Midwife Calling!

W-n-P: Section four: Purpose, Definitions & General Provisions + Responsibilities of CaLM to CB families:

I. Purpose, Definitions & General Provisions:

A. Standards of Care, policies, protocols, guidelines, technical bulletins and published opinions provide a framework to proactively guide and retroactively evaluate the California licensed midwife’s practice. This is to ensure that midwifery care provided by LMs is safe, ethical, and consistent with physiologically-based principles, scientific evidence and the professional practice of midwifery as defined by the international, national and state organizations identified below.  ^O^  fg

The professionally licensed midwife who conforms to the standards, policies, and guidelines associated with these practice requirements is judged to be competent. Sources and documentation for practice standards and guidelines requirements include, but are not limited to, the following:

  1. The International Definition of a Midwife (International Confederation of Midwives) and international scope of practice  (see page# ?)
  2. Customary definitions of the midwifery model of care by state and national midwifery organizations, including the LMPA of 1993 and its four amendments, including SB 1479 in 2000 (see its Legislative Intent language at end of this section), SB 1950 in 2002, SB 1638 in 2006 and AB 1308 in 2013. ^O^ fg
  3. Standards of practice for community midwives published in the English language by state and national midwifery organizations in the US, Canada and Europe (Alaska, British Columbia, Colorado, England, Netherlands, New Mexico, Texas, Tennessee, Washington State, Vermont)
  4. Philosophy of Care, Code of Ethics, and Informed Consent Policy published by state and national midwifery organizations in the US Educational competencies published by state and national midwifery organizations in the US.

(URL for list) note to self; the completed list contains 23 references (past of post on intro to CaLMs)

LINK TO → Concepts, excerpts and specific vocabulary for this document were taken from (partial list):

  1. Alaska Statutes and Regulation – AS 08.64 and 12 AAC 14;
  2. Arizona Licensed Midwives Rulemaking – 8 AAR 2896, June 18, 2002;
  3. College of Midwives British Columbia, Professional Guidelines, (Canada);
  4. Florida State Statutes for the Practice of Midwifery ~ Responsibilities of the MIdwife;
  5. Midwives Alliance of North America’s Core Competencies for Basic Midwifery Practice;
    6. Midwives Alliance of North America’s Standards of Practice, October 1997;
  6. New Hampshire Statutes for Professional Midwifery Practice;
  7. New Zealand Handbook For Practice, Code of Ethics, 2001;
  8. Office of Administrative Law ruling by California Judge Roman in August 1999 ~ Standards of Practice, Duties and Responsibilities acknowledge as appropriate for licensed midwives;
  9. Tennessee Association of Midwives ~ Practice Guidelines, adopted January 2001
  10. Texas Statutes for Direct-Entry Midwives;
  11. Washington State Criteria ~ Pilot Project for Planned Home Birth
  12. Washington State Standards for the Practice of Midwifery, December 2002

Additional source for 2015 version #3 – ACNM website – defining “evidence-based practice”

B. The California licensed midwife is a professional health care practitioner who maintains all requirements of state certification, keeps current with safe and ethical midwifery practice and who practices in accordance with:

  1. The body of knowledge, clinical skills, and clinical judgments described in the Midwives Alliance of North America (MANA) Core Competencies for Basic Midwifery Practice
  2. The statutory requirements as set forth in the Licensed Midwifery Practice Act of 1993, all current and future amendments to LMPA and the Health and Safety Code on Birth Registration ^O^ fg
  3. The standards, guidelines for community-based midwifery practice
  4. The protocols of the individual midwifery service/practice

C. The California licensed midwife provides care in clinics, physician offices, hospitals, birth centers and the family’s residence. The licensed midwife provides well-woman services pre- and inter-conceptually and maternity services to essentially healthy women who are experiencing a normal pregnancy. ^O^ fg

An essentially healthy woman is without serious pre-existing medical or mental conditions affecting major body organs, biological systems, or competent mental function. An essentially normal pregnancy is without serious medical conditions or complications affecting either mother or fetus.

D. The California licensed midwife must be able to give the necessary supervision, care and advice to women prior to and during pregnancy, labor, and the postpartum period, to conduct normal spontaneous deliveries in all settings, and care for the healthy neonate. This includes preventative measures, policies and protocols for the management of variations, detection of clinically-significant deviations from norm and complications in mother or neonate, and the procurement of medical assistance when necessary.

Maternal-neonatal safety also requires that licensed midwives sometimes provide emergency measures as a ‘first-responder’. Use of emergency medical methods is appropriate while arranging emergency transport and when medical care is unavailable due to prolonged travel time, geographical barriers, inclement weather, and civil disasters of any type. ^O^ fg

E. The California licensed midwife’s primary ethical accountability is to the women in her care within the context of the midwife’s responsibility to uphold professional standards and avoid compromise based on personal or institutional expediency.

F. The California licensed midwife is also accountable to peers, the regulatory body (MBC), and to the public for safe, competent, ethical practice. It is the responsibility of the licensed midwife to incorporate an evaluation process into her practice, such as soliciting feedback from client families and community groups concerned with improving childbirth practices and maternity care services. Monitoring the safety of licensed midwifery practice in California requires that each midwife participation in mortality and morbidity reporting and on-going review processes. This is satisfied by filing the Licensed Midwives’ Annual Report. The CCM encourages the use of data from the LMAR whenever  professional policies, education, and practice standards are being developed or amended. ^O^ fg

G. The California licensed midwife is accountable to the client, the community, and the midwifery profession for evidence-based practice. Evidence-based care is generally defined as a combination of (a) the best research evidence available at the time; (b) the clinical experience of its practitioners and {c} the informed choice of childbearing women and their families. Evidence-based care and “best practices” includes but is not limited to continuing education and ongoing evaluation of the scientific literature. This may include sharing midwifery knowledge and participating in research regarding midwifery outcomes. ^O^ fg

II. A synopsis of the California licensed midwife’s overall obligation to childbearing women and their unborn and newborn babies

A. The California licensed midwife engages in an ongoing process of risk assessment that begins during the initial consultation and continues through the completion of care. Within the midwifery model of care, the licensed midwife’s duties to mother and baby shall include the following individualized forms of care:

  1. Antepartum care and education, preparation for childbirth, breastfeeding and parenthood
  2. Risk assessment, risk prevention, and risk reduction, identifying and assessing variations and detection of clinically-significant deviations from normal, complications and emergent situations ^O^ fg
  3. Maintaining an individualized plan for consultation, referral, transfer of care, and emergencies for each client family (see section #?? for sample form for medical interface as required by SB 1479)
  4. The use of evidence-based physiological management to facilitate spontaneous progress in labor and normal vaginal birth, while minimizing the need for medical interventions
  5. Procurement of medical assistance when indicated
  6. Execution of appropriate emergency measures in the absence of medical help
  7. Standard postpartum care to mother and baby, including counseling and education
  8. Maintaining up-to-date knowledge in evidence-based practice and proficiency in life-saving measures by regular review and practice, which includes bi-annual recertification in NRP & CPR
  9. Maintaining necessary equipment and supplies, preparation of documents including educational handouts, charts, informed consent waivers, birth registration documents, newborn screening, practice protocols, morbidity reports, annual statistics, and other required documentation.

Next topic: III. Standards of Care (ref: College of Midwives, British Columbia)