Two Paths to One Truth
Sweet Pea Births - ...celebrating every sweet pea and their birth
RSS Follow Become a Fan

Delivered by FeedBurner

Recent Posts

How to Reduce Breastfeeding Inequality
Postpartum Wellness Series: Nutrition
World Kindness Day 2017
Postpartum Wellness Series: SLEEP
In Their Own Words: Erica ~ Part 2

Most Popular Posts

An Inside Look: Modern Mommy Boutique
Breastfeeding Support Groups: La Leche League
A Look At the honest company
An Inside Look: Placenta Encapsulation
Mommy-Con Phoenix Ticket Giveaway


Artifical Rupture of Membranes
Ask the Doula
Avoiding harmful substances
Baby blues
Baby Concierge
Baby games
Baby-led weaning
Back Labor
Bag of Waters
Bedtime Routine
Belly Cast
Berman's Law
Big Latch On
Birth center
Birth Centers Phoenix AZ area
Birth Circle
Birth Mantra
Birth News
Birth place options
Birth plans
Birth Story
Birth Story Listening
Birthing From Within
Blog Carnival
Bradley Day Family Picnic
Bradley Method®
Bradley Method® birth story
Bradley Method® for next baby
Bradley Method® for second pregnancy
Bradley Method® outcome
Bradley® Coaches
Bradley® Dads
Bradley™ classes and the next baby
Bradley™ classes for next pregnancy
Bradley™ classes for second pregnancy
Breast Pumps
Breast Pumps and Workplace
Breastfeeding 101
Breastfeeding Awareness Month
Breastfeeding Challenges
Breastfeeding in Public
Breastfeeding support
Breech presentation
Breech turning techniques
Cassandra Okamoto
Cephalo-Pelvic Disproportion
Cesarean Birth
Cesarean Support Group
Cesarean Surgery
Child Spacing
Children's Books
Chiropractic Care
Co Sleeping
Coach's Corner
Comfort Measures
Cord Clamping
Cry It Out
Dairy Allergy
Debbie Gillespie, IBCLC, RLC
Dehydration and Pregnancy
Delayed Cord Clamping
Drinking during labor
Due Date
Eating during labor
Essential Oils
External Cephalic Version
Eye Drops
Eye Ointment
Eye Prophylaxis
Failure to Progress
Family Bed
Family Fest
Family Fun
Fear-Tension-Pain Cycle
Fetal Distress
First Birthday
First Foods for baby
First stage labor
First Trimester
Flower Essences
Fluid Retention
Full term
Fussy baby
Gestational Diabetes
Going to your birthplace
Green Nursery
Grief Counseling and Support Services
Healthy, Low-Risk
Hearing Screen
Heat Comfort Measures
Hospital Birth
Hyperemesis Gravidarum
Hyperthermia and Pregnancy
Immediate Cord Clamping
In Their Own Words
Increase Breastmilk
Induction of Labor
Infant Care
Infant Classes
Infections and Pregnancy
Info Sheet
Information Center
Information Sheet
Informed Consent
Inside Look
La Leche League
Labor Augmentation
Labor Induction
Labor Marathon
Labor Sprint
Labor Support
Lactation Consult
Lactation Consultation
Managing or coping with natural labor
Maternity Keepsake
Meet the Doula
Midwifery Care
Midwifery Scope of Practice Committee
Milk Supply
Miscarriage or Stillbirth
Modern Mommy Boutique
Monday Mantra
Morning Sickness
Natural Alignment Plateau
Natural birth
natural labor coping mechanisms
Natural labor coping techniques
Neonatal Eye Drops
Neonatal Eye Ointment
Neonatal Eye Prophylaxis
Newborn Care
Newborn jaundice
Newborn Procedures
Next baby
Next pregnancy
Nursing and Maternity Bras
Nursing In Public
Nursing Strike
Obstetrical Care
Pain management
Pain management natural labor
Past due date
Patient Bill of Rights
Phoenix Mommy-Con Mini
Placenta Encapsulation
Planning for Baby
Playing with baby
Postmature baby
Postpartum Depression
Postpartum Doula
Postpartum Plan
Pregnancy Loss
Premature Baby
Premature Ruptture of Membranes
Pre-term Labor
Prolonged Labor
Q&A with SPB
Rally to Improve Birth
Relaxation practice
Repeat Bradley™ classes
Rights for Homebirth
Rupture of Membranes
Scavenger Hunt
Second Stage Labor
Sensory games
Sibling Preparation for Newborn Arrival
Sleep Sharing
Soft-structured carrier
Starting Solids
Stripping Membranes
Support Groups
Sweeping Membranes
Sweet Pea Births
Swelling in Pregnancy
Tandem Nursing
The Bradley Method®
The Bradley Method® classes
The Bradley Method® pain management
Third Trimester
Thoughtful Thursday
Tongue Tie
Tongue Tie Procedure
Toxins, pesticides, chemicals and pregnancy
Upcoming Events
Use of vacuum extraction
Uterine Rupture
Vaginal Birth After Cesarean
Vaginal Birth After Multiple Cesareans
Variations and Complications
Vitamin K
Warning Labels
Webster Protocol
Weekend Activities
Why we chose the Bradley Method® childbirth classes
Wordless Wednesday
World Breastfeeding Week
powered by

