Midwife Calling!

W-n-P #1: Title page, informational notes, sample Table-of-Contents & Description of Physiological Management

Working Title:

California Midwives
Collaborative Work Group 2015

Current participants:

Rosanna Davis, LM,
Karen Ehrlich, LM
Faith Gibson, LM,
Firen Jones, LM,
Tosi Marcelene, LM,

~ A Work-n-Progress ~
Defining and Describing evidence-based
maternity care as provided by California Licensed Midwives
~~~
Reviewed by academic advisors, experienced midwives, and physicians

Includes:

Policies

Code of Ethics
Standards of Care
Practice Guidelines
Principles & Policies
Administrative Obligations
Criteria for Client Eligibility
Minimum Practices Requirements
Physician Consultation, Referral, & Transfer

Addendum of Documents

 

California College of Midwives Standards & Guidelines ~ Version 3 Original Publication ~ 2004;
Most recent update Jan 2015; reflects requirements of AB 1308

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Background information and Instructions for review and feedback by CaLMs

FAITH’S NOTE on background 2004 CCM document & use of it as a template:

The following body of principles, policies, standards, practice guidelines, and administrative duties for the independent practice of midwifery in this Google draft document are consistent with historic and contemporary standards of care, guidelines, evidence-based recommendations that identify best practices as published in the  in the US, Canada and other English-speaking jurisdictions. A list of contributing sources can be found at the end of Section 1.

They were originally developed by me to provide guidance to, and permit evaluation of community-based midwifery care provided by LM & CNM members of the Professional Liability Consortium (malpractice insurance) from 1998 to 2000. This material was  redacted by me a second time specifically to conform with the legal requirements of the LMPA  as a formal Standard of Care for members of the College of Midwives.  

To avoid having to start over and create a brand new standard of care from scratch the 2015 Collaborative Standard-of-Care Work Group choose to use the CCM 2004 document as a working template. We are currently redacting it with additional guidance from published sources, including CAM’s original standard of care (1985-1989), MANA standards, College of Midwives of British Columbia, ACNM, etc.  Our intention is not to re-writen it but simply redact it — that maintaining its integrity but updating and clarifying the content where necessary, and tailoring specific passages to conform with the post-AB 1308 LMPA.

We are mindful of our practical goals and vision for the project, which is to produce a comprehensive Standard-of-care that provides effective guidance to California licensed midwives at all levels of experience, is informative to the general public, provides for the accountability of Ca LMs and some measure of legal protection to midwives when providing care under its .    

We hope to have a first draft within 90 days that will be available on-line so Ca LMs can read it, and provide feedback if so inclined.

The final standards and guidelines of the Collaborative Work Group 2015 may be voluntarily adopted in full or in part by any individual midwife or group practice. This Standard-of-Care document may also be adopted  by other midwifery organizations for use by its membership.

In either case please cite the CCM placeholder document as the originating source, as CCM’s version acknowledges in turn all the previous contributors (click here to see list here). In more poetic terms, the CCM document stands of the shoulders of giants in field of midwifery and our generation in turn as ‘keeper of the flame’ will bequeath the wisdom of vouched safe in these legacy documents to future generations of midwives and the families we serve.

FAITH’S NOTE on Commentary process & feedback as reviewed by Ca LMs:

The Collaborative Work Group 2015 is encouraging LMs who want to provide comments and feedback to first read the entire document by starting at page one and reading to the end like you would read a book so you get the holistic. Then return, pen-in-hand, to review each of the Standard of Care topics.

The Ca-LM.org website has a place for constructive feedback at the bottom of each topic. But first you will have sign-up (I will automatically give posting privileges to all CaLMs), and then sign-in each time you want to leave a comment. This it to prevent internet trolls and Amy-2-2 from leaving insults and hate mail on the website.

To better manage such a feedback system, we ask that each LM first decide if you can agree with 90% (or more) of the current content of each topic. If you can live with it as it is, that’s probably as good as it gets, since every addition of new content will inevitably make it problematic for other LMs. No one realistically expects that we will ever get 100% consensus from 100% of practicing midwives. However, its also unlikely that 100% of CaLM will be interested in reading the document or would choose to adopt these published standards and guidelines.

If a particular the topic doesn’t meets the 90% level of acceptance, use the “comments” area at the bottom to state specifically what you see as the main problem, AND what you think would fix it. Please organize you comments on the top 3 issues for any one particular topic. I suggest that you print it out first and write your edits and ideas on the paper version. This will help your comments and/or requests to be as clear as possible. The categories of edits are:

  • add words or ideas
  • delete words or ideas
  • re-word or re-work the current material
  • move the same sentence into a different part of the paragraph, or different place in the document

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Standards of Care & Practice Guidelines
