Our next Midwifery Scope of Practice Advisory Committee meeting will be Monday (January 14th) from 6-8 pm in the Lab conference room. The Agenda is packed with 2 full hours of information and discussion. We’ll be reviewing data from other states, and what scopes of practice they allow, as well as reviewing our own data collected from the midwives’ quarterly reports along with data from AZ birth certificates. This data will give us a better picture of how many Arizona home deliveries had successful outcomes, and how many required transfer to a hospital for delivery or complications. Two of our advisory committee members will be providing a presentation on a successful midwifery home birth model from the State of Washington, called Smooth Transitions.
We’ll also be going over some interim draft regulations (for discussion purposes) that would allow licensed midwives to (under certain circumstances) attend a delivery at home even if the mom is carrying twins, if their baby is in a breech position, and when the mom has had a previous Caesarian-section (also known as vaginal birth after cesarean, or VBAC). For example a midwife could attend a birth at home even if the mom has had a previous C-section if she’s: 1) had a successful vaginal birth since their last C-section; or 2) it’s been more than 18 months since the last C-section and she had a low transverse incision and an ultrasound that shows the placenta in the right place and growing normally.
Because there are higher risks with these types of deliveries… the draft language has certain conditions. For example, the language asks: 1) midwives to develop an emergency action plan for patients with one of these conditions; 2) the patient is to meet with an OB/Gyn to discuss the risks, adverse outcomes, benefits and alternatives of a home birth for their condition (this is known as obtaining informed consent); and 3) midwives to send the patient’s medical records to the hospital listed in the emergency action plan at 32 weeks. Once the patient goes into labor, the midwife would need to call the hospital to let them know her patient is in labor, and then again after the baby is born or if the mother needs to be transferred for delivery or a complication.
Getting ready for this high-profile meeting has been an effort of teamwork from almost every part of the agency. Thanks to staff from IT (Jennifer Tweedy, Gannon Wegner, and Jesse Lewis) and Preparedness (Paul Barbeau, Tim Singleton and Steven Becker) for setting up the meeting so that it can be viewed on Livestream. Fernando Ortega in Facilities has been instrumental in coordinating for after-hours security and parking. Also, thanks go out to Kristin Feelemyer, Shoana Anderson, and Khaleel Hussaini for developing a special database that we’re using to mine our data. Also, thanks to the Rules and Administrative Counsel team (Patti Cordova and Teresa Koehler) for working hard to provide draft rule packages language for the committee to review, as well as researching other states and their rules and regulations for licensed midwives.
This is just one of many examples of the team work and collaboration within our Department. It’ll result in an evidenced based decision that will hopefully improve birthing experiences and outcomes for patients that want to have a planned at-home birth.