Midwifery in NC

[Matrescence]

Hey ladies, I was reading the post about the midwifery distance training courses and saw some discussion on the midwifery climate here in NC... thought I'd forward on some information about what's going on

From Nancy Koerber, CPM May 16, 2005

Quote:

Patti Barnes, CPM has been meeting with various parties who are influencial with physician issues legislatively. We have been told that without the support of physician groups, Sen. (Dr.) Purcell will not hear our bill in the Women and Children's Healthcare Committee. Patti has been systematically meeting with different physicians and counsel toward the goal of eliciting their support for the CPM model of care. Patti met with the legal counsel for the NC Medical Society. After a lengthy dialogue lasting over several occasions, the lawyers indicated that they had changed their minds about CPMs and would assist in legislative efforts. Following that dialogue, Patti was invited to address the NC Medical Society Executive Board meeting that was held, Friday, May 6, at the Grove Park Inn in Asheville, NC. Two very supportive and articulate physicians agreed to attend the meeting with her. Dr. William Brannan is the Chief Medical Officer of Mission St. Joseph Health System, Medical Director of the Mission Children's Hospital and the Mission Women's Center. He also is a Clinical Assoc. Professor in OB/Gyn at Chapel Hill. Dr. Martin Allen has been Patti's consulting physician for a number of years. Dr. Allen has been publicly outspoken regarding the legitimacy of the CPM model and for the need for NC to offer licensing to credentialed midwives to increase reputable alternatives for homebirth families. Both of these physicians have dedicated many hours to the CPM legislative effort with phone calls and attendance at meetings. We especially appreciate Dr. Allen's committment to attend this meeting on very short notice, rearrange his schedule, and travel several hours in spite of a dental emergency the night before. We are incredibly blessed to have had both of their input at this meeting. Dr. Brannan's attendance was poignant given that he is seriously ill, and every day is valuable and precious. We are honored and grateful that Dr. Brannan considers the CPM legislation of such importance that he was willing to make the time to attend when he already has such a full plate. Patti was able to present the CPM credential and to provide handouts including the national map indicating the midwifery status in each state. Drs. Brannan and Allen made very strong and positive statements in favor the CPM credential. Dr. Brannan likened it to a master's level program. Both spoke highly of CPMs with whom they had had personal experience. The presentations were followed by a lengthy question and answer period which Patti said was rigorous and fast-paced. When Patti paused to reflect on an answer, Dr. Brannan stepped forward and responded as if on cue. Both physicians offered evidence of the benefits that they had seen for the community from CPM care, and the disadvantages to consumers with regard to issues of safety because NC has not licensed CPMs in the past. The physicians were asked about the feelings of the NC CNM community, and Dr. Brannan stated that they were supportive. There were approx. 20 people in the room including Patti, Drs. Brannan and Allen, and the 2 counsel for the NC Medical Society. The Executive Board is made up of physicians who represent various specialties of practice. There were several OBs on the Board. After much debate, the President of the Medical Society pronounced that his mind had been opened about the issue, and that he felt that it was an important one. Following the meeting the Board Members personally thanked Patti and the Drs. and indicated that they were supportive in philosophy, but reminded them that these things "take time". It was also made clear that whether or not the CPM is legitimized by the NC General Assembly, organized plans are in place to increase the current penalty for violation of the midwifery statute from a 3rd degree misdemeanor to a felony. Should that happen, midwives currently practicing illegally will individually evaluate whether they can continue to sacrifice the personal risk to them and their families for their service to the homebirth community. That would leave a void in safe options for families wanting to birth at home, and encourage families with conviction to choose planned unassisted births. Studies have shown that place of birth is not a safety issue as long as you have low-risk women with trained attendants. When either of those parameters is not met, the research shows an elevation of risk with homebirth. Still, the physicians and legislators have been reminded that homebirth is not illegal, and that it is in the best interest of the state to offer legal recognition to those trained in the service of homebirth care. Our bill has now circulated among most, if not all, of the power players in state politics. We have received fairly positive feedback, but we have been told repeatedly that they will not support a credential which gives midwives the freedom to attend high- risk situations at home. Risk factors frequently cited are VBACs, breeches and twins. Though midwives everywhere empathize with parents' disappointment at the lack of good options for women attempting low-interventive births in these situations, it is becoming more and more apparent that the biggest risk with VBACs, breeches and twins is the risk to the provider(midwives included). Though statistics do support a legitimate concern with the increased risk of those types of births, it is the public's current perception of acceptable risk which has fueled this debate. Our culture is currently embroiled in a national debate about healthcare and liability issues. Until we find a better way to handle long-term healthcare needs and change the American culture that reflects that any level of risk in maternity is too much, we will continue to see the elevation of the "medical machine" to a medical monster in the very near future. Sadly, the consumers have not been supportive in the numbers necessary to influence any change. As committed as families seem to be while pregnant in wanting non-interventive options, once their risk status is increased, that committment often wavers when complications develop that result in real risk to the health of the mother or baby. Unfortunately, no one has a way to predict which births will have real complications versus the fear of complications. Hindsight is 20/20, but too frequently the decision- making which reflected an attempt to honor the wishes of the client for alternatives is not valued as a legitimate management plan in a court of law. Until our culture balances these issues and provides some safety net for the midwives, families will continue to experience an erosion of options. How can you help? Consumer groups are desperately needed to debate these issues publicly. We had made great strides within the medical community over the years, but we have lost the culture battle. Our worst enemy is ourselves---an American culture which expects life to be perfect, and seeks to assign blame when it is not. The old midwifery motto-"Each one, teach one" needs to be circulated within the consumer birth movement. Women need to speak loudly about the empowerment and benefits of their natural, non- interventive birth experience. Women need to speak compassionately about the benefit of overcoming the fear of pain and the value of that the whole birthing experience brings to the entire family. In addition, financial support for our legislative cause is urgently needed. You can donate money to this cause through this web site. Spread the word---we need to fight to hold the space of midwifery and homebirth options now in order to ensure that birthing choices will survive this time in history. Nancy Koerber, CPM North Carolina Midwifery Alliance President