for Evidence-based Maternity Care  ~
Updated June 2015 ~

Table of Contents

Note — this list is currently just a place-holder. Think of it like a ‘sample’, since it doesn’t have all topics, and the one that are here may not be in their proper place.

Introduction Material & Preface:

Part A. Physiological Management of Normal Labor & Birth Defined

Part B. Midwifery ~ Word definitions, historical practice identified and described as a non-allopathic discipline; midwifery as a modern profession, and as midwifery is practiced by contemporary California LMs.

Section I – A thru J: Principles of practice, purpose, definitions, general provisions, Standards of Care, ethics, and practical guidelines for midwifery practice by California licensed midwives

I B Standards of Practice …………………………………………………………………………………………… 4

I C Midwife & Client Rights & Responsibilities ……………………………………………………………. 8

I D Medical Interface, Emergency Plan & Other Requirements of LMPA ………………………. 11

I E Record Keeping for Licensed ………………………………………………………………………………. 13

I F Termination of Midwife- Client Relationship & Withdrawal of Service ……………………..14

I G Prohibitions in the Practice of Midwifery ……………………………………………………………….15

I H Professional Relationships between Physicians & Licensed …………………………………….. 16

I I Practice Protocols and Policies ……………………………………………………………………………… 18

I J Distinguishing between ‘variations’ & ‘deviations’ — the crucial role of clinical judgment

Protocols & Criteria for Moderate-Risk Labor & Birth UNAVAILABLE – being reviewed  20

 

Section II – K thru X: Consultation, Referral, Transfer of Care & Minimum

II K Criteria for Client Selections ~ Eligibility for Community-based Childbirth Services …….. 27

II L Safe Environment for Planned Home Birth ……………………………………………………………. 29

II M Equipment & Administration of Medication …………………………………………………………… 30

II N Emergency Care & Emergency Transfer ………………………………………………………………. 31

 

Practice Guidelines for physiologically-based care in a non-medical setting during the antepartum, intrapartum, postpartum and neonatal period by California licensed midwives

II O Minimum Practice Requirements ~ Antepartum Care ………………………………………………32

II P Physician Consult and Transfer of Care ~ Antepartum Referral ………………………………. 34

II Q Minimum Practice Requirements ~ Intrapartum Care ………………………………………………36

II R Physician Consult and Transfer of Care ~ Intrapartum Referral ………………………………. 39

II S Minimum Practice Requirements ~ Postpartum Care …………………………………………….. 41

II T Physician Consult and Transfer of Care ~ Postpartum Referral ……………………………….. 43

II W Minimum Practice Requirements ~ Neonatal Care ……………………………………………….. 44

II X Physician Consult and Transfer of Care ~ Neonatal Referral …………………………………….46

II Y Guidelines for Assessing the Neonate ………………………………………………………………….. 48

II Z Instructions for Parents on Newborn Care …………………………………………………………….. 51

===================== end sample Table of Contents ===========================

New Page ~ Introductory Section

Science-based principles of physiologically-based care for spontaneous labor and normal birth in healthy women with normal pregnancies

Stedman’s Medical Dictionary defines: “physiological” as “…in accord with or characteristic of the normal functioning of a living organism” (1995).

Essential Elements of Physiological Management during normal labor & birth

  1. Continuity of care
  2. Patience with nature
  3. Social and emotional support
  4. Mother-controlled environment (place) for labor and birth
  5. Mother-directed activities, positions, and postures for labor and birth including encouragement to be upright and mobile during all stage of active labor
  6.  Recognition of the non-erotic but nonetheless sexual nature of spontaneous labor and normal birth and associated requirement for psychological privacy (persons present)
  7. Absence of arbitrary time limits as long as some progress, mother and baby OK
  8. Full-time presence of primary birth attendant during active stages of labor & immediate PP-NN period (first 2 hours)
  9. Use of non-pharmaceutical pain management; includes walking about, one-to-one care, touch relaxation, showers, access to deep water tub, other non-pharmaceutical coping strategies
  10. Judicious use of drugs and anesthesia when needed in hospitalized labor patients
  11. Vertical postures, pelvic mobility and the right use of gravity for pushing
  12. Maternal choice for birth position by unless clinically significant medical factors require otherwise
  13. Mother-directed, non-coached pushing without prolonged breath-holding (i.e., the Valsalva maneuver) unless clinically significant factors require otherwise
  14. Physiological clamping/cutting of umbilical cord– after circulation between baby and placenta has stopped (approximately 3-5 minutes)
  15. Immediate possession and control of newborn by mother and father unless clinically-significant medical factors require otherwise
  16. On-going and unified care and support of the mother-baby during the postpartum/postnatal period.

Physiological management is the science-based model of maternity care for essentially healthy women with normal pregnancies. As such it should be the foremost standard of care for this healthy population of childbearing women, regardless of the category of maternity care provider and regardless of the setting for labor and birth (hospital, home or birth center).

No healthy childbearing woman should ever be forced to choose between a physician and a midwife, or between a hospital and an OOH birth setting in order to have physiologically managed normal childbirth.

Childbearing families and their midwives look forward to the time when physiologic childbirth is again acknowledged as the science-based standard of care for healthy women with normal pregnancies.

Next topic start with: Definitions & Fundamental Principles: