From: "faith_gibson" <goodnews@...>
Date: Thu Mar 3, 2005  4:53 am
Subject: CCM Membership / work group for editing CCM document

 State Chapter of ACCM // California College of Midwives

The California College of Midwives would like to invite all LMs to
participate in the on-going development of the CCM Standard of Care,
relative to the following goals (hyperlink) and in conjunction with
the following defined activities (hyperlink) and within the identified
organizational structure (hyperlink):

Priority Goals:

1.To have the Midwifery Model of Care officially acknowledged by the
MBC, with or without a regulatory reference. Presently, letters and
other public records from the MBC and ACOG contain a clear
acknowledgment by both organizations that the practice of midwifery is
different and distinct from the practice of medicine. Clearly we have
already achieved aspects of this goal and these public documents would
serve us in the future should we have to define or defend the concept
in a legal context.

2. To have the entire CCM Standard of Care remain under the control of
its members, as is the convention for other comparable professional
disciplines.

3. To perfect the CCM Standard of Care by addressing two areas of
concern: (a) correcting any errors, omissions, inconsistencies or lack
of clarity and, (b) removing any statements that conflict with
evidence-based parameters, prevent appropriate practitioner
flexibility or block the appropriate updating of criteria based on
current scientific data

4. To continue making the CCM Standard of Care document (revised
edition) available as a public service via the internet to all
interested parties: consumers, other professionals, our regulatory
agency and to California Legislators.

5. To add language or sections that deal with recognized methods and
criteria for the incorporation of new or advanced practice skills for
individual practitioners, and for new skill sets for all California
licensed midwives.

6. To add language that (a) recognizes the important field of study,
knowledge, and skills sets relative to providing care to women
recovering from post-traumatic stress disorder and/or childhood sexual
abuse, and (b) that recognizes that the LM makes the appropriate
referrals while providing appropriate support for clients with signs
of postpartum depression and/or PP anxiety /mood disorders.

7. To participate fully in good-faith negotiations with the MBC and
ACOG to reach a mutually agreeable solution that acknowledges the
midwifery model of care as the appropriate standard of care, while
still permitting the language defining the standard of care for
California licensed midwives to remain, as with other professional
disciplines, separate from the regulatory process (i.e., not
referenced in regulation).

During this process we, as members of CCM, would accept a compromise
solution incorporating in regulation those revised (per goal # 3)
sections 1 and 2 of the CCM Standard of Care, provided that such a
compromise (a) upholds the autonomy of the healthy, mentally competent
woman with a normal term pregnancy as defined in the LMPA (no current
medical complications, spontaneously progressive labor and vaginal
birth not necessitating the use of artificial, forcible or mechanical
means) and (b) acknowledges a woman's right of informed refusal
relative to medical management of her normal pregnancy and (c) allows
licensed midwives with specified additional skills, appropriate client
selection criteria and appropriate practice protocols, to continue to
provide midwifery care for a planned home birth to clients with VBAC,
frank breech or twins who meet the agreed upon criteria.

Secondary Goals ~ Family Planning / Routine Gyn Care // Hospital Based
Practice

Many LMs are interested and able to add an additional section for
family-planning & well-woman gynecology. This would require research
into the language in the LMPA regarding the legal impact of the word
"intraconceptionally". There is at least one instance in which an
obstetrician claimed that LMs were not permitted to do "pre" and
"post" conceptional gyn care -- i.e., the virgin and the crone -- and
refused to hire an LM to work in his office. However, if a solid case
can be made for routine gyn care under the LMPA, it should be included
before the Midwifery Task Force meeting, or at the very least,
recommended as a "work in progress", to be completed as soon as possible.

As for hospital practice, at present the LM is under the supervision
of her sponsoring physician who determine scope and standard of care
issues.

Defined Activities

The deadline for our first official activity will be that of the next
scheduled Midwifery Task Force meeting (approximately 6-8 weeks).
Using the internet as a forum for communication among members, I will
post, in sequence, each subdivision in sections one and two of the
current CCM document. These will be sent out one at a time to be
commented on via the Yahoo CAmidwives group. At the close of that
discussion (approximately 72 hours), each individual member's
corrections, additions or substitutions should be sent to me to
reconcile and incorporate. I will then circulate that revised version
on the Yahoo group.

The current working title makes several artificial distinctions that
are not actually representative of its contents and which, resulted in
confusion. For the purpose of our own internal understanding of the
legal concepts, any subdivision that contains the words "the midwife
shall" or "the midwife must" or "is required" is functionally
considered to be a "standard of care". By common definition all but
one of the individual topics is a "standard" Therefore the title of
the revised edition will be changed to read "Standard of Care". Within
that framework, the participating members will identify each
subdivision (A thru M) as belonging in one of following categories:

·Definition of terms
·Statement of a professional standard
·A guideline
·A protocol
·A direction to the LM to create and maintain her own practice
guidelines and protocols
·A minimum standard for the competent practice of midwifery
·Any necessary information, instructional or teaching material

For the present, the structure of the two sections will remain
essentially the same, except for "educational" material deemed to be
of a background or non-essential nature. These will be moved to
"Clarification and Commentary" (section 4). I will edit the responses
into a cohesive format and post the final edition. This document will
then be put to a vote of participating members before the next Mfry
Task Force workgroup.

Organizational Structure

In order to be involved in editing the CCM publication, an LM must
agree to be identified as a member of the ACCM/CCM. Membership
involves no dues or other financial responsibilities to the ACCM/CCM –
all economic aspects of professional representation with MBC and
Legislature to remain with CALM // Renee Anker, Chair. While
membership doesn't require your money, a request for membership is a
statement of concurrence with the seven goals and defined activities
listed above and the organizational structure as described in this
section.

·Ability to withdraw membership status upon your request

·Simple majority vote for simple business

·Super majority (60%) for final decisions on Standard of Care language

·Finalization of "interim" edition before May MBC meeting // agenda item

·Concur that it is appropriate for me to negotiate for the members of
the CCM on behalf of the above goals at Midwifery Task Force and the
May Medical Board meetings, both of which will also be attended by
designated reps from CAM, MANA, CALM and many independent midwives
representing their personal point of view (including CCM members)

·Revisit and reassess the Standard of Care one year after the
finalized version is published and every two years thereafter (with
recognition of an emergency clause, based on CCM's advice or a
supermajority vote of the membership, to be applied whenever necessary).

Request for Membership

If you concur with the above statements and wish to be a voting member
of the ACCM/CCM, please reply by email. Provide your full name,
licensure status, address and phone number and any comments or
qualifiers that you want to have recorded. Please note whether or not
we have permission to list your name in the published roster of
members posted to the College of Midwives' website.

Last but not least, please consider joining CALM if you are not
already a member.

=============================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu Mar 3, 2005  7:39 am
Subject: Re: what next // How i learned to love the bomb (i.e. ACOG)

Claudia Glass wrote:
>>> Since midwifery is not medical and should be judged by a midwifery
>standards instead of obstetric standards--as is agreed upon by the
>MBC--why are OBs being given a voice in defining a midwifery >standard?

OK, I'll bite – why is ACOG being given a voice in defining midwifery
standards?

But first, I have to mention the obvious -- what we midwives
think/feel about the topic is irrelevant to the actual politics/power
structure of the MBC and the legislative underpinning of our licensing
law and its most recent amendment, SB 1950.

Competent, college-educated people who regularly collect a 6 figure
salary show up to work everyday, five days a week, 50 weeks a year,
devoting all their time and talent, year after year after year, to
advancing or to blocking the interests of licensed midwives. Some of
these people work for the legislature, some as lobbyists for CMA and
ACOG and some as various staff and appointed members of the Medical
Board of California. I think everyone can agree that **full time
devotion of money and talent equals political power**.

So far, that "power" has been aligned AGAINST us. For example i spoke
with an LM today who is currently being prosecuted by the MBC. The
case involves a VBAC. She has already spent $40,000 defending herself,
with estimates of an additional $80,000 in legal fees if she decides
to fight to the finish. That could be any of us in a heartbeat. Can
you blame her for hoping that we can make peace with ACOG and get a
little useful "cover", becasue she sure would like to come in out of
the rain.

You can hate the power inequities, bemoan the injustice of it all, get
furious, lash out in endless diatribes, but at the end of the day
Organized & Politically-Effective Power scores a **1000** and
unorganized, politically ineffective puny-power LMs socres about
**25** and most of that is begged, borrowed or stolen.

So far our so-called political **power** lies in our good fortune to
have curried the favor of nice people, who were able to appeal to the
good nature of Jay DeFuria (Senate B&P committee) who beseeched
Figueroa's office staff to interest her in the plight of midwives.

That is how SB 1479 // 2000 happened. Since that time we have had a
bit of a free ride with Figueroa's office staff, who helped to keep
**our hat** in **her ring**. That is how we got SB 1950 in an attempt
(abet one that has become complicated) to end discrimination by the
MBC against LMs in regard to the Board using obstetrical expert
witnesses to testify against midwives.

So that brings us up to the present, which is to say that the Medical
Board is a bureaucracy whose policy decision essentially "rubber
stamp" the `opinions' of organized medicine. Like I said before, if
ACOG is not happy, ain't nobody gonna be happy.

Now, why does ACOG get a "vote"? Easiest answer is because ladies, we
call obstetricians or take our moms to hospitals who call
obstetricians whenever we get in over our heads and our clients need
services that only physicians can supply, which is about 10% of the
time. So when it come to "boots on the ground", ACOG members are often
hot under the collar about the aspect of independent midwifery that
they get to see up close and personal. Far too often, they don't like
what they see.

At the last MANA conference, I attended a workshop given by a
homebirth mother and academic researcher from Washington State (you
know, the state where everything about midwifery is peachy-keen
wonderful!). In a state that does NOT require physician supervision,
she mailed out questionnaires to doctors listed on state records as
providing backup, collaboration and consultation with home birth
midwives. She asked how that was working for them, and did they enjoy
working with HB midwives and/or their clients.

Oh the sad, bad news......

70% of midwife-friendly doctors said "Hell, no, only do it because my
boss makes me" (if they work in a clinic or group) or "I only do it
for humanitarian reasons so that these poor deluded women and their
unborn babies can get essential medical services".

The researcher asked if "NO", then why not? The docs said because
there is no rhythm or reason to the way midwives practice, everyone of
them is a law unto themselves, everything changes all the time, they
have no loyality or appreciation and argue against my advise right in
front of the patients and of course, half the time their patients hate
us for doing necessary procedures in order to deliver them in the
hospital. They described a loose-loose situation.

