From: "faith_gibson" <goodnews@...>
Date: Thu Mar 3, 2005  4:53 am
Subject: CCM Membership / work group for editing CCM document

 State Chapter of ACCM // California College of Midwives

The California College of Midwives would like to invite all LMs to
participate in the on-going development of the CCM Standard of Care,
relative to the following goals (hyperlink) and in conjunction with
the following defined activities (hyperlink) and within the identified
organizational structure (hyperlink):

Priority Goals:

1.To have the Midwifery Model of Care officially acknowledged by the
MBC, with or without a regulatory reference. Presently, letters and
other public records from the MBC and ACOG contain a clear
acknowledgment by both organizations that the practice of midwifery is
different and distinct from the practice of medicine. Clearly we have
already achieved aspects of this goal and these public documents would
serve us in the future should we have to define or defend the concept
in a legal context.

2. To have the entire CCM Standard of Care remain under the control of
its members, as is the convention for other comparable professional
disciplines.

3. To perfect the CCM Standard of Care by addressing two areas of
concern: (a) correcting any errors, omissions, inconsistencies or lack
of clarity and, (b) removing any statements that conflict with
evidence-based parameters, prevent appropriate practitioner
flexibility or block the appropriate updating of criteria based on
current scientific data

4. To continue making the CCM Standard of Care document (revised
edition) available as a public service via the internet to all
interested parties: consumers, other professionals, our regulatory
agency and to California Legislators.

5. To add language or sections that deal with recognized methods and
criteria for the incorporation of new or advanced practice skills for
individual practitioners, and for new skill sets for all California
licensed midwives.

6. To add language that (a) recognizes the important field of study,
knowledge, and skills sets relative to providing care to women
recovering from post-traumatic stress disorder and/or childhood sexual
abuse, and (b) that recognizes that the LM makes the appropriate
referrals while providing appropriate support for clients with signs
of postpartum depression and/or PP anxiety /mood disorders.

7. To participate fully in good-faith negotiations with the MBC and
ACOG to reach a mutually agreeable solution that acknowledges the
midwifery model of care as the appropriate standard of care, while
still permitting the language defining the standard of care for
California licensed midwives to remain, as with other professional
disciplines, separate from the regulatory process (i.e., not
referenced in regulation).

During this process we, as members of CCM, would accept a compromise
solution incorporating in regulation those revised (per goal # 3)
sections 1 and 2 of the CCM Standard of Care, provided that such a
compromise (a) upholds the autonomy of the healthy, mentally competent
woman with a normal term pregnancy as defined in the LMPA (no current
medical complications, spontaneously progressive labor and vaginal
birth not necessitating the use of artificial, forcible or mechanical
means) and (b) acknowledges a woman's right of informed refusal
relative to medical management of her normal pregnancy and (c) allows
licensed midwives with specified additional skills, appropriate client
selection criteria and appropriate practice protocols, to continue to
provide midwifery care for a planned home birth to clients with VBAC,
frank breech or twins who meet the agreed upon criteria.

Secondary Goals ~ Family Planning / Routine Gyn Care // Hospital Based
Practice

Many LMs are interested and able to add an additional section for
family-planning & well-woman gynecology. This would require research
into the language in the LMPA regarding the legal impact of the word
"intraconceptionally". There is at least one instance in which an
obstetrician claimed that LMs were not permitted to do "pre" and
"post" conceptional gyn care -- i.e., the virgin and the crone -- and
refused to hire an LM to work in his office. However, if a solid case
can be made for routine gyn care under the LMPA, it should be included
before the Midwifery Task Force meeting, or at the very least,
recommended as a "work in progress", to be completed as soon as possible.

As for hospital practice, at present the LM is under the supervision
of her sponsoring physician who determine scope and standard of care
issues.

Defined Activities

The deadline for our first official activity will be that of the next
scheduled Midwifery Task Force meeting (approximately 6-8 weeks).
Using the internet as a forum for communication among members, I will
post, in sequence, each subdivision in sections one and two of the
current CCM document. These will be sent out one at a time to be
commented on via the Yahoo CAmidwives group. At the close of that
discussion (approximately 72 hours), each individual member's
corrections, additions or substitutions should be sent to me to
reconcile and incorporate. I will then circulate that revised version
on the Yahoo group.

