III. Standards of Practice for Community-Based Midwifery
STANDARD ONE ~ The licensed midwife shall be accountable to the client, the midwifery profession and the public for safe, competent, and ethical care.
STANDARD TWO ~ The licensed midwife shall ensure that no act or omission places the client at unnecessary risk.
STANDARD THREE ~ Within realistic limits the licensed midwife shall provide continuity of care to the client throughout the childbearing experience according to the midwifery model of practice.
STANDARD FOUR ~ The licensed midwife shall respect the autonomy of the mentally competent adult woman and work in partnership with her, recognizing individual and shared responsibilities. The licensed midwife recognizes the healthy woman as the primary decision maker throughout the childbearing experience.
STANDARD FIVE ~ The licensed midwife upholds the client’s right to make informed
choices about the manner and circumstance of normal pregnancy and childbirth (per SB 1479) and shall facilitate this process by providing complete, relevant, objective information in a non-authoritarian and supportive manner, while continually assessing safety considerations and the risks to the client and informing her of same.
STANDARD SIX: The licensed midwife is required by the LMPA to refer the client to a physician if at any point during pregnancy, childbirth, or postpartum care the client’s condition deviates from normal. The category of deviations differs from variations in that deviations are clinically significant conditions likely to have a detrimental affect on the health of the childbearing woman and/or unborn or newborn baby. The midwife employs clinical judgment to distinguish a ‘variation’ from a ‘deviation’ in each individual circumstance, taking into account all other relevant aspects of the situation. ^O^ fg
STANDARD SEVEN ~ The licensed midwife shall confer or collaborate with other healthcare professionals (including other midwives) as needed. When the client’s condition or needs exceed the midwife’s scope of practice, shall consult with and refer to a physician or other appropriate healthcare provider.
STANDARD EIGHT ~ Should the pregnancy deviate from normal and primary care be transferred to a physician, the licensed midwife may, at the client’s request, continue to counsel, support, and advise the client. ^O^ fg
STANDARD NINE ~ The licensed midwife shall maintain complete and accurate health care records and make them accessible to the client upon request. (June 1st)
STANDARD TEN ~ The licensed midwife will keep health information confidential and private, disclosing only as necessary to facilitate insurance claims and / or communicate with other health care providers involved in providing care and in the event of emergency as is necessary to provide appropriate care. (edtd June 1st- rmd)
FG – need to record the phrase deleted and include it as a reference of “examples” of emergency situations and circumstances: “or in extraordinary circumstances where the failure to disclose will result in immediate and grave harm to the client, baby, other immediate family members or members of the midwifery care team”
STANDARD ELEVEN ~The licensed midwife shall make a good-faith effort to ensure that a second professional midwife or other qualified midwife assistant is present when the baby is expected to be born and for the first hour following the birth or until mother and neonate are both stable. Qualified midwife assistant is limited to state-licensed MDs, RNs, CNMs, LMs, EMTs, legally defined midwife assistants and /or midwife students enrolled in an approved midwifery training program. Such midwife assistants must be certified in neonatal resuscitation and adult CPR, and trained in the management of excessive postpartum bleeding. (edtd – June 1)
STANDARD TWELVE ~ The licensed midwife orders, uses or administers only those drugs supplied devices and procedures that are consistent with the licensed midwives professional training, community standards and the provision of the LMPA and does so only with the client’s informed consent. (edtd- June 1)
STANDARD THIRTEEN ~ The licensed midwife orders, performs, collect samples for, and/or interprets those screenings and diagnostic tests for a woman or newborn which are consistent with the licensed midwife’s professional training, community standards, and provisions of the LMPA, and does so only with the client’s informed consent. (edtd- June 1)
STANDARD FOURTEEN ~ The licensed midwife shall participate in the continuing education and evaluation of self, colleagues, and the maternity care system. (edtd- June 1)
STANDARD FIFTEEN~ The licensed midwife is responsible for regularly and critically assessing evidence-based research in determining ‘best practices’ and developing or updating midwifery policies, guidelines, and protocols. (June 1)
SB 1479 ~ Amendment to the Licensed Midwifery Practice Act of 1993
Section 4 ~ THE LEGISLATURE FINDS AND DECLARES THAT:
(a) Childbirth is a normal process of the human body and not a disease.
(b) Every woman has a right to choose her birth setting from the full range of safe options available in her community.
(c) The midwifery model of care emphasizes a commitment to informed choice, continuity of individualized care, and sensitivity to the emotional and spiritual aspects of childbearing, and includes monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and identifying and referring women who require obstetrical attention.
(d) Numerous studies have associated professional midwifery care with safety, good outcomes, and cost-effectiveness in the United States and in other countries. California studies suggest that low-risk women who choose a natural childbirth approach in an out-of-hospital setting will experience as low a perinatal mortality as low-risk women who choose a hospital birth under management of an obstetrician, including unfavorable results for transfer from the home to the hospital.
(e) The midwifery model of care is an important option within comprehensive health care for women and their families and should be a choice made available to all women who are appropriate for and interested in home birth.
Next topic: Midwife & Client Rights and Responsibilities
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