Do you wonder why ACOG thinks it rightfully has a "dog in this fight"?

Now back to politics. ACOG at the district level is entertaining the
possibility of meeting us "half-way" in regard to some of the
objections voiced at the hearing. They have already met us at the 99%
level by acceeding to the CCM standard of care as written (if you
acknowledge the CCM document as reflecting typical domiciliary
midwifery practice and aside from the issue of whether you think it
**should** be put in regulation). That's a "really big deal".

So I leave you with my favorite physician-midwife power relationship
story. It goes like this:

The wife of President Roosevelt, Eleanor Roosevelt, was once asked who
she put first – her husband, who was at that time the president of the
United States, or their children? She responded, "Together with my
husband, we put the welfare of our children first".

Well, ladies, together with obstetricians we midwives must put the
welfare of mothers and babies first. That means we want and need ACOG
to meet us half way. In order for that to happen, we need to enlist
ACOG as our ally instead of enemy in an endless war that none of us
will win.

I often tell clients who are in early labor that if one does not
surrender to "necessary suffering" (i.e. don't fight early labor
contractions!), ultimately, they will have to surrender to the
**unnecessary** suffering of unnatural pain and eventually, to painful
medical interventions.

For us, **necessary** suffering may be as simple as swallowing our
pride. Its not about our rights or our status as MLP. What we need is
for ACOG to give Dr Fantozzi the green light. Otherwise, better start
saving money for lawyers, because it is just a matter of time before
someone out there makes a complaint to the MBC against each and every
one of us.

When you put it that way, ACOG seems so much more attractive, hence
the tried and true wisdom about how "politics makes for stange bedfellow".

good night ladies, i'm off to bedfellow land with a song in my heart
and a smile on my face! ^)^

========================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  12:49 am
Subject: First installment of CCM editing // Pages 2 thru 5

This is hard to read since color can't be used to distinquish the new
or deleted material. I used **new** to indicate substitive changes or
additions.

However, If you want a better look, go to the
<www.collegeofmidwives.org> website, drop to very bottom of home pages
and click on link *March2005* for web-based copy of the material below.

======================================================================
STANDARDS OF PRACTICE

Professionally licensed midwives offer primary care to healthy women
and their normal unborn and newborn babies throughout normal
pregnancy, labor, birth, postpartum, neonatal, and intra-conceptional
periods.

**new** The Standard of Care as published by California College of
Midwives / ACCM is comprised of the following: Section 1 addresses
community-based maternity care and includes a statement of purpose,
overview, definition of terms, professional principles, policies
relative to professional relationships, and protocols for special
circumstances. Section 2 consists of minimum practice requirements for
maternity-care related areas of clinical practice, client selection
criteria and medical consultation, referral and transfer of care.
Section 3 addresses family planning and well-woman gynecology.
Subsequent sections of the CCM document include administrative
obligations, practice guidelines, clarifying commentaries, samples of
informed consent documents and instructional and educational materials.

**new** However, the following standard of care document taken as a
whole is not meant to replace the clinical judgment of the licensed
midwife.

I. Purpose, Definitions & General Provisions:

A. Standards of practice provide a framework to evaluate the licensed
midwife's practice to ensure that it is safe, ethical, and consistent
with the professional practice of midwifery in California. The
professionally licensed midwife who conforms to these standards and
their associated practice requirements is judged to be competent.
Sources and documentation for practice 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
2. Customary definitions of the midwifery model of care by state and
national midwifery organizations, including the 2000 LMPA amendment
(See language from SB 1479 at end of this section.)
3. Standards of practice for community midwives published by state and
national midwifery organizations
4. Philosophy of Care, Code of Ethics, and Informed Consent Policy
published by state and national midwifery organizations
5. Educational competencies published by state and national midwifery
organizations

B. The California licensed midwife is a competent 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 amendments to LMPA and the Health and Safety
Code on Birth Registration
3. The standards and 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, client homes, hospitals & birth centers. The
licensed midwife provides well-woman services pre- and
inter-conceptionally and maternity care to essentially healthy women
who are experiencing a normal pregnancy. 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 deliveries, and to care
for the newborn infant. This care includes preventative measures,
policies and protocols for variations/ deviations from norm, detection
of complications in the mother and child, the procurement of medical
assistance when necessary, and the execution of emergency measures in
the absence of medical help.

E. The California licensed midwife's fundamental accountability is to
the women in her care. This includes a 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, and to the public for safe, competent, ethical
practice. It is the responsibility of the licensed midwife to
incorporate evaluation of her practice that includes ongoing community
input and participation in mortality and morbidity reporting and
review processes. The results of these individual evaluations can be
distributed to influence professional policy development, education,
and practice.

G. The California licensed midwife is accountable to the client, the
community, and the midwifery profession for evidence-based practice.
This includes but is not limited to continuing education and on-going
evaluation of the scientific literature. It may also include
developing and sharing midwifery knowledge and participating in
research regarding midwifery outcomes.

**New** H. The licensed midwife may expand her skill level beyond the
core competencies of her training program by incorporating new
procedures that improve care for women and their families into the
individual midwife's practice by:

1. Identifying the need for a new procedure taking into
consideration consumer demand, standards for safe practice, and
availability of other qualified personnel.
2. Ensuring that there are no institutional, state, or federal
statutes, regulations, or bylaws that would constrain the midwife from
incorporation of the procedure into practice.
3. Demonstrates knowledge and competency, including:
a) Knowledge of risks, benefits, and client selection criteria.
b) Process for acquisition of required skills.
c) Identification and management of complications.
d) Process to evaluate outcomes and maintain competency.
4. Identifies a mechanism for obtaining medical consultation,
collaboration, and referral related to this procedure.
5. Reports the incorporation of this procedure to the CCM.

II. A brief overview of the licensed midwife's duties and
responsibilities 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 deviations from normal and detection of
abnormal conditions
3. Maintaining an individual plan for consultation, referral, transfer
of care, and emergencies
4. 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. 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
9. Maintaining all necessary equipment and supplies, preparation of
documents including educational handouts, charts, informed consent
waivers, birth registration, newborn screening, practice protocols,
morbidity reports, annual statistics, and other required documentation.

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 shall uphold the client's right
to make informed choices about the manner and circumstance of normal
pregnancy and childbirth 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 shall collaborate with other
healthcare professionals and, 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 SEVEN ~ Should the pregnancy become high-risk and require
that primary care be transferred to a physician, the licensed midwife
may continue to counsel, support, and advise the client at her request.

STANDARD EIGHT ~ The licensed midwife shall maintain complete and
accurate health care records.

STANDARD NINE ~ The licensed midwife shall ensure confidentiality of
information except with the client's consent, or as required to be
disclosed by law, or in extraordinary circumstances where the failure
to disclose will result in immediate and grave harm to the client,
baby, or other immediate family members.

STANDARD TEN ~ The licensed midwife shall make an **deleted word**
effort to ensure that a second midwife or a qualified birth attendant
who is currently certified in neonatal resuscitation and
cardiopulmonary resuscitation assist at every birth.

STANDARD ELEVEN ~ The licensed midwife shall order, prescribe or
administer only those prescription drugs and procedures as authorized
in the Licensed Midwifery Practice Act, Section 2514 and shall do so
in accordance with the client's informed consent.

STANDARD TWELVE ~ The licensed midwife shall order, perform, collect
samples for, or interpret those screening and diagnostic tests for a
woman or newborn in **new** accordance with customary midwifery
practice and the client's informed consent. (note reference to LMPA
deleted)

STANDARD THIRTEEN ~ The licensed midwife shall participate in the
continuing education and evaluation of self, colleagues, and the
maternity care system.

STANDARD FOURTEEN~ The licensed midwife shall critically assess
evidence-based research findings for use in practice and shall support
research activities.
=======================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  5:19 am
Subject: Re: let's come together // questioning this idea

Liz Woscester wrote:
>
> Hello Dear Everyone,
>
> So, it seems there may still be two camps happening. CAM and it's
> ACNM/MANA idea and Faith and the CCM followers. Is there anyway we
> can all get together in our regions rather than have separate
> meetings of these camps? I care about us ALL and believe
> we can come together for a solution. With love, Lis Worcester SF

Unfortunately, what "come together" seems to mean in CAM terms is for
everyone else to simply acceed to the CAM's point of view. Consensus
is achieved by having people with a differing point of view drop out.

The opportunity in the current situation is to continue the dialogue
between the various 'camps' so that each point of view is able to be
fully expressed. As we go thru time, circumstances will present
themselves so that some eventual conclusion will arrise, and no doubt
it will either combine elements of both points of view or it will be a
totally different "third way" necessitated by circumstances and out of
our control (and usually beyond our ability to imagine ahead of time).

The question has always been what MBC & ACOG and Senator Figueroa's
staff find acceptable, not CAM vs CCM.

The CCM document gives up the easy ability to made changes in exchange
for a legal acknowlegement of "full service" midwifery based on the
healthy, mentally competent mother's right to have control over the
manner & circumetance ofher normal childbirth, even if she is a VBAC
or other medically unpopular status. Presently we have a definition
arrived at by various MBC investigators and lawyers for the AG's
office, who continue to beieve that "the midwifery standard of care is
dangerous" and 'guilt by association', that is, if a midwife was
associated with the mother or the birth, she is 'guilty' for haivng
caused a bad outcome or for failing to prevent a bad outcome.

If an articulated standard of care such as the CCM document gives us
shelter from the storm, its worth the inconvience of having to return
to the Board for regulatory "updates" and eventually, to remove it
from its status as "incorporated" 2 to 5 years down the road. This is
similar to having the luxuary of quiting your job -- in order to do
that, you first have to get hired.

If the identified "standard", whether that is the CCM pages 2-5, MANA,
NACPM or ACNM standards do not do protect and preserve mother-friendly
midwifery, then we are going to have to find us a good legislator so
we can pursue those goals thru a "legislative remedy". The legislative
remedy is about 25 times as harder (in time, money and worry) and
takes much longer.

