The final Midwifery Scope of Practice Meeting was held on
Wednesday, May 15, 2013. It
is now time for the families of Arizona, and anyone else who believes that
compassionate care is a human right’s issue for the mother and the baby to take
You can click on the links
below to read a copy of the current draft rules and to see Wednesday’s
Here is my statement on the Arizona Department of Health Services Website:
In addition to agreeing wholeheartedly with Allyson Fernstrom's statement
below, I want to direct the committee to THIS
brief article with references if
they want to dig deeper:
As the article and study succinctly show, "FTP"
and "CPD" in the 21st century are mostly iatrogenic. "Watchful waiting" IS the midwifery
model of care in the hospital, in the birth center and in the home
setting. Many midwives have less than a
15% cesarean rate (defined as an "acceptable" rate by the WHO
in their practices because they do not intervene until necessary. This does not mean emergency; read: most of
these are non-emergent and appropriate.
At this point in our history, 99% of births are still
occurring in the hospital setting (read more HERE
and a vast majority of those women are still under the OB model of care: the
"do something to help this along" model. A 32.8% cesarean rate calls into question the
common practices that are being forced on women. It should not surprise us that some of these
women are demanding a different model of care with subsequent pregnancies.
It is unreasonable to essentially punish women who are
seeking compassionate care after feeling abused in the traditional care system
by doctors who subscribe to a different philosophy about birth. By including FTP and CPD in the final version
of the rules and regulations, you are essentially providing a VBAC option on
paper without providing a VBAC option that will be a choice for the majority of
the consumers who are now faced with choosing unassisted births instead of
facing the trauma they faced in a previous birth.
Before a final draft is approved, I implore Dir. Humble to
attend a home birth. See what it is we
are talking about. Really understand why
we are so passionate about this cause, and why we believe that birth is a
fundamental human right and a woman's rights issue. We are not asking for the sun, the moon and
the stars. We simply want you to
understand the power of birth, and why we want our care providers to have all
the tools they need at their disposal if we choose a home birth setting.
Midwives have the ability, the training, and the knowledge
to bring babies safely into the world without compromising the health of the
mother. They believe that mothers care
about the life they carry within them, and will do their research when it comes
time to choose or decline procedures.
Midwives also know how to recognize non-reassuring patterns and when it
is time to safely transfer to a different birth setting in the rare cases that
complications do arise.
I advocate for midwives to be free to choose the clients
that they feel they have the training to care for, be that VBAC, breech, or
mothers of multiples. As an informed
consumer, I ask for the state to certify that the women who offer this care are
educated in the care and management of those labors. Along with this, I trust that midwives will
have the opportunity to continue their education so that they can assist at
VBAC, breech and multiples births once they have completed training in those
areas. I am glad to see that there is a
review process to keep midwives accountable for their decisions, none of which
will be made lightly because at midwives care deeply about the women and the
children that they serve.
Dir. Humble, you have the opportunity to lead here and set a
new standard for the great state of Arizona.
Please take it.
Mother of 4
Statement from Allyson Fernstrom:
"I am extremely grateful to see that VBAC is still
included in the drafts. I believe this is a huge step in the right direction.
It shows that the department is listening to the concerns of the consumers. I
appreciate that more options are being opened up to the growing number of women
who desire to achieve a VBAC. However, I have GREAT concern with some of the
conditions suggested. It currently reads that a midwife can not attend a VBAC
if their was a diagnosis of "failure to dilate" or cephalopelvic
insufficiency". I heard in the last meeting that it is supposed to read
"failure to progress". That does not make the problem better. Failure
to progress, failure to dilate and cephalopelvic insufficiency/disproportion
are ALL unacceptable. There is NO literature to support this rule. Listen to
the members of the committee, including those from the medical community, who
have mentioned may times that FTP is over diagnosed. FTP only tells you that a
mother did not progress. It did not tell you WHY she did not progress. What if
there was failed induction? What if it is an emotional issue that stalled
labor? What if the baby was in a poor positioning? Maybe the care provider
followed the Friedman's Curve, which does NOT allow the typical mother enough
time to labor to full dilation? There are too many variables in play. A woman
should not be excluded from attempting a VBAC because she had a failed
induction, an emotional block, a baby in a poor position, an impatient care
provider, etc. Because the diagnosis of FTP does NOT explain WHY the woman had
a cesarean section, it should NOT be used to determine whether or not she is
capable of vaginal delivery. CPD is also highly disputed in the literature. It
is difficult to ever give a TRUE diagnosis of CPD. The testing is unreliable.
FTP and CPD are subjective, over diagnosed and would be completely
inappropriate in the rules. Director Humble mentioned that if he allows VBAC,
he does not want to make it so restrictive that no one can do it. Leaving in
FTP and CPD would essentially make it impossible for most VBAC clients to
qualify for a homebirth VBAC. Consumers and members of the committee have been
asking from the beginning that this be removed from the rules. Listen to these
Do you want to get involved? Please do!!
There is a peaceful Rights For Birth rally being planned for today and Monday
in the Phoenix area – click HERE
for all the details.
Do you want to submit your own comment?
for to make a direct public comment.
Let me be clear that I do not believe that OB's are bad people. I simply disagree with the birth paradigm under which many of them practice. I am forever grateful for their skill set as surgeons when it is an appropriate and needed use of their considerable skill in the operating theater.
Do you believe birth is a human right and/or a woman's rights issue? Why or why not?
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