The current working title makes several artificial distinctions that
are not actually representative of its contents and which, resulted in
confusion. For the purpose of our own internal understanding of the
legal concepts, any subdivision that contains the words "the midwife
shall" or "the midwife must" or "is required" is functionally
considered to be a "standard of care". By common definition all but
one of the individual topics is a "standard" Therefore the title of
the revised edition will be changed to read "Standard of Care". Within
that framework, the participating members will identify each
subdivision (A thru M) as belonging in one of following categories:

·Definition of terms
·Statement of a professional standard
·A guideline
·A protocol
·A direction to the LM to create and maintain her own practice
guidelines and protocols
·A minimum standard for the competent practice of midwifery
·Any necessary information, instructional or teaching material

For the present, the structure of the two sections will remain
essentially the same, except for "educational" material deemed to be
of a background or non-essential nature. These will be moved to
"Clarification and Commentary" (section 4). I will edit the responses
into a cohesive format and post the final edition. This document will
then be put to a vote of participating members before the next Mfry
Task Force workgroup.

Organizational Structure

In order to be involved in editing the CCM publication, an LM must
agree to be identified as a member of the ACCM/CCM. Membership
involves no dues or other financial responsibilities to the ACCM/CCM –
all economic aspects of professional representation with MBC and
Legislature to remain with CALM // Renee Anker, Chair. While
membership doesn't require your money, a request for membership is a
statement of concurrence with the seven goals and defined activities
listed above and the organizational structure as described in this
section.

·Ability to withdraw membership status upon your request

·Simple majority vote for simple business

·Super majority (60%) for final decisions on Standard of Care language

·Finalization of "interim" edition before May MBC meeting // agenda item

·Concur that it is appropriate for me to negotiate for the members of
the CCM on behalf of the above goals at Midwifery Task Force and the
May Medical Board meetings, both of which will also be attended by
designated reps from CAM, MANA, CALM and many independent midwives
representing their personal point of view (including CCM members)

·Revisit and reassess the Standard of Care one year after the
finalized version is published and every two years thereafter (with
recognition of an emergency clause, based on CCM's advice or a
supermajority vote of the membership, to be applied whenever necessary).

Request for Membership

If you concur with the above statements and wish to be a voting member
of the ACCM/CCM, please reply by email. Provide your full name,
licensure status, address and phone number and any comments or
qualifiers that you want to have recorded. Please note whether or not
we have permission to list your name in the published roster of
members posted to the College of Midwives' website.

Last but not least, please consider joining CALM if you are not
already a member.

=============================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu Mar 3, 2005  7:39 am
Subject: Re: what next // How i learned to love the bomb (i.e. ACOG)

Claudia Glass wrote:
>>> Since midwifery is not medical and should be judged by a midwifery
>standards instead of obstetric standards--as is agreed upon by the
>MBC--why are OBs being given a voice in defining a midwifery >standard?

OK, I'll bite – why is ACOG being given a voice in defining midwifery
standards?

But first, I have to mention the obvious -- what we midwives
think/feel about the topic is irrelevant to the actual politics/power
structure of the MBC and the legislative underpinning of our licensing
law and its most recent amendment, SB 1950.

Competent, college-educated people who regularly collect a 6 figure
salary show up to work everyday, five days a week, 50 weeks a year,
devoting all their time and talent, year after year after year, to
advancing or to blocking the interests of licensed midwives. Some of
these people work for the legislature, some as lobbyists for CMA and
ACOG and some as various staff and appointed members of the Medical
Board of California. I think everyone can agree that **full time
devotion of money and talent equals political power**.

So far, that "power" has been aligned AGAINST us. For example i spoke
with an LM today who is currently being prosecuted by the MBC. The
case involves a VBAC. She has already spent $40,000 defending herself,
with estimates of an additional $80,000 in legal fees if she decides
to fight to the finish. That could be any of us in a heartbeat. Can
you blame her for hoping that we can make peace with ACOG and get a
little useful "cover", becasue she sure would like to come in out of
the rain.

