This week there were about 120 home-birth enthusiasts demonstrating in front of our building for about 3 hours. The crowd was expressing their unhappiness about our draft regulations for Licensed Midwives. You might have also seen the Arizona Republic article on the demonstration.
As I’ve written before, we started the process of revising the rules for Licensed Midwives about a year ago and we’re coming near the end of the process. My main goal has been to improve the entire system- including coordination with EMS and hospitals as well as data collection and analysis, oversight, and emergency planning… with the goal of ensuring (to the extent we can) the health and safety of moms and newborns.
Anyway- one of the issues the demonstrators were discussing is the administration of medications like oxygen and Pitocin by Licensed Midwives. The current rules outline several emergency measures to be performed before emergency personnel arrive in cases where the health of the mother or newborn is at risk. These rules outline guides for the administration of some medication (oxygen, Pitocin). The rules currently in effect require a Licensed Midwife to identify a physician that has agreed to provide back up, consultation, and a prescription for these medications.
Some in the midwifery community would like the ADHS to grant the authority for midwives to obtain and administer medications on their own (without consulting a physician)… however that would require a change in state law that I have no authority to make because it requires a statutory change. When I explained that I don’t have the authority to permit midwives to obtain and administer medications without consulting a physician, a member of the committee (a midwife) asked us to remove all references to medications. I’m inclined to keep the current medication rule language so at least these meds will be in scope (in consultation a physician).
Another provision that’s controversial in the current and proposed new rule asks women to take certain blood and urine tests as a condition of having a licensed midwife attend their homebirth. 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.
The parties on the Advisory Committee still don’t agree on several points. Hopefully, the draft final rules for public comment that we publish next week will get the parties closer to at least grudging consensus. If there’s still gross disagreement about the final regulations, we could always just scrap the entire effort and keep using the existing scope of practice.