Information ~ CaLM’s Standard-of-Care Development Website: part 1

by faithgibson on May 28, 2015

in Discussions, Introductory Material, Legislation ~ AB 1308, any new bills

Intro, Overview & Grand Vision:

Our Standard-of-Care is also our most public face

A standard of care is like a professional Constitution & Bill-of-Rights all rolled into one. As published online, this document is the single most important source of public information about the principles and professional practice midwifery available to childbearing families, journalists, reporters, legislators, attorneys and other interested parties.

As our public face, we need to be sure that any Standard-of-Care for CaLMs accurately reflects the principles of midwifery practice as a professional, evidence-based, 21st-century healthcare discipline, while functioning smoothly at the practice level for midwives and the childbearing families we serve.

By weaving together the traditional knowledge and practice of midwifery from multiple legacy resources with the most recent scientific advances, it possible create a custom standard of care for CaLMs that will help us preserve and protect the eternal verities of midwifery practice.

The CaLM Collaborative Work Group is a small volunteer work-group of Ca LMs with a passionate interest in a formal standard-of-care that reflects the community-based practice of midwifery in California. We represent ourselves as individual practitioners and we also reflect and represent the views and values of various midwifery-related groups and organizations.

We begin to meet regularly on May 23rd, 2015 and are currently teleconferencing weekly. We hope to finish the first draft in the next 90 days. We are using the California College of Midwives‘ Standard of Care (2004 version, updated 2015) as a placeholder and structural template. However, the final product will be a public document not associated with any particular midwifery organization, but rather an eclectic blend of the best contributions from all sources.

So in addition to our own personal opinions and perspectives, we are making use of the ‘institutional memory’ (i.e. traditional wisdom) provided by already published professional standards-of-care, practice guidelines, and evidence-based policies (see list of legacy documents at the end). These historical and contemporary documents are an excellent source of in-depth information and time-tested ways of expressing these important concepts. It also is a way to acknowledge that we stand on the shoulders of those who went before us and that we recognize the value of these traditions and are proud to carry them forward to future generations.

The purpose of a professional standard of care for CaLMs is to:

  • function as a reliable source of updated information, practice guidance, and technical bulletins
  • provide information about the professional practice of community-based midwifery to interested parties, including the public, client families, legislative and regulatory bodies
  • provide objective criteria for evaluating an individual midwife’s practice
  • provide some measure of legal protection to individual midwives who provide community-based midwifery care in California that is consistent with a published professional Standard-of-Care

The eventual goal is to produce a cohesive whole that will be informative to individual practitioners and the public at large, as well as providing legal guidance for the community-based practice of professional midwifery in the state of California.

The time-consuming background research on comparable Standards-of-Care has already been done, so thankfully our Collaborative Work Group does not have to re-invent the wheel. Instead, we are simply updating and tailoring CCM place-holder material to better serve CaLMs in the post-AB 1308 world. We are paying close attention the clarity of its language, economy of words, and the specific legal requirements of the LMPA (all 4 amendments, especially AB 1308).

For anyone familiar with either the long (52-page) 2004 CCM version or the short, 14-page version adopted by the MBC in 2006 as the SCCLM, these edits are relatively small and should not greatly affect the day-by-day practice of community-based midwifery.

However, we are also concerned about the geographical & political realities of practicing OOH midwifery a big state such as California and also the issues that are unique to any midwife with a very low-column practice, especially in remote or rural areas. Customary practices at the local can be very different in different communities. Much depends on the area’s healthcare resources, especially access (or lack of access) to physician consultation and emergency response services.

Obviously those are very different in a big metropolitan area such as LA county, San Diego, San Francisco-Oakland, and Sacramento, when compared to rural counties (Humboldt, Mendocino, etc), agricultural areas north of Sacramento and the Central Valley, and high desert communities in the area of Bakersfield, Lancaster, Palm Springs, etc.  One size obviously doesn’t fit all, hence the need for feedback from practicing midwives.

After we complete the first draft,  we will provide CaLMs with an online opportunity to read and provide feedback (questions, comments, suggestions, and requests!) As is appropriate, we will integrate the collective body of suggestions to produce a finished product that will update the “best of the best” to “even better”. This process may take as long as a year to complete, but we hope to offer a professional Standard-of-Care for the practice of professional, OOH midwifery in California.