I've noticed that the line of LMs who want to give up big, successful
midwifery practices so they can travel to Sacramento to attend MBC
meetings and legislative hearings is very short. And we still have the
issue of physician looming over us.

warm regards ^O^

=========================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  8:56 am
Subject: Re: let's come together // questioning this idea

Carrie >>>>> I really have to take issue with you saying that CAM is
not trying to find a point of compromise. CAM seems to be the only
one trying to find a point of compromise.

faith reply: If you read my reply carefully, you will notice that i
was suggesting it was not "bad" to be continuing the dialogue and that
it was perfectly fine for each 'camp' to do what they felt would help
to further the action. Last i heard, CAM was having regional meetings
to work out new language for the ACNM document. I am not complaining
that this is some kind of disloyality for CAM to follow thru on the
plan decided on at your last board meeting. Quite the contrary.

Carrie: >>>>> In terms of who has to accept it we can leave the
senators office out of it because they will support anything that can
make it through the MBC as long as it says midwives at the top. They
dont care if it is the one sentence we had last year or the current
book as long as midwives are being judged by the midwifery standard.
Carrie

faith's reply: Yes, i have been saying this since last September --
Senator Figueroa's purpose in crafting this provision of SB 1950 was
something that said "midwives" at the top. They liked the first
regulation which simply said "mfry standard == California Community of
Licensed MIdwives"

As for Ed's suggestion that simplier would be OK with him, the dumbing
down the standard of care is no trouble at all to Figueroa's office.
Ed Howard does not have a 'dog in the fight", he just wants this issue
to get resolved and the sooner the better. The bottom line question
remains **will the MBC tolerate (i.e. vote to pass) this 'simpler'
version? We had "simple" before and it didn't work.

I regard to the idea that my posted comments are designed to 'scare'
people, it scares me to think that this dangerous distraction by CAM
could very well cripple licensed midwifery in California for another
decade. Stand back and take a good, long look at this situation. We
actually have a historic first here -- both the MBC and ACOG in
agreement on a midwifery standard of care and suprise, surprise --- it
was CAM that threw a monkey wrench into the machinery with the idea
that somehow a national standard (that doesn't offer any protection
California midwives or mothers) would be better.

If the 'solution' to SB 1950 ONLY states the obvious, that midwives
are to be judged by a mfry rather than a medical model, we will in
fact have created absolutely NO change in our relationship with the
MBC as a result of the regulation. For the last 3 years, the Board has
indeed been using LMs as 'expert witnesses' -- i.e. they have,
functionally speaking, acknowledged that using OBs as the source for
midwifery standards isn't legally supportable in an administrative law
hearing (such as Alison's).

The political gain possible in a delineated standard is that it
acknowedges "mother-friendly" midwifery in return for more "details"
than other MLPs. From the standpoint of midwives and mothers, I think
that is a fair price to pay and in fact, we are getting the best of
the bargin. That will be important to every midwife who gets
"reported" for providing care to someone who does not fit the mold of
the lowest of low risk pregnancies. Because the CCM document "spells
it out" she will NOT get prosecuted.

If CAM bargins that chip away, each and every prosecution of LMs for
the type of cases identified in the "moderate risk" categoty will be
unnecessary prosecutions.

I remember only too well when i was being criminally prosecuted by the
MBC for the "illegal" practice of midwifery in 1991-1993,CAM's offical
line was that they "couldn't get involved in these cases". In other
words, you are on your own girlfriend. We sympethize with your plight
but as an organization, we can't help you defend yourself. We just
stand by and hope for the best.

So i did my own legal research and the legal information i uncovered
is why i eventually prevailed in court. When i left the court house i
walked right out that door into being a permanently politically active
midwife becasue it was clear that the only person that i could count
on to fight for my civil liberties was me and I've had me nose to that
grind stone for 11 years now and pretty succeffully at that. I have an
"informed opinion" becasue i did my home work. You can disagree with
it but trying to make me and it "wrong" is unacceptable.

I and others will continue to pursue the CCM document as a potential
vehicle for satisfying SB 1950 becasue it has a good track record so
far and is the most likely solution if judged by the MBC's own
reasoning and prior actions and by ACOG's goals.

The "point of compromise" here between the CCM position and CAM is
that CAM should do own its "thing" and CCM will do own its "thing".

Sometime in the next 1-2 months we will have a mfry task force
workgroup, which will be chaired by Dr Fantozzi and attended by Lori
Gregg (the OB on the DOL/Med Bod), the ACOG lawyer/lobbyist and the
District IX OB, Dr Haskins. The 3 main proposals-- CAM, CCM, Senator
Figueroa's office -- will be put on the table, discussed and in a very
short time, we will know what is going to be 'acceptable' to the
people who count -- our regulatory agency.

faith ^O^

===========================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  9:09 am
Subject: Re: a different idea Diane Holzer> wrote:
>>>>>> I have been trying to think about a way that we could all get
what we need out of this regulation and have come up with the
following idea. >>>> That we offer the suggestion to the MBC that we
will organize a grievance committee. When a complaint comes into the
MBC, it should go directly to the grievance committee. We would offer
to volunteer as midwives to be appointed to the committee. Midwives
could submit their CV's to the MBC and the MBC could choose who they
would like to sit on the committee. We would also offer to find OBs
and pediatricians willing to volunteer their time to sit on a
grievance committee.

Faith's reply: This idea doesn't actually address **this** regulation.
The concept would require new legislative authority, which would mean
getting Figueroa or another legislator to carry a bill repealing SB
1950's provision and creating a grievance committee in its place.

Such a bill would have to reorganize the way the MBC currently deals
with complaints and possibly other licentiates (doctors) would also
like to have this different system. Presently the first decision of
"merit" is based on a doctor hired by the Board for that purpose (for
mfry,it used to be Dr Pat Chase).

If we had a different type of board (such as the one the naturopaths
have, which is to say, our own board), this might work.

warm regards, ^O^

========================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Mar 16, 2005  4:38 am
Subject: my email to CAM lawyer Tim Chanber about editing CCM document

aLL Yahoo group midwives, esp. CAM members:

CAM lawyer Tim Chambers called me recently, concerned that CAM
midwives and board members felt left out of the CCM editing process.
Clearly that has not been the case but just in case anyone else is
confused, see my reply to him below. Also, the CCM membership and work
group info has been copied at the end.

So far, Carrie is the only person to comment on or make editing
suggests for the first installment. All her suggestions were
incorporated in the "Standards of Practice" subdivision of the CCM
document, along with adding a line from the Tennesse Assoc of Midwives
that states ".... the following standard of care document is not meant
to replace the clinical judgment of the licensed midwife.

Also it states that we have a 'section three' that addresses family
planning and well-woman gynecology. So where are the midwives doing
gyn who are going to write section #3????

faith ^O^

======================================================================
Dear Tim,

Below is info on CCM organizational goals relative to the MBC
regulatory process. Please read the 7 priority goals and especially
note numbers 2 and # 7.

And again i will restate that ALL California LMs, as well as
consumers, physicians, CNMs, etc already are (and continue) to be
contributors to the CCM document. The theoretical voting status of
CCM members means that WHAT CCM members would eventually be presented
to vote on as a finished product will be the general consensus of all
the above listed sources -- all LMs, (both CCM members and
non-members), CAM midwives, as well as non-midwives, including both
consumers, lawyers, MBC staff and physicians.

You may think of this process as similar to voting in the Nov. general
election -- who we get to vote for is what the grass-roots party
politics & the primary election has presented us with. In this case ,
non-members actually have a numerically larger in put into the final
product than members have. And conversely, if those suggestions turn
out to be counter-productive, then CCM members can keep such content
from becoming ensconced into an official form by voting it down.
Practically speaking, its a nice parity of power and you may be sure
that i will not be presenting a defective version of the document to
anyone -- members or otherwise. The goal here is to find a workable
solution (and live to fight another day!).

Cheers, faith ^O^
================================================================================\
========
--
Membership -- State Chapter of ACCM // California College of Midwives

The California College of Midwives would like to invite all LMs to
participate in the on-going development of the CCM Standard of Care,
relative to the following goals (hyperlink) and in conjunction with
the following defined activities (hyperlink) and within the identified
organizational structure (hyperlink):

Priority Goals:
1. To have the Midwifery Model of Care officially acknowledged by the
MBC, with or without a regulatory reference. Presently, letters and
other public records from the MBC and ACOG contain a clear
acknowledgment by both organizations that the practice of midwifery is
different and distinct from the practice of medicine. Clearly we have
already achieved aspects of this goal and these public documents would
serve us in the future should we have to define or defend the concept
in a legal context.

2. To have the entire CCM Standard of Care remain under the control of
its members, as is the convention for other comparable professional
disciplines.

3. To perfect the CCM Standard of Care by addressing two areas of
concern: (a) correcting any errors, omissions, inconsistencies or lack
of clarity and, (b) removing any statements that conflict with
evidence-based parameters, prevent appropriate practitioner
flexibility or block the appropriate updating of criteria based on
current scientific data

4. To continue making the CCM Standard of Care document (revised
edition) available as a public service via the Internet to all
interested parties: consumers, other professionals, our regulatory
agency and to California Legislators.

5. To add language or sections that deal with recognized methods and
criteria for the incorporation of new or advanced practice skills for
individual practitioners, and for new skill sets for all California
licensed midwives.

6. To add language that (a) recognizes the important field of study,
knowledge, and skills sets relative to providing care to women
recovering from post-traumatic stress disorder and/or childhood sexual
abuse, and (b) that recognizes that the LM makes the appropriate
referrals while providing appropriate support for clients with signs
of postpartum depression and/or PP anxiety /mood disorders.

7. To participate fully in good-faith negotiations with the MBC and
ACOG to reach a mutually agreeable solution that acknowledges the
midwifery model of care as the appropriate standard of care, while
still permitting the language defining the standard of care for
California licensed midwives to remain, as with other professional
disciplines, separate from the regulatory process (i.e., not
referenced in regulation).

During this process we, as members of CCM, would accept a compromise
solution incorporating in regulation those revised (per goal # 3)
sections 1 and 2 of the CCM Standard of Care, provided that such a
compromise

(a) upholds the autonomy of the healthy, mentally competent woman with
a normal term pregnancy as defined in the LMPA (no current medical
complications, spontaneously progressive labor and vaginal birth not
necessitating the use of artificial, forcible or mechanical means) and

(b) acknowledges a woman's right of informed refusal relative to
medical management of her normal pregnancy and (

c) allows licensed midwives with specified additional skills,
appropriate client selection criteria and appropriate practice
protocols, to continue to provide midwifery care for a planned home
birth to clients with VBAC, frank breech or twins who meet the
**agreed-upon criteria.