Sweet Peas, Pods & Papas: All About Birth, B@@bs & Babies

Two Paths to One Truth

The final open meeting of the Midwifery Scope of Practice committee was held yesterday, June 3, 2013.  The whole time I have been attending or watching the livestream recordings, there has been a nagging thought that was tugging on my brain.

The Director of Health Services wrote THIS blog post that really helped me clarify the thought that had been rolling around in my head, and I couldn’t quite pin it down until I read his post:

“In the draft rules, there are a handful of tests that women need to take if she wants to have Licensed Midwifery services.  These tests (HIV, Hepatitis B, blood glucose, and blood Rh factor) are the only way for the midwife to establish that the birth will be low risk and safe for the health of the newborn and mom.  The mom-to-be can still refuse the tests, but that means she wouldn’t be able to have a Licensed Midwife present during the home-birth because it wouldn’t be possible to determine if the birth is low-risk and suitable for a home delivery.”
       ~Will Humble, Arizona Department of Health Services Director

Here is an excerpt from the comment I left him:

"The ADHS is approaching birth as something that needs to be established as “low-risk” in order to proceed at home. Those of us who have had a homebirth, and the care providers who support us, have a belief that pregnancy and birth are low-risk from the outset.

The medical model wants birth to be proven safe; the midwifery model believes birth is safe until it is proven otherwise. We will continue to go around and around about what is best for mothers and babies until some sort of resolution is found between those two disconnected approaches to pregnancy and birth."

The good news is: thanks to the public outcry against the mandatory testing, that part of the rules and regulations is being left alone for the most part to stand as it was.  Some minor updates are being made to take account new information about infectious disease since the rules were last updated in 1999.  For the most part, consumers and midwives were happy with the verbal agreement reached by the committee about how testing is going to be written in the updated rules.

Sadly, the issue of the "Us Versus Them" mentality that exists between the medical model and the midwifery model has not been resolved.  Here are two interactions that happened at the June 3, 2013 Midwifery Scope of Practice Meeting that clearly illustrate the disconnected paradigms in two approaches to one fact of life: Birth Happens.

1.) The medical community does not understand the scope of midwifery training.
Transcript of video ( starting at time stamp 13:18
Maria Manriquez, MD, FACOG, President of ACOG Arizona: “In your explanation, that’s then inferring that you continue care of the neonate.  Does that imply that you are not providing the infant with a pediatrician or a doctor of it’s own at the appropriate time?  Correct me; I am assuming you are not implying that you then become the provider for the newborn?  You are practicing out of scope of practice! You’re not pediatricians or lay pediatricians!” 

Wendi Cleckner, CPM, points out that on page 24 of the May 24, 2013 version of the rules, the parameters of a midwife’s care for the newborn are clearly stated.  (There are 16 different clinical observations a midwife must make about the newborn, and if necessary, protocols for referrals that she will follow that are in the best interest of the baby, before she can say her role in that infant’s care is complete.)

Janice Bovee, CNM, MSN, “Midwifery, including Certified Professional Midwives and Certified Nurse Midwives, in our programs, and in our training; we include mother’s pregnancy, intrapartum care, birth, postpartum care and care of the newborn.  We are trained in that.  That is part of the midwifery model.”

