Midwife Calling!

W-n-P: Section six ~ Rights & Responsibilities for Midwives and Clients

III. MIDWIFE RESPONSIBILITIES

A. The principal objective of the midwifery profession is to render service to healthy women and their infants with full respect for human life and human dignity. Licensed midwives should merit the confidence of women entrusted to their care, rendering to each a full measure of service and devotion.

Each licensed midwife should uphold the dignity and honor of the profession and accept its self-imposed disciplines. Such disciplines include a responsibility to uphold professional standards, to avoid compromise based on personal or institutional expediency, and to adhere to professional rather than commercial standards in making known the availability of their services.

Midwife’s duty to provide client information and obtain informed consent for Community-based Midwifery Services

B. The licensed midwife shall provide accurate information regarding the standards of care and scope of midwifery practice, professional fees, medical consultation arrangements, and the rights and responsibilities of the client.

These included but are not limited to providing a professional disclosure to each client that includes a brief description of the following information in verbal or in written form, or by reading on-line sources, including access to this Standard of Care document if the parents express an interest:

  1. The licensed midwife’s practice standards, guidelines, protocols and policies
  2. The licensed midwife’s training and years of experience
  3. The licensed midwife’s compliance with adult and infant cardiopulmonary resuscitation and neonatal resuscitation certification, continuing and/or special education
  4. The licensed midwife’s practice statistics, noting the number of clients served annually and the percentage of NSVD at home, of hospital transfers and subsequent Cesarean or instrumental deliveries, and the perinatal mortality rate for her practice (LMAR)
    2. ALTERNATIVE WORDING: The licensed midwife’s practice statistics, noting the number of clients served annually and the percentage of NSVD at home, of hospital transfers and subsequent Cesarean or instrumental deliveries, and the average neonatal mortality rate for California LMs as reported by LMAR over the last 5 years  (come back to this, 6/15)
  5. Any limitations on the skill, practice, or other special requirements specific to the licensed midwife
  6. Care and equipment available and supplies provided
  7. How to contact the licensed midwife for routine communication
  8. How to reach the licensed midwife in an emergency, including phone numbers for a second-call midwife or backup arrangements if the licensed midwife cannot be reached
  1. The client shall attest, by either checking off the appropriate box on  the midwife’s “Consent for Care” form, or adding a handwritten notation signed by the client, that she has read and/or received complete, relevant, objective information on as list in the section titled: Client Rights and Responsibilities and Midwife Responsibilities
  1. All Disclosure and Consent forms shall include the date, name and signature of the client and, if appropriate, her partner, and become an official part of the client’s records.
  1. Mandated disclosure forms include the “Medical Interface for Community-Based Maternity Services & Plans for Emergency Response” as required by SB 1479 (2000) and the information, client disclosures and client consent as mandated by AB 1308 (2013).

Each licensed midwife shall disclose to a client, in oral and/or written form:

  1. The legal scope of practice for licensed midwives under the LMPA, including 2014 amendment (AB 1308) which specifically restricted the Ca LM’s practice and expanded the midwife’s obligation to provide legally specific information,  disclosures and client consent.
  2. The specific arrangements for the client to access medical services including consultation and transfer of care during the prenatal period, hospital transfer during labor, birth and the immediate postpartum
  1. How to obtain appropriate emergency medical services for mother and baby when necessary
  1. The professional liability insurance status of the licensed midwife
  1. How to inquire about the midwife’s licensure status from the Medical Board of California
  1. Methods to report unsatisfactory or unethical care to the Medical Board of California

The Medical Interface “Plan for Routine and Emergent Care” form shall include the date, name and signature of the client and, if appropriate, her partner and become an official part of the client’s records. The Medical Interface Form, as developed by the California College of Midwives, is accepted by the MBC as satisfying the requirements of the 2000 amendment to the LMPA.

However, any licensed midwife may develop her own version as long as it includes the same six areas of mandated information.

 

CLIENT RIGHTS & RESPONSIBILITIES SPECIFIED

  1. The client shall receive complete, relevant, objective and, where appropriate, evidence-based information regarding community-based midwifery as a form of care that is separate from the practice of obstetrics as a medical-surgical specialty. This information can be provided verbally, in writing, or any combination of both. It should include but is not limited to the following topics: ^O^ fg
  1. The risks and benefits associated with midwifery services provided in the client’s home or freestanding birth center
  1. The right of the client to change her mind and seek out obstetrical services or hospitalization
  1. A written or verbal description of the responsibilities for the client and her family, relative to choosing community-based maternity care
  1. The client’s right to receive full information, including risks, benefits, options, and alternatives, and to provide permission or informed consent prior to the performance of routine procedures of midwifery care or other treatments, procedures, or administration of any drug to mother or newborn
  1. The client’s right to decline standard protocols or recommended midwifery care. The client’s decision to decline recommended care will be noted in the chart and signed or initialed by the client and kept as a part of the client’s official record.
  1. Birth-related legal requirements for California residents include newborn screening for inborn errors of metabolism (PKU/newborn genetic screening), eye prophylaxis, registration of birth and death certificates, and reporting requirements for emergency transports involving mortality or serious complications. Some but not all of these can be declined by the parents under informed consent/decline protocols.
  1. Information regarding the client’s medical conditions and other concerns for which a licensed midwife may need to consult with a physician, refer client to a physician, and/or transfer the client to a physician’s care
  1. Information and referral of the client to other providers and services whenever requested or if the care required by the client is outside the scope of practice for midwifery or the protocols of the individual licensed midwife
  1. The grievance process for client complaints to the Medical Board of California regarding unsatisfactory or unethical care; (Medical Interface form per SB 1479 – see Section I-D)
  1. The client’s right to have pertinent records in her chart forwarded to other professionals when requested, to obtain copies of her midwifery records and those of her baby
  1. The licensed midwife provides information about her expectations of the client and the reasons and process of discontinuing care under specified circumstances