Secondary Goals ~ Family Planning / Routine Gyn Care // Hospital Based
Practice

Many LMs are interested and able to add an additional section for
family-planning & well-woman gynecology. This would require research
into the language in the LMPA regarding the legal impact of the word
"intraconceptionally". There is at least one instance in which an
obstetrician claimed that LMs were not permitted to do "pre" and
"post" conceptional gyn care -- i.e., the virgin and the crone -- and
refused to hire an LM to work in his office based on that
(mis)understanding. However, if a solid case can be made for routine
gyn care under the LMPA, it should be included before the Midwifery
Task Force meeting, or at the very least, recommended as a "work in
progress", to be completed as soon as possible.

Hospital-based midwifery practice and well-woman gynecology as
provided in clinics and physician's offices currently falls under the
direction of the LM's own physician supervisor and thus is beyond the
scope of the CCM document as it is presently written.

Defined Activities

The deadline for our first official activity will be that of the next
scheduled Midwifery Task Force meeting (approximately 6-8 weeks).
Using the Internet as a forum for communication among members, I will
post, in sequence, each subdivision in sections one and two of the
current CCM document. These will be sent out one at a time to be
commented on via the Yahoo CAmidwives group. At the close of that
discussion (approximately 72 hours), each individual member's
corrections, additions or substitutions should be sent to me to
reconcile and incorporate. I will then circulate that revised version
on the Yahoo group.

The current working title makes several artificial distinctions that
are not actually representative of its contents and which, resulted in
confusion. For the purpose of our own internal understanding of the
legal concepts, any subdivision that contains the words "the midwife
shall" or "the midwife must" or "is required" is functionally
considered to be a "standard of care". By common definition all but
one of the individual topics is a "standard" Therefore the title of
the revised edition will be changed to read "Standard of Care". Within
that framework, the participating members will identify each
subdivision (A thru M) as belonging in one of following categories:
· Definition of terms
· Statement of a professional standard
· A guideline
· A protocol
· A direction to the LM to create and maintain her own practice
guidelines and protocols
· A minimum standard for the competent practice of midwifery
· Any necessary information, instructional or teaching material

For the present, the structure of the two sections will remain
essentially the same, except that "educational" material deemed to be
of a background or non-essential nature will be moved to
"Clarification and Commentary" (section 4). I will edit the responses
into a cohesive format and post the final edition. This finalized
document will then be put to a vote of participating members before
the next Mfry Task Force workgroup.

Organizational Structure

In order to be involved in **editing the CCM publication an LM must
agree to be identified as a member of the ACCM/CCM.

(**Tim, all public sources get to be contributors -- providing
suggestions, want they might want to add in or request to be taken out
or re-worded, where as only CCM members get to block or "edit out"
material -- i.e., veto power but not "source" power),

Membership involves no dues or other financial responsibilities to the
ACCM/CCM all economic aspects of professional representation with MBC
and Legislature to remain with CALM // Renee Anker, Chair. While
membership doesn't require your money, a request for membership is a
statement of concurrence with the seven goals and defined activities
listed above and the organizational structure as described in this
section.
· Ability to withdraw membership status upon your request

· Simple majority vote for simple business

· Super majority (60%) for final decisions on Standard of Care language

· Finalization of "interim" edition before May MBC meeting // agenda item

· Concur that it is appropriate for me to negotiate for the members of
the CCM on behalf of the above goals at Midwifery Task Force and the
May Medical Board meetings, both of which will also be attended by
designated reps from CAM, MANA, CALM and many independent midwives
representing their personal point of view (including CCM members)

· Revisit and reassess the Standard of Care one year after the
finalized version is published and every two years thereafter (with
recognition of an emergency clause, based on CCM's advice or a super
majority vote (60%) of the membership, to be applied whenever necessary).

Formal Request for Membership

If you concur with the above statements and wish to be a voting member
of the ACCM/CCM, please reply by email. Provide your full name,
licensure status, address and phone number and any comments or
qualifiers that you want to have recorded. Please note whether or not
we have permission to list your name in the published roster of
members posted to the College of Midwives' website.

Please consider joining CALM if you are not already a member.

======================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Mar 16, 2005  6:53 am
Subject: Re: my email to CAM lawyer Tim Chanber // sec #3 WW gyn

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:
>
> Thank you Faith for doing this work, replying and for your time and
effort. Sue Turner, LM

You're quite welcome. I hope someone comes forward to start the family
planning // well-woman gyn section as i have little to offer in that
department.

warm regards, faith ^O^

===================================================================

April 2005

From: "faith_gibson" <goodnews@...>
Date: Thu Apr 14, 2005  8:12 am
Subject: Reply to Jodi's request for update on CCM

Dear Jody and others,

Apparently the midwives on the Yahoo group, as well as those who read
the California College of Midwives' web site, were not interested in
editing, adding to or otherwise making changes in the CCM document.
Except for Carrie, no one emailed me any suggestions. Either people
like it as it is, or they were uninterested in modifying it.

As for the addition of gyn language to the CCM Standard of Care, no
one has expressed an interest (except for our phone conversation) in
actually writing standards for family planning & well-woman gyn. No
one has come forward to offer language for it that was not basically
just a list of protocols taken from a medical practice.

As for the Medical Board, they are unable to make any changes (that
is, to let us make any additions) in the CCM document as published
prior to the last regulatory hearing, due to the legal restraints of
the regulatory process (what they vote on May 6th must match the
content of notice sent out 45 days ago).

The Midwifery Task Force work group will consider deleting topics or
sections from the CCM document and, as of last week, they are planning
to amend the language of the regulation by incorporating the changes
ACOG asked for.

The ACOG language states unequivocally that clients with multiple
gestation, breech presentation or post-cesarean pregnancy must to be
referred to a physician for care and that the midwife must immediately
terminate her care. It also stipulates that LMs may not provide any
midwifery services to clients referred to a physician for evaluation
or for obstetrical services until such a time as the client is
released from the physician's care.

As for the on-going politics from CAM, I can only express my continued
bewilderment. The most recent letter from CAM is again proposing the
MANA standards as regulatory language, as if the critical factor (and
eventual decision by the Board) was solely to be determined by the
preference of midwives, that is, simply a matter of us `voting' for
our favorite. The thing that seems to be missing from CAM's plan is an
acknowledgement of basic political realities and the qualities of
negotiation, compromise and offers to met our worthy opponents half way.

The Medical Board and ACOG have and will continue to have interest in
and control over the practice of licensed midwives for the foreseeable
future. Just as midwives "need' certain things in order to be able to
do our job, so the Board and ACOG have "needs", that is, conditions
that must be met so that they can fulfill their obligations and
preserve their honor and the respect of their peers. The Medical Board
especially needs to be seen (by themselves and others) as competently
performing their duties as regulators.

They see their role as a `high calling', which consists of protecting
the interests of consumers and the reputation of the Medical Board
(and that of the medical profession) in the eyes of the public. They
are horrified at the idea of being embarrassed in public or in front
of other doctors by a `bad' decision and thus are "risk adverse". They
want important decisions to have the support and approval of all the
heavy hitters in the field – in this case, ACOG, CMA, doctors on the
Board and Senator Figueroa's office. (Sorry girls, but we don't have
much political capital in this arena!)

I believe that it behooves us to figure out what the Board and ACOG
want and come to the table willing to meet them half way. We need the
good will and cooperation of organized medicine and our regulatory
agency. It is to our benefit to forge permanent, mutually-satisfying
relationships, as it assists us in achieving our `calling' as
midwives. Our calling includes the need to protect and preserve the
right of mentally-competent, healthy women to have control over the
manner and circumstance of normal childbirth (thus acknowledging the
mother's right to choose independent midwifery care and home-based
birth services), even when or if the mother makes a medical unpopular
decision (which acknowledges our right to provide home-based midwifery
care and the mother's right to have access to professional childbirth
services). Childbearing women are intellectually unprepared (and often
lack expereince, insight and foresight) to be the primary locus of
political activism in regard to these issues. They need our wise-woman
"midwifing" here just as much as when they are in labor.

However, what I see and hear in the CAM strategy is denial of the
Board or ACOG' legitimacy, that is, the idea that neither should have
any `say' in regard to the practice of midwifery, that how we practice
is "none of their business". This results in a rejection of any effort
to study the dynamics of the Board or ACOG, to learn what makes them
tick and to do one's best to give them what they want so the we can
get what we need from them in return.

While it would be nice to have total and complete control over the
public face of midwifery, it isn't what is actually happening (just
ask anyone who is being investigated or prosecuted by the Medical
Board or endures ACOG's lock out of midwives in regard to doctor
backup, obstetrical services or hospital privileges). All over our
country and world, there are individuals and groups who are strongly
opposed to other people and political entities. Resenting them or
wishing they would be different doesn't reduce their influence over
our lives.

For instance, the Republican party wishes that all Democratic
candidates running for public office would just go away, liberals wish
the religious right would just disappear, the far right wishes all gay
peoples would be magically converted to heterosexual Christianity
overnight and all of us wish OPEC would just evaporate so that gas
prices would come down out of the stratosphere. And yet none of us
would vote for a public official whose `plan' for dealing with these
natural conflicts of interest was simply to ignore their reality and
insist that we can get what we want by just insisting, and we don't
need to learn about our opponents, enter into on-going dialogue,
negotiate in good faith or be willing to meet them half way.

When I think about this I can't help but note that the practice of
midwifery is itself very isolated (and isolating) and so often happens
without any interface with the `real' world. What I mean is that many
times we get called after going to bed, get up and drive thru the dark
to someone's home in the middle of the night, catch their baby, weight
it, clean up, pack up and return home before daybreak and before our
family's ever realized that we had gone out (my family thinks I'm just
lazy and like to sleep all day!). As a midwife, our relationship with
midwifery is very private and personal and "none of your business".

Functionally speaking our experience of midwifery usually does not
have any public `face', doesn't interface with other professionals or
bureaucrats. This invisibility is magical and rewarding but it is also
disorienting. It seems to lead us to believe that we midwives `own'
midwifery', that it is our personal possession and therefore, anyone
who isn't a midwife (for example Frank Cuny or Senator Figueroa) and
anyone who isn't a **CAM** midwife, has no business butting in. "Its
ours, go away and leave us alone" seems to be a constant theme.

We all wish it was just our private business and personal possession.
However, when our clients need obstetrical evaluation, NSTs,
ultrasound, Rhogam or hospital transfer or have an emergency, we need
and want the respect and cooperation of the public, bureaucratic
daytime world.