You can hate the power inequities, bemoan the injustice of it all, get
furious, lash out in endless diatribes, but at the end of the day
Organized & Politically-Effective Power scores a **1000** and
unorganized, politically ineffective puny-power LMs socres about
**25** and most of that is begged, borrowed or stolen.

So far our so-called political **power** lies in our good fortune to
have curried the favor of nice people, who were able to appeal to the
good nature of Jay DeFuria (Senate B&P committee) who beseeched
Figueroa's office staff to interest her in the plight of midwives.

That is how SB 1479 // 2000 happened. Since that time we have had a
bit of a free ride with Figueroa's office staff, who helped to keep
**our hat** in **her ring**. That is how we got SB 1950 in an attempt
(abet one that has become complicated) to end discrimination by the
MBC against LMs in regard to the Board using obstetrical expert
witnesses to testify against midwives.

So that brings us up to the present, which is to say that the Medical
Board is a bureaucracy whose policy decision essentially "rubber
stamp" the `opinions' of organized medicine. Like I said before, if
ACOG is not happy, ain't nobody gonna be happy.

Now, why does ACOG get a "vote"? Easiest answer is because ladies, we
call obstetricians or take our moms to hospitals who call
obstetricians whenever we get in over our heads and our clients need
services that only physicians can supply, which is about 10% of the
time. So when it come to "boots on the ground", ACOG members are often
hot under the collar about the aspect of independent midwifery that
they get to see up close and personal. Far too often, they don't like
what they see.

At the last MANA conference, I attended a workshop given by a
homebirth mother and academic researcher from Washington State (you
know, the state where everything about midwifery is peachy-keen
wonderful!). In a state that does NOT require physician supervision,
she mailed out questionnaires to doctors listed on state records as
providing backup, collaboration and consultation with home birth
midwives. She asked how that was working for them, and did they enjoy
working with HB midwives and/or their clients.

Oh the sad, bad news......

70% of midwife-friendly doctors said "Hell, no, only do it because my
boss makes me" (if they work in a clinic or group) or "I only do it
for humanitarian reasons so that these poor deluded women and their
unborn babies can get essential medical services".

The researcher asked if "NO", then why not? The docs said because
there is no rhythm or reason to the way midwives practice, everyone of
them is a law unto themselves, everything changes all the time, they
have no loyality or appreciation and argue against my advise right in
front of the patients and of course, half the time their patients hate
us for doing necessary procedures in order to deliver them in the
hospital. They described a loose-loose situation.

Do you wonder why ACOG thinks it rightfully has a "dog in this fight"?

Now back to politics. ACOG at the district level is entertaining the
possibility of meeting us "half-way" in regard to some of the
objections voiced at the hearing. They have already met us at the 99%
level by acceeding to the CCM standard of care as written (if you
acknowledge the CCM document as reflecting typical domiciliary
midwifery practice and aside from the issue of whether you think it
**should** be put in regulation). That's a "really big deal".

So I leave you with my favorite physician-midwife power relationship
story. It goes like this:

The wife of President Roosevelt, Eleanor Roosevelt, was once asked who
she put first – her husband, who was at that time the president of the
United States, or their children? She responded, "Together with my
husband, we put the welfare of our children first".

Well, ladies, together with obstetricians we midwives must put the
welfare of mothers and babies first. That means we want and need ACOG
to meet us half way. In order for that to happen, we need to enlist
ACOG as our ally instead of enemy in an endless war that none of us
will win.

I often tell clients who are in early labor that if one does not
surrender to "necessary suffering" (i.e. don't fight early labor
contractions!), ultimately, they will have to surrender to the
**unnecessary** suffering of unnatural pain and eventually, to painful
medical interventions.

For us, **necessary** suffering may be as simple as swallowing our
pride. Its not about our rights or our status as MLP. What we need is
for ACOG to give Dr Fantozzi the green light. Otherwise, better start
saving money for lawyers, because it is just a matter of time before
someone out there makes a complaint to the MBC against each and every
one of us.