Thank you, Janice for defining the scope of practice for midwives for Dr. Manriquez and anyone else who is unclear about exactly what midwives are trained to do.  A midwife is trained to practice in the home setting, so she must assume some of the care that a pediatrician would perform in the hospital setting because childcare is not in the obstetrical job description.  Whether she works in the home, a birth center or a hospital, a midwife is willing, capable, and knowledgeable in the care of both the mother and the neonate as part of her scope of practice every day of the week.

(Side note: can you see how midwives start to lower the cost of healthcare in this simple illustration?  One person caring ably for two people, instead of two people caring for two people.)

2.) The medical community does not understand the rigors of midwifery training.  The fact that practitioners of midwifery care are not learning to do surgery does not mean that their training is inconsequential. 
The second exchange, that occurs at time stamp 26:23 of the meeting:
Maria Manriquez, MD, FACOG, President of ACOG Arizona: “Is there any room for demonstrating actual; I know that you’re at least, that’s what Wendi has communicated, that you have to demonstrate physical competency?  So, all of the physician providers have to demonstrate competency.  So what physical competency is demonstrated by licensed midwives?  So there’s an exam, there’s NARM certification, but it doesn’t spell out specifically what and who signs off on that particular practitioner.”

Wendi Cleckner, CPM: “That’s what we’re adopting as the CPM process, is NARM.  The national organization does all of that and there is a clinical aspect; that you are in front of a qualified examiner who takes you through scenarios, you have to work on models, you have to demonstrate your clinical skills in front of them, and then they pass or fail you.”

Maria Manriquez: “We break it down even more specific.  So you can be knowledge, medical knowledge approved but not clinical, and vice versa.  So, is there an opportunity to have that information?”

Wendi Cleckner: “It’s on the website of NARM.”

Maria Manriquez: “So on the website, I could go and look you up and see that you had passed both the medical knowledge portion and the (unintelligible)?”

Wendi Cleckner: “If I did not pass all the sections, I would not be a CPM.  You would not be certified, you would not get your license, if you didn’t pass all the sections.”

Mary Langlois, CPM: “You also have to pass an apprenticeship.  So, you have a preceptor who is designated to oversee your competency.  So you’re taught by the preceptor, and the preceptor also does skills check offs and oversees you and helps you manage the deliveries.  So not only do you have to complete the clinical side, and then you would have to complete all your documentation, you take it to NARM, you take the practical examination, you pass that, then you take the written.”

I especially love Mary’s comment because it reminds us that the midwifery model is personal not just to the woman receiving care, but also to the woman who is providing the care.  Another women who saw her passion, helped her hone her skills, and took the time to teach her.  She was not taught in an amphitheater setting, and not in a residency program designed to weed out the weak links, but in the intimate, person-to-person knowledge transfer, one or two students at a time.

Without too much extrapolation, I think it is easy to see that the medical model of training looked at the eons-old midwifery model of knowledge transfer and sterilized it to suit the needs of the medical community.  If we are honest with ourselves, we need to ask ourselves what the conflict is really about. 

Is it really about the safety of the mothers and the babies, or is it the continual push of one system against another?  One system still trying to prove it’s soaring above the other one that is merely trying to stay grounded and true to its roots.

As Bradley™ teachers, Bruss and I recognize that there is real value brought to the table by both knowledge sets.  We help couples find a path to stay healthy and low-risk so that they a variety of birth options available to them.  If they want midwifery care at home or at a birth center, great!  If they want midwifery care in the hospital – fantastic!  If they feel comfortable with the obstetrical approach, we know there are care providers that support natural birth.  They have choices. 

Although very seldom, occasionally there are developments that move a couple’s pregnancy or birth out of the healthy and low-risk category wherever they are seeking care.  We want those couples to have specialized obstetrical care so that they, too, can have a Healthy Mom, Healthy Baby outcomes like their low-risk counterparts.

Director Humble and his team are in the unique position of being able to set the tone and the groundwork for collaborative care to really take root in the United States.  It is our hope and prayer that a peaceful, respectful and collaborative model of care will be pioneered in the state of Arizona. 

Please leave us a comment - it will be moderated and posted. 
*I think* that the amount of traffic you so generously generate has led to a lot of spam posting.  In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

0 Comments to Two Paths to One Truth:

Comments RSS

Add a Comment

Your Name:
Email Address: (Required)
Make your text bigger, bold, italic and more with HTML tags. We'll show you how.
Post Comment
Website Builder provided by  Vistaprint