The way to get that respect and cooperation is to give respect and
cooperation. That's my `plan' for the April 27th Task Force work
group. Hope lots of others who are committed to such a goal will also
attend, listen carefully and see if we can't simply accept that the
Medical Board is doing what its doing because it needs go down this
road right now.

Its impossible to predict the outcome of the Task Force meeting, as it
depends mostly on entities outside of the midwifery community and
outside of the control of any of us as individuals. The answer willbe
an amalgamation of the input f ACOG, Figueroa's office, MBC politics,
the legal restrictions of the regulatory process and perhaps other,
incidental or "happy accident" events. The one overriding concern is
that we not permit a standard of care regulation to re-define and
limit our scope of practice.

Lets all pray for a lot of good will and happy accidents.

======================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  12:20 am
Subject: The timber we trade does not belong to us

"Lesley@m..."wrote >
> -----Original Message-----
> From: faith_gibson [mailto:goodnews@b...]
> "Childbearing women are intellectually unprepared (and often
> lack expereince, insight and foresight) to be the primary locus of
> political activism in regard to these issues. They need our
wise-woman "midwifing" here just as much as when they are in labor."
>
Leslie: I disagree, most respectfully. Midwifery belongs to
childbearing women and no one else.

Dear Leslie,

Thanks for the wonderful phrase about the 'timber we trade not
belonging to us'. Your right if you mean that midwives are "not
childbearing women" but frankly (even thought my ovaries are honorably
retired!) i still feel myself to be a woman and one who was and is
interested in promoting improvement in childbearing services.

As for depeding on childbearing women to be the agents of change in
their own behalf, I share your sentiment, admire your trust,
appreciate your hope in humanity but disagree with the practicality of
it. If we midwives are waiting and expecting (young, inexperienced,
distracted, financially vulnerable, often single) childbearing women
to "lead" the way, we are foolish and will simply continue to wonder
in the wilderness, which we have now been doing (that I can personally
attest to) for forty years. Worse yet, we sentence our daughter and
granddaughter and great granddaughters to more of the same – which is
to say, the extinction of physiological childbirth and by extension,
of independent midwifery.

Forty years ago, as a student nurse, I expressed this same sentiment,
and trust and was wildly hopeful as I patiently waited for women to
see the travesty in "knock'em out, drag'em out" childbirth (forceps
and general anesthesia) and rise up the wings of a pure white dove and
march in droves on Washington – The Million Moms and Midwives March
for Sanity and Common Sense in Childbirth.

In 1962 when I was an 18 y/o student nurse in L&D, women were
routinely being given scopolamine (an hallucinogenic and amnesic drug)
during labor and general anesthesia, episiotomy and forceps (what I
call a `vaginal CS) for birth. Many of us L&D nurses were properly
horrified at this institutionalized violence (to say nothing of the
male chauvinist aspects of it) and dreamed of the day when CB women
would stop asking for and expecting to be 'put to sleep'. However, all
laboring women (including my mother) had delivered this way since the
early 1940s and so by 1960-something, there was no one left alive of
childbearing age to tell their daughters anything about normal labor
and natural birth.

Twenty years later the push for "awake and aware" childbirth was
successful but that success had a great deal more to do with a simple
change of fashion in the medical profession that was independent from
any influence of women or birth educators. It was time for a "change",
in this case, a move to replace the more dangerous general anesthesia
with the less dangerous regional (spinal and epidural) anesthesia. The
profession of anesthesiologist was just hitting its peak, and running
registered nurse anesthetist (CNAs) out of the business, just as GP
and midwives had already been dispended with by OBs in earlier decades.

This change in anesthetic style and staff was greatly benefited and
advanced by the makers of medical supplies, in particular, the
suppliers of angio-cath IV equipment (Baxter, Bayer, etc) who gave
free workshops at every hospital to teach L&D nurse how to do away
with the metal hypodermic needles that had been used for administering
IVs for the last 100 years. At that time we used the same kind of
needle that goes on a hypodermic syringe to give IVs by placing it in
the antecubital space (bend of the elbow). This required the mother's
whole arm be taped down to an `IV board', which was then tied to the
bed, as without this restraint device the needle would puncture the
woman's arm if she accidentally bent her elbow.

As a result, giving people IVs was creepy and none of the nurses liked
doing it. However, with the more acceptable angio-cath, giving
laboring women IVs (which was a necessary accompaniment to
spinal/epidural anesthesia) became acceptable and routine. And
incidentally, it also gave doctors a "better way" to administer
Pitocin and soon that too became routine. We quietly exchanged
drug-the-mom and drag-the-baby out delivery under general anesthesia
for "awake and aware" induction, epidural, episiotomy and low forceps
birth, with the dad in the delivery room. Then our hospital added some
colorful curtains to the labor room window, put a comfortable chair
next to the hospital bed and advertised itself as having "liberalized"
policies which promoted natural childbirth! However, childbirth was
and is (and I'm afraid will be) STILL faithfully conducted and billed
as a surgical procedure and that hasn't been changed one bit in more
than a hundred years. I know, I regularly provide labor support for
these "natural" births in our local hospitals.

In 1962 the CS rate at our hospital was 3 percent. In 2003 it was 27.6
percent. I believe that `Waiting and Hoping' as an effective political
strategy has been tested and found to be a failure. During that time I
have listened to other nurses and childbearing women and more
recently, midwives and young mothers who have had home births, repeat
that same mantra about this silently growing ground swell of savvy
childbearing women (or of childbirth educators) who are going to
change the world, one birth at a time. This notion reminds me of my
flower-child days and anti-Viet Nam movement – "What if they gave a
war and nobody came?" Well, I've noticed, young men still keeping
becoming soldiers in great numbers and childbearing women still
keeping going to obstetricians in great numbers and when in labor keep
coming to hospitals for 100% medically intervened with childbirth.

This "just be patient and wait for women to rise up" idea was repeated
as recently as yesterday as I encouraged a home birth client (gravida
4 who incidentally will be running the Boston Marathon this next
Monday at 15 weeks of pregnancy) to consider becoming a midwife when
her youngest child started to school. One of her many remarks was
about how she was going to teach her daughters about how `natural'
childbirth was and then by the time they were having babies, the whole
problem would have gone away, because women will just "see the light"
and then maybe she'd train to be come a midwife.

So here are the major flaws in depending on childbearing women as a
political strategy. First childbearing women are usually young,
inexperienced, untested by life, naturally afraid they won't have the
"right stuff" and overly sensitive to the opinions/trends and fashions
of their peer group. At present their peer group (and ever magazine,
TV show and movie) have a very simple message – "childbirth is AGONY,
it is DANGEROUS – the baby could DIE, it RUINS your body so you wind
up PEEING down your leg OR having to wear DEPENDS and you are STUPID
if you don't (a) get an EPIDURAL in the parking lot or (b) have a nice
neat, conveniently scheduled CESAREAN! Well, now that we have
discussed everything there is to know about having a baby, where shall
we eat and what movie did you want to see?"

And second, you have to have some history or experience of `another
way' to have the vision and intellectual tools to function as a
political change agent – a deep understanding and well founded
commitment – to work for the social, economic and political changes to
necessary to bring it about. However, the 20th century propaganda
machine of organized medicine exterminated the common history of
childbearing women who talked to one another and passed on the benefit
of their experience. Women who give birth under general anesthesia
don't have a lot of memories, so for the whole of the 20th century, we
have never had a large enough pool of cultural wisdom that there was
something to "pass on" in sufficient numbers to do the job.

Equally lethal, the propaganda machine marches on with more effective
tools and more influence, in particular, thru the ubiquitous media of
the 20th century world which is now beamed even to third world
countries that used to use midwives but are now beginning to see the
error of their backward way. All we have to do is tune in the "Baby
Story" on the cable channel (its being watch by young women in Bali!)
and get taught how to be a good obstetrical patient – one who demands
to be induced and demands to be given "our" epidural on admission to
the hospital so we won't "feel anything" while being functionally
paralyzed from the waist down. People with spinal cord injuries might
wonder that we are so quick to think being numb from the waist down
and unable to stand is something to aspire to. Worse yet, in Bali and
other non-industrialized countries where women traditionally squat to
give birth, young childbearing women are now beginning to show up at
the hospital, lay down on the bed and put their feet in stirrups in
expectation of "being delivered" by the doctor "just like they do in
America!"

So the issue is who or what is a responsible and dependable and
effective 'change agent' in this regard to this issue. Its not who
SHOULD do it (i.e, childbearing women), it's who CAN do it (i.e., has
the understanding and know-how) and unfortunately, the natural answer
to that is us – i.e., midwives.

Bummer………………

=======================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  12:27 am
Subject: Re: Questions for Faith --- In CAmidwives@yahoogroups.com, "licensedmidwife"
<licensedmidwife@y...> wrote:

> I may be confused again, but the reason that I asked for an update was
> because I thought the changes were going to be on this site and the
> CCM members( I thought I signed up) were going to be able to see all
> changes and comment on them. I have not read anything here and have
> been watching daily. I was looking for the posts on section 1 and 2
> revisions if any.

Faith reply: I didn't post additional sections because i got NO
response to what was posted. And then shortly after that happened, the
Medical Board called me and in our conversation let me know that the
document could not be changed at this juncture. So after the next
round of hearing we can try again.

> I still believe that the CCM document will serve us best and I hope
> that the MBC will appreciate our willingness to work together.

Faith: Me too, but there are ways to improve it and if possible i'd
like to do that. The Gyn-issue if one of those issues. As for the file
you sent, appearently i did not get it or it got accidentily trashed as
spam. Could you send it again?

> Thanks for all you are doing.

faith : Thank you -- always appreciated being appreciated.
> Jodi
========================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  1:28 am
Subject: Views on MANA document & recent MBC mailing

I think there is a lot of misunderstanding about the role of the MANA
document, particularly in regard to the SB 1950 regulation. The
Medical Board has, in public and in private, said repeatedly that they
did not think the MANA standards were appropriate for being
incorporated as regulatory language.

However, that does not mean that California midwives cannot "practice"
under them or that MEAC-approved schools should not teach their
philosophy and principles. Along with the core competencies, they are
the heart of the preparation of students and they define the
overarching foundation for the practice of independent midwifery. Not
adopting them only means that, **in addition**, California LMs have
regulations which we **also** would have to take into account.