When you put it that way, ACOG seems so much more attractive, hence
the tried and true wisdom about how "politics makes for stange bedfellow".

good night ladies, i'm off to bedfellow land with a song in my heart
and a smile on my face! ^)^

========================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  12:49 am
Subject: First installment of CCM editing // Pages 2 thru 5

This is hard to read since color can't be used to distinquish the new
or deleted material. I used **new** to indicate substitive changes or
additions.

However, If you want a better look, go to the
<www.collegeofmidwives.org> website, drop to very bottom of home pages
and click on link *March2005* for web-based copy of the material below.

======================================================================
STANDARDS OF PRACTICE

Professionally licensed midwives offer primary care to healthy women
and their normal unborn and newborn babies throughout normal
pregnancy, labor, birth, postpartum, neonatal, and intra-conceptional
periods.

**new** The Standard of Care as published by California College of
Midwives / ACCM is comprised of the following: Section 1 addresses
community-based maternity care and includes a statement of purpose,
overview, definition of terms, professional principles, policies
relative to professional relationships, and protocols for special
circumstances. Section 2 consists of minimum practice requirements for
maternity-care related areas of clinical practice, client selection
criteria and medical consultation, referral and transfer of care.
Section 3 addresses family planning and well-woman gynecology.
Subsequent sections of the CCM document include administrative
obligations, practice guidelines, clarifying commentaries, samples of
informed consent documents and instructional and educational materials.

**new** However, the following standard of care document taken as a
whole is not meant to replace the clinical judgment of the licensed
midwife.

I. Purpose, Definitions & General Provisions:

A. Standards of practice provide a framework to evaluate the licensed
midwife's practice to ensure that it is safe, ethical, and consistent
with the professional practice of midwifery in California. The
professionally licensed midwife who conforms to these standards and
their associated practice requirements is judged to be competent.
Sources and documentation for practice requirements include, but are
not limited to, the following:

1. The International Definition of a Midwife (International
Confederation of Midwives) and international scope of practice
2. Customary definitions of the midwifery model of care by state and
national midwifery organizations, including the 2000 LMPA amendment
(See language from SB 1479 at end of this section.)
3. Standards of practice for community midwives published by state and
national midwifery organizations
4. Philosophy of Care, Code of Ethics, and Informed Consent Policy
published by state and national midwifery organizations
5. Educational competencies published by state and national midwifery
organizations

B. The California licensed midwife is a competent health care
practitioner who maintains all requirements of state certification,
keeps current with safe and ethical midwifery practice and who
practices in accordance with:

1. The body of knowledge, clinical skills, and clinical judgments
described in the Midwives Alliance of North America (MANA) Core
Competencies for Basic Midwifery Practice
2. The statutory requirements as set forth in the Licensed Midwifery
Practice Act of 1993, all amendments to LMPA and the Health and Safety
Code on Birth Registration
3. The standards and guidelines for community-based midwifery practice
4. The protocols of the individual midwifery service/practice

C. The California licensed midwife provides care in clinics,
physician offices, client homes, hospitals & birth centers. The
licensed midwife provides well-woman services pre- and
inter-conceptionally and maternity care to essentially healthy women
who are experiencing a normal pregnancy. An essentially healthy woman
is without serious pre-existing medical or mental conditions affecting
major body organs, biological systems, or competent mental function.
An essentially normal pregnancy is without serious medical conditions
or complications affecting either mother or fetus.

D. The California licensed midwife must be able to give the necessary
supervision, care and advice to women prior to and during pregnancy,
labor and the postpartum period, to conduct deliveries, and to care
for the newborn infant. This care includes preventative measures,
policies and protocols for variations/ deviations from norm, detection
of complications in the mother and child, the procurement of medical
assistance when necessary, and the execution of emergency measures in
the absence of medical help.

E. The California licensed midwife's fundamental accountability is to
the women in her care. This includes a responsibility to uphold
professional standards and avoid compromise based on personal or
institutional expediency.

F. The California licensed midwife is also accountable to peers, the
regulatory body, and to the public for safe, competent, ethical
practice. It is the responsibility of the licensed midwife to
incorporate evaluation of her practice that includes ongoing community
input and participation in mortality and morbidity reporting and
review processes. The results of these individual evaluations can be
distributed to influence professional policy development, education,
and practice.

