidia testing but not the other testing- required 

    and because of a typo they had left  oxygen in there but it goes too

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#6 of 17 Old 05-18-2013, 07:50 AM
 
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Does this apply to CNM's attending home births, or jst CPM's? Do these new rulea apply to free-standing birth centers or only home births?

Supposedly they expanded the scope of practice for CPM's. Are they now permitted to do VBAC's, twins, and breeches?
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#7 of 17 Old 05-18-2013, 08:02 AM - Thread Starter
 
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It applies to LMs and state licensed CPMs, and it does apply no matter what setting they may be working in there are several free standing birth centers in the Phoenix area that have LMs/CPMs working at them.

Breeches have been a consult all along... But now they can be done with certain limitations,
Vbacs with a particular history are allowed, and with limitations
No twins... Because of high mortality rates.
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#8 of 17 Old 05-18-2013, 08:52 AM
 
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Rogham too? 


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#9 of 17 Old 05-18-2013, 09:15 AM
 
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Part of me is glad to see breeches are allowed - but is there any additional training required to ensure midwives actually know how to safely deliver vaginal breechs? Many doctors do not even do this, and even in midwifery its a dying art.

This whole thing looks suspiciously like setting midwives up for failure. Take away modern medicine that makes homebirth safe, allow higher risk practices that may increase complications, then record results? This is a step toward providing "evidence" that midwifery should be illegal.
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#10 of 17 Old 05-18-2013, 11:40 AM - Thread Starter
 
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Yes rhogam too

It doesnt look ok.

We did a practice survey and about 30% of the midwives that replied are skilled in breech birth and are willing to teach/assist others, other things are planned as far as didatic training to go along with assisting via clinical- but it will all take time.
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#11 of 17 Old 05-18-2013, 07:01 PM
 
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here in va part of the rules they agreed to so they coulds get licensed was not being allowed to have/give rx's. so not pit,oxygen,ect.

I have seen miwives here do vbacs and twin births so not sure if there is a rule against that or not. sad that az has had it all this time and now they are deciding to take it away- why wouldn;t they do the study on the effectiveness it has had or not had all these years??


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#12 of 17 Old 05-18-2013, 10:16 PM - Thread Starter
 
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Long story about lack of funding... They had us turning in detailed quarterlies that they had no funds or staff to collate or data enter...
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#13 of 17 Old 05-20-2013, 10:52 AM
 
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I just don't get it- why would you consent to twins, vbacs and breeches increasing the likelihood of complications (from their pov) and take away the very things that could result in a successful homebirth??  This is very puintive! They want us to stay away from midwives obviously. This sounds like a attempted shutdown of midwifery in AZ.  


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#14 of 17 Old 05-20-2013, 01:49 PM - Thread Starter
 
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Here is a facebook page you can like

https://www.facebook.com/ProtectYourBirthRightsAz
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#15 of 17 Old 05-20-2013, 02:45 PM
 
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Part of this makes a little sense to me - especially the hemorrhage meds. I can see the argument that if there is a suspected hemorrhage that the mother transfer. I don't agree with it, necessarily, but I get it. But, no Rogahm? So all Rh- mothers need to go into an OP or ER or whatever for a simple shot? 

 

And, yes, I do agree that limiting the scope of practice while allowing for more risk than what is typical in other areas seems like an odd combo. 


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#16 of 17 Old 05-20-2013, 07:16 PM - Thread Starter
 
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I think that hemorrhage is a yes or a no . I can either help promote contractions and help mom to stop bleeding. Either through natural means or with meds if natural fails... But the time frame I am thinking of can be as short as 5 minutes or less into a signifigant bleed.
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#17 of 17 Old 05-20-2013, 07:45 PM
 
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I'm not sure what you mean, mwherbs, but I do understand the need for hemorrhage drugs at home. I considered prophylactic anti-hemorrhage, actually. I'm just saying that I see a difference between some of these proposed restrictions. 

 

For instance, I think when I was in CA ('01) my MWs were not allowed to give an IV. Memory could be serving me wrong though.  I ended up transferring and had an IV and was in good shape to continue with the birth. While an IV was what I needed and I would have much, much preferred to have gotten that at home, I suppose a good enough case can be made that if labor was long enough and strenuous enough  to need an IV, maybe a transfer isn't such a bad thing. 

 

But, to have to transfer for something like Rogham, or if you want your child to have Vit K and the like seems like it essentially takes the advantages of HB out of the equation. Do you know what the proposed solutions for this are?  Is there any planned support for doctors who want to visit HB mothers and babies in need of medication? 


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