Our hope is that CaLMs will voluntarily adopt the document either in toto or in part, such as group midwifery practices that identify specific portions as the standard-of-care for their individual practice.

It must be stressed that its use by any individual LM is strictly voluntary and that this is the normal relationship between all healthcare professions and the professional practice guidelines published by their various professional organizations. This even true for ACNM, ACOG, AAP, etc.

A big part of what makes us professionals in the ‘healing arts’ is that we voluntarily and publicly commit to adopt and abide by a published standard of care for our discipline. Legally a CaLM can create her own unique ‘version’ (which is available to her clients) or she chooses instead to inform her clients that she practices under the standards of care developed by her professional organization (CALM, California College of Midwives, etc) and them provided a copy or a link to the organization’s formal document.

You have finished Part 1 — to read part 2 click here

 References ~


Direct Link to

Professional midwifery organizations and state, national and international sources originally used in compiling the 2004 Standard-of-Care document and the shorter, 14-page document (SCCLM) adopted in 2006 by the MBC:

  1. Alaska Statutes and Regulation – AS 08.64 and 12 AAC 14
  2. Arizona Licensed Midwives Rulemaking – 8 AAR 2896, June 18, 2002
  3. California Assoc. Midwives’ Certification, part3 – Regulation for the practice of midwifery, Standards, Duties and Responsibilities and Guidelines of Practice 1985, 1989
  4. Central Midwives Board Handbook, Incorporating the Rules of CMB; UK, 25th edition, 1962
  5. College of Midwives British Columbia, Model of Midwifery Practice – Philosophy of Care, Ethics, General & Specific Competencies, Standards of Practice, Professional Guidelines, Indications for Midwives to Discuss, Consult & Transfer Care, Statement on PHB (Canada, 1997)
  6. Essential Documents, National Association of Certified Professional Midwives; Philosophy and Principles of Practice, Scope of Practice,  Guidelines for Profession Conduct, 8-part Standards of Practice; June 2004 {citations – International Confederation of Midwives Code of Ethics, New Zealand College of Midwives Standards of Practice, Service & Eduction 1988, 1992; Mothers and Midwives: The Ethical Journal, London Books for Midwives, 2003; Midwives Rules and Code of Practice, United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1998
  7. Florida State Statutes for the Practice of Midwifery ~ Responsibilities of the Midwife
  8. From Quackery to Quality Assurance – First 12 Decades of the Medical Board of California, 1995
  9. Midwives Alliance of North America’s Core Competencies for Basic Midwifery Practice
  10. Midwives Alliance of North America’s Standards of Practice, October 1997
  11. New Hampshire Statutes for Professional Midwifery Practice
  12. New Zealand Handbook For Practice, Code of Ethics, 2001
  13. Office of Administrative Law ruling by California Judge Roman in August 1999 ~ Standards of Practice, Duties and Responsibilities acknowledged as appropriate for licensed midwives
  14. Original  Statutory Requirements to Practice Midwifery 1917 to 1993 ~ for state certified (i.e. licensed) midwives under the regulatory authority of the California Medical Board
  15. Principles of Midwifery Practice; Netherlands, Kloosterman (unsure of date but probably mid-1990s)
  16. Standards for the Practice of Nurse-Midwifery; Philosophy, Ethics, Guidelines for Incorporating New Procedures into Nurse-Midwifery Practice, ACNM
  17. Standards & Guidelines Professional Nursing Care of Women & Newborns, AWHONN 1998
  18. Second Stage Labor Management; Promotion Evidence-Based Practice & Collaborative Approach to Patient Care, AWHONN, 2000
  19. Tennessee Association of Midwives ~ Practice Guidelines, adopted January 2001
  20. Texas Statutes for Direct-Entry Midwives
  21. The Obstetrician’s Professional Liability – Awareness & Prevention; Dr. David S. Rubsamen, MD, LL.B 1993
  22. Washington State Criteria ~ Pilot Project for Planned Home Birth
  23. Washington State Standards for the Practice of Midwifery, December 2002


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