As for the idea that it never hurts to ask, well of course, asking is
a fine idea. However, anyone who has actually been personally involved
is convinced that we have asked, again and again, and their answer was
no. It will be no again this time, if only due to the legal complexity
of the Keen Baggley Act. This law results in a requirement and a
specific process for "government in the sunshine', which in this case
means that Board can't vote on anything that wasn't sent out already
during the 45-day pre-hearing notice period. We midwives benefit from
this rule because it means the Board can't vote in something that none
of us had read or ever heard of.

I think the packet that came today in my mail from the MBC with the
agenda for the April 27th meeting perhaps encapsulizes the issues and
the reason for going forward better than anything i could have
written. On page 4, agenda item 5, it says:

"Dr Fantozzi reported that he directed Dr Pat Chase, Medical
Consultant for the Licensing program, to poll every state regarding
midwifery standards of care. Dr Chase found 18 states that have
regulations in place addressing midwifery standards of care. Dr
Fantozzi then directed Dr Chase to compile a document encompassing all
standards of care, identifying which states include each standard. He
stated that when this information was compared to the CCM Standards of
Care document, CCM's guidelines (the choice of the word 'guideline'
was made by the secretary typing the report and not used in a 'legal'
sense) were found to be complete and fulfilled the requirement. He
indicated that the Standards of Care Subcommittee reached consensus
that the CCM protocols (another instance of general descriptive phrase
chosen by the secretary and not a legal definition of "protocol")
provided an appropriate level of informed consent, were the most
comprehensive and clearly defined the midwives responsibilities and
practice limitation. He explained that CCM protocols (ditto above)
represented the midwifery, not the medical, model of care and these
guidelines (ditto above) could be brought forth as a document that
would satisfy the standard of are regulation requirement.

So the question for everyone in regard to the MANA document is do they:

(1) Track with the regulatory language used in other state midwifery
regulations?
(2) Are they 'comprehensive'?
(3) Do they provide for an appropriate level of informed consent?
(4) Do they clearly defined the responsibilities of midwives?
(5) Do they clearly define the midwife's practice limitation?

Since the current version of the MANA document does not (as yet) do
these things, it will not be seen by the Board as an acceptable
reference for the regulation. That isn't happening because I somehow
wrongly influenced the Board.

In fact, if we did not have the CCM document, they would be voting on
the Alaska regulation instead. The reason they aren't is because i too
download the regulations from the same 18 states, stole their ideas
and plagerized their language, carefully leaving out (of course)
things that were unfaithful to the midwifery tradition, failed to
acknowledge the clinical judgement of the professional midwife or
would be harmful to the rights of healthy, mentally-competent
childbearing women.

Here is what Lesley posted on the topic of Alaska's regs just yesterday

" Having come from a state in which midwives sold-out long ago for
their license (Alaska – no HBAC's Twins or Breeches, along with a long
list of reasons to transfer and transport that can't be deferred to
good judgment or informed decision-making), I can tell you, the
mothers and babies have both benefited and suffered.

And now the midwives will not fight for mother's rights – it is up to
the mothers themselves.

In my mind, HBAC's and breeches are deal-breakers. I'd give up my
license (if I had one!) for these.
With love, Lesley Nelson, CPM AAMI #1585

============================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  1:36 am
Subject: Re: Questionaire in the mail today from CAM

sue turner wrote:
>
> Correct me if I am wrong but, I was not under the impression that
the medical board had reviewed or is in anyway reviewing an other
protocols(ie MANA).
> I thought that the time period for this has passed for a protocol
to be submitted. It is also my understanding that the midwifery task
force which CAM in just a single digit among quite a few, is to
refine and not to submit new to. Is this not correct? Faith?
> Sue Turner, LM

Yes and no -- it's not impossible to start all over again, just darned
unlikely and in my own opinion, not very helpful.

Just consider this for a minute -- what if we all just gave up and
acceeded to the reality that the Board was going to pass the
regulation as written, with only a few modifications.

Then our role and goal would be to be certain that those few "new"
words were to our benefit and not to our detriment and we could get
together to agree on what is most helpful to add in and what is most
necessary to keep out.

And we could come to some general consensus on what would be a "deal
breaker" and what we do if we have to 'break' out.

Have any thoughts on that? warm regards, faith ^O^
======================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  3:19 am
Subject: Re: The timber we trade does not belong to us

"Tonya Jamois" <president@i...> wrote:
>
> Interesting discussion on the role of the childbearing women as
> agents of change.

Please be assurred that i am not inferring that the entire class of
childbearing women was somehow unable to act on their own behalf --
quite the contrary, the experience CB woman are a powerful force to be
reckoned with -- and i'm one of them.

What i'm pointing to is that it is irrational to expect women who have
not yet given birth, as a class, to take the lead in this campaign.
The obstetrical professionon needs to be held accountable for the
false claims and misleading promises of organized medicine but i
question the idea that this group of "maidens" would be the first and
best choice to do that, since they are in a different part of their
journey. Its unfair to them and to us.

And when i speak of 'midwives', i'm using that general category as a
verb instead of a noun. You "midwife" the ICAN organization 40 hours a
week. Many in your organization funtion as the 'spirit' of midwifery
in serving the "walking wounded" amoung new mothers, faciliting public
education and protecting our options (as individuals and for society)
for a normal (physiological) birth.

And yes, i believe that ICAN is a crucial player, espeically because
ICAN is not easily derailed and sullied by the 'blow-back' from the
sharply differing opinions among midwives. Your independence is a good
thing.

Somehow, somewhere all our groups have to coalease into a lean, mean
fighting machine and literally bring an end to flat earth obstetrics
in our life time, for the good of women, for midwives, for taxpayers
and yes, even the good of doctors. Don't you think obstetricians would
be happier doing real obstetrics (breeches, twins, VBACs,
macrosomia,high-risk moms, etc) instead of **pretend** obstetrics --
delivering the 7 1/2# babies of perfectly healthy mothers who are numb
from nipples to knees?

Looking forward to seeing you Friday, April 29th at the Conference. Be
there or be square!

warm regards, faith ^O^
=========================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  2:39 am
Subject: Re: MBC Regulations for Phys Supervision -- coming up fast

No, not AOL -- it was the Attorney General's office. The MBC was
awaiting the AG's opinion, which technically was addressed to Senator
Figueroa's office. The specific content is sealed (ie not published,
not helpful). T

This means the waiting phase is now over and the Medical Board will be
drafting language and scheduling a regualtory hearing the near future.
Any idea about proposed language? faith ^O^

--- In CAmidwives@yahoogroups.com, Lis <stara4@y...> wrote:
> Thanks for the heads up Faith. Hasn't the OAL been reviewing
something too, as I recall?
> Best, Lis
>
> faith_gibson <goodnews@b...> wrote:
>
> Dear Midwives,
>
> I know that everyone's attention is on the standard of care issue at
> this point. But irrespective of the outcome of the Aprial 27th work
> group, the MBC is also planning to move forward on the 2nd half of
> SB1950 -- regulations defining physician supervision.
>
> In this regard, its best that we try NOT to track too closely with
> CNMs, as their paperwork requirements would be impossible for us to
> meet. By insisting that the LMPA law is functionally "the same" of it
> is for CNMs, it opens up the way for the Board to look to the BRN and
> use CNM regulations/standard procedures as a model for an "equivilent"
> regulation on supervision.
>
> It would be a good thing for LMs to begin to think about proposed
> language for the other half of this reTgulatiry process. What would one
> say in a regulation about physician supervision that would in any way
> track with what is possible (as usual, determined by the MBC, ACOG and
> Figueroa's office). And we should keep this topic in mind when it
> comes to negotiating with the Board and ACOG during the upcomming
> April 27th meeting.
>
> If it seems that midwives are naively unaware of political realities,
> stubornly unrealistic in our expectations and lack a grasp for what is
> achievable, we risk being discounted as a force to be reckened with.
> If that happens the Board will fall back to its super-authoritarian
> mode of yester year and craft's its own version, which would include
> some form of documented mutual agreement with a supervising physician.
>
> Unfortunately, the regulatory process for physician-supervision will
> likely make the standard of care issue look like a walk in the park.
>
> warm regards, faith ^O^
>

=====================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  5:44 am
Subject: Onerous micro-management protocolsanother state

I was doing a legal review and came accross these protocols that are
used in another state. They is a good example of hardcore
micro-management via protocols in other jurisdictions:

I know that we argue endlessly about the amount of "detail" in the CCM
document, but for regulatory language, its pretty good.

==============================================================
General Protocols:

Persons able to perform neonatal resuscitation procedures will be
present at each birth.

Records shall be complete and accurate to assure transferable
comprehension.

Prenatal Criteria **mandating physician consultation or transfer**:

The following conditions should **at all times warrant consultation
with a physician when observed by the midwife or reported by the
patient**: (partial list only)

a)Elevation of BP: rise of more than 30 mm Hg systolic and /or 15 Hg
diastolic or 140 systolic or 90 diastolic.
b)Persistent glycosuria and /or abnormal blood sugars
c)Unusual finding on abdominal examination including (excerpt)
polyhydraminios and excessive fetal size
d)Persistent vomiting, persistent weight loss aft eh first trimester,
pain unrelated to minor discomforts of pregnancy, dizziness,fainting,
loss of consciousness
e)Pregnancy more than **two weeks beyond EDC
f)Skin rashes
g)**Herpers genitalis
h)Any problem which would indicated the **need for an ultrasound
i)A **combination of two or more** of the following:
a.Albiminuria
b.Excessive wt gain (4# a week)
c.Edema of hands, face or legs
d. visual disturbances
e.headache – severe or recurrent

Protocols for Intrapartum Management:

1. First Stage of Labor (partial list)
a)Evaluates labor status
b)Remains at client's home if home birth is planned or leaves
client home if false labor or early labor diagnosed
c)Reviews antepartum record and takes medical and obstetrical
history as indicated
d)Reassesses physical stats as indicated

Re-evaluates presentation and position

1)At beginning of labor
2)With abnormal progress
3)Any time mal-presentation or mal-position suspected
4)Consults with a physician if any abnormal evaluation is made

Assesses need for and implements the following"
g)Ambulation
h)Type of nutrition & hydration

Observes for signs & symptoms requiring medical consultation
j)Consults with physician if any complication develops
k)Assesses labor progress as well as physician and emotional status

Monitor maternal and fetal condition according to the following schedule:

1.Measure and record vital signs **as follows

a.take temp, pulse, respiration and BP on initial exam
b.measure BP every hour until cervix is 8 cms, then every 30 minutes
c.take pulse every two hours while membranes intact and temp normal,
and every hour after membranes rupture
d.take temperature every 4 hours to rule out dehydration or
infection and every hour if elevated to 100 F or above

