Last month, the Oregon Board of Direct Entry Midwifery (Midwifery Board) voted seven to one to submit revised administrative rules to the Oregon Health Licensing Agency (OHLA).
This is the latest development in a nearly ten-month process of literature review, expert testimony and public comment. Not altered since 1993, the administrative rules regulate licensed direct entry midwifery. They include definitions for certain births that may not be attended by the state’s 65 licensed direct-entry midwives (LDM). Click here for a definition of LDM.
Proposed rules: http://www.oregon.gov/OHLA/DEM/Midwifery_Laws_Rules.shtml.
What should consumers know?
The draft rules are evidence based and serve the vast majority of practicing LDMs and Oregon women desiring their care. They identify three new types of high or absolute-risk birth that may not be attended by a LDM:
- Three cesarean sections unless previous successful vaginal birth
- Monochorionic, monoamniotic twins
- Breech where feet or knees are presenting and fetal hips are extended (Proposed Div 25 & 30 – p. 7)
Additionally, there is a new non-absolute risk requiring consultation with another Oregon licensed health care provider, including an LDM, with appropriate experience. Here is the new non-absolute risk:
Lack of adequate progress in vertex presentation is when there is no progress after a maximum of three hours in cases with full dilation, ruptured membranes, strong contractions and sufficient maternal effort; (Proposed Div 25 & 30 – p. 14)
Following is the definition of consultation:
For the purpose of this rule “Consultation” means a dialogue for the purpose of obtaining information or advice from an Oregon licensed health care provider who has direct experience handling complications of the risk(s) present, as well as the ability to confirm the non-absolute risk, which may include but is not limited to confirmation of a diagnosis and recommendation regarding management of a medical, obstetric, or fetal problems and condition. (Proposed Div 25 & 30 – p. 16)
Time to wrap it up
The revision process has been a long, fraught one. There are individuals and organizations that no doubt view the draft rules as granting too much or too little scope of practice for LDMs. It is critical for consumers in support of the Midwifery Board’s more than ten-month effort to balance these views by publicly supporting its recommended rules.
Consumer voices make a significant difference. Letters and public testimony make an impression on elected officials and appointees. Earlier in the revision phase, letters and public testimony demanding continued access to LDMs most certainly strengthened the position of like-minded members on the Midwifery Board. As a result of public accountability, these members were better able to counter efforts to impose unwarranted restrictions on individual choice in maternity care and to instead press for governing rules that are in step with consumer preference and evidence-base care.
Consumer power works
Earlier this year, state employees and dependents petitioned the Public Employees Benefit Board to restore access to maternity care with LDMs after it erroneously denied claims and gave incorrect benefit information to individuals desiring this benefit. And, just last month, PEBB stated it would defer to the Midwifery Board when determining coverage for LDM-attended births.
More than 140,000 Oregonian are covered by PEBB. This makes the recent decisions a significant and positive development for choice in maternity care.
Grab your pen
Write a letter of support to the Oregon Board of Direct Entry Midwifery and send it to:
Samie Patnode, Policy Analyst
700 Summer St NE, Suite 320
Salem, OR 97301-1287
Work: (503) 373-1917
Fax: (503) 585-9114
Send it to your elected representatives and post it on your personal Facebook pages. Send it to Oregon Midwifery Council at firstname.lastname@example.org.
Come to Salem
On October 28, 2010, the agency and the board will hold a public hearing where a contracted hearings officer will receive oral testimony. More info here.