And this was the last hting I read about it, also from Nancy Jul 14, 2005

Quote:

The legislative drive here in NC has been moving at a snail's pace, but it has been moving. Patti Barnes, CPM, has been meeting with numerous legislators, and reps. for the NC Medical Society. She was invited to address the NC Medical Society Executive Board and she brought with her two very knowledgeable physicians who support the CPM credential. There was a lengthy, spirited debate of the issues, but in the end the Board stated that they would work towards licensing CPMs in the state. However, they reminded everyone that change takes time.... For years we have been up against the opposition of one legislator who singly holds the power to kill any legislation supporting non-nurse midwives. We have built support with the CNMs in our state, and they have publicly argued in favor of CPM licensure. We were told by this legislator that without the blessing of the NC Medical Society he will kill any bill that is brought to the assembly. We shall see if our support holds. NCMA celebrates the victory of our sister state, VA, with the recent CPM legislation, along with the timely release of the BMJ published CPM 2000 study. In the meantime, the North Carolina Midwifery Alliance (NCMA) continues to meet to strategize. Karen Strange will be holding her NRP seminar in Asheboro in August. NCMA also would like to publicly acknowledge our appreciation of Dr. William Brannan who is CMO of Mission/St. Joseph's Health Care System, Medical Director of Mission Children's Hospital, Mission Women's Center located in Asheville,NC, and Clinical Assoc. Prof. OB/Gyn in Chapel Hill. He has supported midwifery causes and been a "birth-change" agent for 25+ years. Over the years he has supported not only issues important to CNMs in the hospital setting, but has fought tirelessly in support of the legitimizing CPMs in NC. Currently, he is is LIVING with terminal cancer, but in spite of his illness continues to work, fight for CPM legislation, travel, spend time with family, and ride his horse. He is dying with grace and humor. A few wks. ago he actually attended his own wake; told his family and friends that he wanted to have it while he was alive so that he could be there with everyone. He will be missed. Nancy Koerber, CPM Asheville, NC

We're keeping a close watch on what's going on

[fearlessbirth]

Thank you so much LeAnne!!! That is so awfully sad (and gave me chills) that the biggest medical proponent of midwifery is not going to be with us much longer (or if he's already passed on at this point).

I'm not big on politics at all to begin with but am trying each day to learn a little bit about how this all works, etc. because in some states it really is important to rally together and make change. Only I don't quite know how to start. These artibles really help clarify some things.

[Matrescence]

Dr Brannan did pass last fall It was really sad but happy at the same time. I've never had the fortune to meet him but have heard so many wonderful things about him through close friends. We held the workshop with Penny Simkin last year in his memory. The truly sad part is he was a huge key person in this issue, he stood up for midwives and for normal birth, a big loss for the birthing community as well as his friends and family.

[regi]

Ifind this just about everwhere here in NC. I have to say Asheville is an exception. But for the most part this state is so content with not introducing new ideas or even old ideas reborn.....

We just need to keep pushing, it will pay off in the end!

Regi

[erikao]

Another good resource is www.fromcallingtocourtroom.net This is an e-book that lists the statutes and laws for midwifery in each state as well as strategies for midwives to avoid prosecution for practicing medicine without a license. We all know that's not what DEM's do, but the birth climate inthis country is so messed up.

Anyhow, give it a gaze if you have a minute.
Erika

[keely]

Dredging up an old thread to ask about homebirth options in the Triangle area. Thought some of you in NC might be able to direct me.

I am an aspiring doula in TN, asking b/c my sister is pregnant with her first and exploring her options in the Chapel Hill/Pittsboro NC area.

Thanks in advance for any help you can offer!

Keely