2.Assess the general condition of the patient as follows:
a.Measures **urinary output at least **every two hours in the active
phase, more frequently if there is a bladder distension
b.Test urine for **keytone every 2 hours
c.Observe for hydration, edema, comfort, and normal progress and
determine patient needs

3.Assess & records the status of labor **as follows:

d.Measures frequency, duration and intensity of the contraction
every **half hour and more frequently if indicated by changes in labor
pattern, bother's behavior, excessive pain, or progress slower than
expected for normal labor
e.Observe vaginal discharge including amniotic and bloody show,
noting changes and deviations from normal color and character

4.Assess and records fetal heart tones **according to the following
schedule:
a.Every hour during the latent phase
b.Every 30 minutes during active phase of first stage
c.Every 15 minutes during transition
d.Every 5 minutes during second stage, preferably at the end of a
contraction
e.Immediately after appearance of amniotic fluid in vaginal discharge

5.Performs sterile vag exam under the following circumstances:
a.Assessment of cervical dilation initially and as necessary to
determine status of labor, presentation, position and station of fetus
and status of membranes
b.If the membranes have ruptured, the patient shall be examined to
determine cervical dilation and presenting part

Immediate postpartum (partial list)
a. inspect cervix, vagina and perineum for bleeding and lacerations
b. Repair **1st degree laceration – **refer to physician for repair
of cervical, second, third or fourth degree lacerations

Newborn Management (partial list)


1.If indicated, clears airway of mucus to establish respiration
(bulb syringe or DeLee
2.Deviation or suspected deviations from norm reported to pediatrician

Intrapartum Problem List (partial list)

1)**Meconium stained Fluid
a. assess amount, thickness, color and time noted
b. carefully monitor FHT
c. If birth is not imminent, **transfer client to hospital via
ambulance for delivery by physician
d. If birth is imminent, **notify EMS and have paramedics in
attendance ready to intubate if necessary
e. Transfer of newborn if respiratory distress is noted

Client will be referred for physician care if the following conditions
occur during the intrapartum period or early postpartum period
(partial list):

1.Fetal heartones of 90 or per minute for 3 minutes
2.Non-vertex presentation
3.**Estimated fetal weight of less than 5 pound or more than 8# and
13 ozs
4.**Lack of steady progress in dilation and descent after 24 hours
in primipara and 18 hrs in multipara
5.Cervical edema
6.Any condition requiring more than 4 hours of postpartum observation

Postpartum Problem List: (partial list)

Fever – definition: any two temperature elevations 6 hours apart of
100.4 or greater

Newborn Problem List (partial list)

1. Resuscitation

b)Apgar 7-10 – no resuscitation required, routine care only
c)Apgar 4-6 -- dry off, suction mouth and pharynx, stimulate by
rubbing spine or flicking feet
d)If respiratory pattern irregular – all ow infant to breathe
"blow-by" O2
e)If respirations absent, give mouth to mouth ventilation at rate of
30 breaths per minute and transfer via EMS
f)If infant **does not become pink on 100% O2 after 1-2 minutes,
call 911 and prepare for **transfer
g)Apgars 0-3 -- dry off, suction mouth and pharynx, begin mouth to
mouth ventilation at 30 breaths per minute with oxygen enrichment via
tube in corner of rescuer's mouth or via nasal cannula (editor's note
– what happened to bag and mask??)

General policy regarding Newborns

1. Any acute deviation from normal, as assessed by the newborn
examination will be referred immediately to pediatric care this
includes but is not limited to the following conditions:

a)Apgar score of 6 or less at five minutes
b)Signs of pre or post maturity
c)Weight less than 25oo grams (5#)
d)Jaundice
e)Persistent hypothermia (less than 97 F rectal temp after 2 hrs
after birth)
f)Respiratory problems
g)Exaggerated tremors
h)Any condition requiring more than 4 hours of observation post-delivery

=====================================================================
Personally I would find it impossible to practice in accord with these
protocols and am grateful not to have to.

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  6:32 am
Subject: Phys Supervision regulations Abigail Reagan <rebirthsf@y...> wrote;
>
> I hear what you are saying about the supervision issue being a much
> bigger and more challenging issue for everyone to work out to their
> satisfaction and that saying "we want to be like the CNMs" will not
> work in our favor on this one. Your thoughts on our approach?

Already crafted language for last go-round, which is what was turned
down, so at present, i don't have any new / different ideas, other
than taklking to Senator Figueroa's staff, maybe they have a new
apporach.

faith ^O^
========================================================================================
From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  6:34 am
Subject: Re: Onerous micro-management protocols another state

BCappsmidwife@c... wrote:

> > 3.**Estimated fetal weight of less than 5 pound or more than 8# and
> > 13 ozs

Me too -- average baby born at home is way over 8 pounds. Many of the
other protocols were likewise very unworkable and unnecessary. faith ^O^

>
> I think this is ridiculous most of my babies weigh between 8-10 lbs.
>
> Brenda Capps

==========================================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Apr 20, 2005  1:15 am
Subject: Texas Law emergency transport/exact language used in CCM

This is the language (and place from whence it came!) used in the CCM
document.

faith ^O^

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:
>
>
> Texas Administrative Code
>
> Next Rule>>
>
> TITLE 22 EXAMINING BOARDS
> PART 38 TEXAS MIDWIFERY BOARD
> CHAPTER 831 MIDWIFERY
> SUBCHAPTER D PRACTICE OF MIDWIFERY
> RULE §831.58 Transfer of Care in An Emergency Situation
>
> In an emergency situation, the midwife shall initiate emergency care as
> indicated by the situation and initiate immediate transfer of care
in accordance with the protocols of his or her practice by making a reasonable
effort to contact the health care professional or institution to whom the
client will be transferred and to follow the health care professional's
instructions; and continue emergency care as needed while:
>
> (1) transporting the client by private vehicle; or
>
> (2) calling 911 and reporting the need for immediate transfer.

========================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Apr 20, 2005  1:16 am
Subject: Re: Texas Law, defiinition of inter-professional Care/Standards of practice

ditto -- also used this language in CCM document, with minor treaking.

faith ^O^

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:

> Texas Administrative Code
>
> Next Rule>>
>
> TITLE 22 EXAMINING BOARDS
> PART 38 TEXAS MIDWIFERY BOARD
> CHAPTER 831 MIDWIFERY
> SUBCHAPTER D PRACTICE OF MIDWIFERY
> RULE §831.52 Inter-professional Care
>
> The following definitions regarding inter-professional care of women
within a midwifery model of care apply to this chapter.
>
> (1) Consultation is the process by which a midwife, who maintains
primary management responsibility for the woman's care, seeks the advice of
another health care professional or member of the health care team.
>
> (2) Collaboration is the process in which a midwife and a health care
> practitioner of a different profession jointly manage the care of a
woman or newborn who needs joint care, such as one who has become medically
complicated. The scope of collaboration may encompass the physical care of the client,
> including delivery, by the midwife, according to a mutually
agreed-upon plan of care.
> If a physician must assume a dominant role in the care of the client
due to increased risk status, the midwife may continue to participate in
physical care, counseling, guidance, teaching, and support. Effective communication
between the midwife and the health care professional is essential to ongoing
> collaborative management.
>
> (3) Referral is the process by which a midwife directs the client
to a health care professional who has current obstetric or pediatric
knowledge and is either a physician licensed in the United States; or working in
association with a licensed physician. The client and the physician (or
associate) shall determine whether subsequent care shall be provided by the physician
or associate, the midwife, or through collaboration between the physician or
associate and midwife. The client may elect not to accept a referral or a
physician or associate's advice, and if such is documented in writing, the
midwife may continue to care for the client according to his/her own policies and protocols.
>
> (4) Transfer is the process by which a midwife relinquishes care
of the client for pregnancy, labor, delivery, or postpartum care or care of
the newborn to another health care professional who has current obstetric or
pediatric knowledge and is either a physician licensed in the United States;
or working in association with a licensed physician. If a client elects not to
accept a transfer, the midwife shall terminate the midwife-client
relationship according to
> §831.57 of this title (relating to Termination of the Midwife-Client
> Relationship). If the transfer recommendation occurs during labor,
delivery, or the immediate postpartum period, and the client refuses transfer; the
midwife shall call 911 and provide further care as indicated by the situation. If the
> midwife is unable to transfer to a health care professional, the
client will be transferred to the nearest appropriate health care facility. The
midwife shall attempt to contact the facility and continue to provide care as
indicated by the situation.
>
> Midwifery Standards of practice

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&
> p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=38&ch=831&rl=51

=============================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu Apr 21, 2005  7:23 am
Subject: Reply to the idea of a conspiracy between Faith & MBC

Carrie wrote:

>>> When CAM asked to be part of the discussion we were told that
**only** Faith would be heard.

Faith's reply: Carrie, we have talked exhaustibly about this issue and
still you continue to misrepresent the simple and straightforward
facts and use that misrepresentation to scapegoat me as an individual,
while working up a firestorm of opposition to the CCM document that is
unjustified and harmful to the interests of midwifery.

In the many years that I was liaison for CAM and other California LMs,
I NEVER, EVER met privately with physician Board members (including Dr
Fantozzi!) nor did any of them EVER confer with me or even so much as
talk to me on the phone or in any way include me in the development of
Board policy towards midwifery. My access to Dr Fantozzi and other MBC
decision makers is exactly the same as EVERY midwife in California (or
any other interested party or consumer) and that is the **US mails**,
in letters address to MBC, 1426 Howe Ave, Sacramento, CA 95824.

I write one to five letters to the Medical Board and other involved
persons each quarter. I attempt to be informative about the scientific
evidence or political realities in regard to the topic du jour (phys
supervision, home birth, birth certificates, regulations, etc). I make
an effort to educate the Board about the midwifery profession in a
manner that acknowledges and is respectful of the Board's role and
honors their "labor" as a regulatory agency. The best way to gain
respect is to give respect.

I have an entire shelf of three-ring binders containing my
correspondence to the Medical Board (copies posted on the CCM web site
for all to read). The notebook for each calendar year since 1993 is 2
inches thick, with an average of 15 letters annually addressed to the
Board or agency staff. Since the last Board meeting in February, I
have written letters to Dr Fantozzi, ACOG, Senator Figueroa's staff,
Governor Schwarzenegger's office (supporting Dr Fantozzi
reappointment), MBC deputy director Joyce Hasnot and emails to Tonya
Jamois (ICAN president) asking that her organization send a
representative to the April 27th meeting and that she ask ICAN members
write letters to Senator Figueroa. I call this important function
"minding the store".

In order to know what needs to be covered in those letters each
quarter, I had to be present and paying attention for the entire Board
meeting cycle (i.e., attend all the meetings during the two days, not
just the one-hour mfry task force). This cycles repeats four times a
year. The way to play the `influence' game is by faithfully "minding
the store", which means to show up and suit up. And it costs plenty in
time, travel, missed births and sometimes, dissatisfied customers (and
my family **hates** that I put Medical Board business before all
else). If they made a movie on my life the title would be: "Married to
the Mob".

And after all that, the only influence I have with the Board is that
they know me and trust my judgment based on my reputation with the
agency staff over the last decade and their personal experience with
me. However, this only means they are willing to listen to me but NOT
that they follow my suggestions or requests. The historic meeting
between LMs and Anitia Scuri at the end of the November Mfry task
force was the first (and only) time a representative of the Board EVER
embarked on a "joint venture" with LMs in regard to crafting language
or making crucial policy decisions on midwifery issues.

As for the October 8th meeting, it has become the embodiment of a
Shakespearian tragedy in which: "Hell hath no furry like a woman
scorned (and if she be a midwife – well, you really better duck and
cover!" You talk about this as if it was a MBC/CCM conspiracy to lock
you or CAM out of the policy-making process but the plain and simple
facts don't support that notion. All that happened was that the Board
changed its mind about the nature of one meeting. As you will recall,
Dr Fantozzi announced at the end of the July 31st, 2004 Mfry task
force meeting that he would convene some form of a "group" which would
include **all interested parties** (his words)to work on the proposed
regs before the next quarterly Board meeting. At that time he
acknowledged that everybody was invited to attend BUT we would "be
more likely to get the job done" if each group sent only one or two
people as representatives for their membership, so it would be more
likely that we could accomplish the necessary work.

Dr Fantozzi was obviously enamored with Alaska regs so when I left
that July 2004 meeting I read them in their entirety and was frankly
horrified. They reminded me of putting a giraffe's legs and elephant's
trunk on a monkey and calling it "cute". My distress over this
possibility (actually a probability!) lead me to embark on the already
much described down-loading and collating of all 18 states regs (along
with other sources) and the eventual crafting of an "example" of what
a good standard would look like -- functionally comprehensive, true to
the history and tradition of midwifery, reflective of the LMPA and
California LM educational requirements, and protected and preserved
the self-determination of childbearing women.

During the time between July and October, Dr Fantozzi was just
chugging forward to `fast track' **his favorite solution**, which is
to say adapting the Alaska regs for California LMs. At the same time,
several of the agency staff had a different opinion.

Pam (the MBC/DOL secretary) called me in late September, to ask if I
could come to a meeting on October 8th. I assumed this was the "whole
enchilada" get-together spoken about at the July Task Force. Being a
good girl, who wanted to be helpful and be a `team player', I called
you and told you about the meeting. Then you called the Board, talked
to one of the staff members. Then the Board secretary called me back
and said the Board had decided against a big "all interested parties"
type of public meeting, becasue they feared it would turn into a food
fight between ACOG, the trial lawyer lobby and the midwives. Since
this would not be helpful to the Board's goals, they nixed the idea (I
think the staff talked him out of it).

Dr Fantozzi decided to have a small work group instead, but
unfortunnately the Keen-Baggely Act prevented the Board from inviting
*just* midwives and not giving the same "notice" to the entire public,
including to organized medicine. The only way around this legal
dilemma was to have one person come as a "consultant" to an agency
staff conference and (according to Pam), Dr Fantozzi asked that I be
that person. He said that was because he knew me better, had worked
with me on this topic already for 3 years and there wasn't time to get
to know you or work with you in advance of that meeting. Pam was very
apologetic and offered to call you if I didn't want to come (due to my
recent retirement). For the same reasons that Dr Fantozzi identified
(worked with him on this topic for 3 years, etc) I thought the right
thing was for me to go, based on my decade of up-close and personal
relationship with the Board and my specific knowledge the topic,
especially the regs for the other 18 states. .

Naturally I was up all night at a birth on October 8th and didn't get
home until 7:30 in the morning. I was so sleepy I had to have a family
member take off work to drive me to Sacramento. The meeting was a
miserable affair, with me sitting between Dr Pat Chase and the new
executive director Dave Thorton (former enforcement director for 24
years who was personally involved in getting me arrested in 1991!).
The style of the meeting was for Dr Fantozzi to grill me about **why
shouldn't the Board pass a regulation about** (name your poison!) –
for instance, that midwives not be permitted to provide care to
pregnant women who were over 40, who smoked more than 10 cigarettes a
day, whose pregnancies were 42 weeks, whose unborn babies were
estimated to weigh more than 8# 12 ozs, if there was ANY meconium,
DGM, VBAC, breech, twims, etc, etc, etc, ad nausem.

For one hour and 45 minutes this went on relentlessly and was doubly
hard for me because I hadn't slept all night and had "fuzzy brain"
syndrome. During the entire meeting I never argued FOR anything nor
even suggested (not one time, not one word) that the CCM standard of
care document be considered as a regulation (didn't even know such a
thing was possible!).

Fifteen minutes before the scheduled end of the meeting) it seemed
clear to me that this was more of the "same ole same old". It didn't
matter what I or other midwives did or said, how much documentation we
had, etc., the Board had already made up it's mind and was going to do
what it was going to do, come heaven, hell or high water. I started
shutting down inside so I wouldn't be too upset by this spectacular
political failure as i watched the functional end of my life as a
licensed midwife pass before my eyes, to say nothing of 10 years
wasted in my attempt to get the Medical to recognize us competent
professionals (instead of teenages who needed the "father's know best"
fix.)

Suddenly there was a lull in Dr Fantozzi's `cross-examination' of me
(for which I was grateful) and that famous interchange between
Fantozzi and Anita occurred (recounted in earlier emails) and poof –
in 5 minutes, they had changed directions 180 degrees. They simply
"decided", on the spot and **without** any discussion, to "incorporate
by reference" the CCM document. I gasped and wondered if I was having
a sleep-deprivation hallucination! But no, they were proposing to
adopt a regulation that was actually compiled by a midwife from
midwifery sources. Better yet this regulation specifically
acknowledged (gasp AGAIN!) the right of LMs to provide care to
moderate risk women (HBAC, breech, twins) and had many other very
mother and midwife friendly policies, including the overarching aspect
that the Board's actions which, for the first time, recognized and
treated LMs as independent professionals.

What I couldn't know then, but what was revealed in the Board's most
recent mail-out, is that the **agency staff** preferred the CCM
document (in part, because it was already a competed work and was
specific to California LMs) and was trying to talk Fantozzi into using
it instead of "recreating the wheel". The workgroup for that day was
scheduled from 10a to 2p but I was only invited to be there from 11 to
1. It's clear that in the hour before I was permitted to come into the
room they had already come to agreement on the CCM document. My
presence and my comments were irrelevant to that decision.

And if instead they had scheduled the `whole enchilada' type of
meeting, indeed, a big fat food fight with ACOG and Tonya Brooks'
organization would have ensued, no consensus or agreement of any kind
would have be arrived at and the Board would have returned to its
smoke filled back rooms to glue the arms of an orangutan on the hind
quarters of buffalo (Alaska regs blended with Arkansas!), outfit the
poor guy with roller skates and send him out to cruse the Santa Monica
freeway during commute traffic, while reporting "Mission accomplished"
to Figueroa's office.

IMHO, the outcome of the October 8th meeting was not a tragedy. I came
away from that meeting (can you believe it!) **actually thinking
(stupid me!) that I had done good for LMs and for childbearing women
and that ** you and other midwives would be **pleased and happy for
our good fortune. And if you will recall, you and Diane were pleased
for the next two months.

Then toward the end of December Elizabeth Davis suddenly "discovered"
that the CCM document and the proposed regulation. After reading it
she took umbrage at the idea that LMs would have to do all those fetal
heart tones (the story going around was that midwives in Holland don't
"do" heart tones until second stage). Elizabeth convinced herself that
if the CCM document to be adopted, she would have to change the
teaching curriculum for her midwifery training program. In one of her
emails, she said midwives WOULD NOT be **WILLING** to follow the CCM
standard of care. First was talk of editing the CCM document, then
Diane and others started talking about how the MANA national standard
would be better because it didn't contain any of those awful `details'.

And presto, change-o, vilifying me became the sport du jour.

However, adoption of MANA standards does NOT provide Cal LMs with any
particular benefit – doing so would mainly be a feather in MANA's cap
and help MANA push for their adoption in other states. What MANA
standards don't say (no 'details') may be an advantage in certain
situations, but the same lack of content also means that **the Medical
Board remains in **control of all the undefined, unsettled issues**
such as HBAC, moderate risk pregnancy issues, PROM, mec, etc and a
host of issues such as a clear definition of terms such as consult,
refer, transfer and transport.

Keep in mind that the Board is already drafting language that will
require each LM to report to the Board each and every time there is a
`transport', as well as reporting all morbidity and mortality. Doesn't
it make sense to be writing the definitions of these terms ourselves
rather than investigators or lawyers for the Medical Board?

**Carrie wrote**: Now is the time for all of us to meet with the MBC
and present the document that should have been presented in the
beginning, the national standard, that of MANA.

Faith's reply: The US mails having being going from your house (as
well as Elizabeth's and Diane's) 365 days a years for all three years
that SB 1950 was on the table. What in God's name were you waiting for
during the last 1000 days?

Never mind, I will make a GodMother deal with you -- one you can't'
refuse. You have my blessings to present the MANA standards at the
very start of the April 27th meeting AND if they are declined, you and
other CAM midwives will get over it and join me and other CCM
supporters in our efforts to preserve self-determination for
childbearing women, while protecting midwives the best we can. This
means that we are all nice to Dr Fantozzi and that we save
"deal-breaker" language for real deal-breakers, not just issues that
are a disappointment. Deal breakers are things that make it impossible
for midwives to do their job (written supervisory agreements) or that
deny healthy women the same right of "informed refusal" as ACOG's
policies and/or criminalize midwifery care for moderate risk women.

warm regards, faith ^O^

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu Apr 21, 2005  5:10 pm
<