G. The California licensed midwife is accountable to the client, the
community, and the midwifery profession for evidence-based practice.
This includes but is not limited to continuing education and on-going
evaluation of the scientific literature. It may also include
developing and sharing midwifery knowledge and participating in
research regarding midwifery outcomes.

**New** H. The licensed midwife may expand her skill level beyond the
core competencies of her training program by incorporating new
procedures that improve care for women and their families into the
individual midwife's practice by:

1. Identifying the need for a new procedure taking into
consideration consumer demand, standards for safe practice, and
availability of other qualified personnel.
2. Ensuring that there are no institutional, state, or federal
statutes, regulations, or bylaws that would constrain the midwife from
incorporation of the procedure into practice.
3. Demonstrates knowledge and competency, including:
a) Knowledge of risks, benefits, and client selection criteria.
b) Process for acquisition of required skills.
c) Identification and management of complications.
d) Process to evaluate outcomes and maintain competency.
4. Identifies a mechanism for obtaining medical consultation,
collaboration, and referral related to this procedure.
5. Reports the incorporation of this procedure to the CCM.

II. A brief overview of the licensed midwife's duties and
responsibilities to childbearing women and their unborn and newborn
babies

A. The California licensed midwife engages in an ongoing process of
risk assessment that begins during the initial consultation and
continues through the completion of care. Within the midwifery model
of care, the licensed midwife's duties to mother and baby shall
include the following individualized forms of care:

1. Antepartum care and education, preparation for childbirth,
breastfeeding and parenthood
2. Risk assessment, risk prevention, and risk reduction Identifying
and assessing variations and deviations from normal and detection of
abnormal conditions
3. Maintaining an individual plan for consultation, referral, transfer
of care, and emergencies
4. Evidence-based physiological management to facilitate spontaneous
progress in labor and normal vaginal birth while minimizing the need
for medical interventions
5. Procurement of medical assistance when indicated
6. Execution of appropriate emergency measures in the absence of
medical help
7. Postpartum care to mother and baby, including counseling and education
8. Maintaining up-to-date knowledge in evidence-based practice and
proficiency in life-saving measures by regular review and practice
9. Maintaining all necessary equipment and supplies, preparation of
documents including educational handouts, charts, informed consent
waivers, birth registration, newborn screening, practice protocols,
morbidity reports, annual statistics, and other required documentation.

III. Standards of Practice for Community-Based Midwifery

STANDARD ONE ~ The licensed midwife shall be accountable to the
client, the midwifery profession and the public for safe, competent,
and ethical care.

STANDARD TWO ~ The licensed midwife shall ensure that no act or
omission places the client at unnecessary risk.

STANDARD THREE ~ Within realistic limits the licensed midwife shall
provide continuity of care to the client throughout the childbearing
experience according to the midwifery model of practice.

STANDARD FOUR ~ The licensed midwife shall respect the autonomy of the
mentally competent adult woman and work in partnership with her,
recognizing individual and shared responsibilities. The licensed
midwife recognizes the healthy woman as the primary decision maker
throughout the childbearing experience.

STANDARD FIVE ~ The licensed midwife shall uphold the client's right
to make informed choices about the manner and circumstance of normal
pregnancy and childbirth and shall facilitate this process by
providing complete, relevant, objective information in a
non-authoritarian and supportive manner, while continually assessing
safety considerations and the risks to the client and informing her of
same.

STANDARD SIX ~ The licensed midwife shall collaborate with other
healthcare professionals and, when the client's condition or needs
exceed the midwife's scope of practice, shall consult with and refer
to a physician or other appropriate healthcare provider.

STANDARD SEVEN ~ Should the pregnancy become high-risk and require
that primary care be transferred to a physician, the licensed midwife
may continue to counsel, support, and advise the client at her request.

STANDARD EIGHT ~ The licensed midwife shall maintain complete and
accurate health care records.

STANDARD NINE ~ The licensed midwife shall ensure confidentiality of
information except with the client's consent, or as required to be
disclosed by law, or in extraordinary circumstances where the failure
to disclose will result in immediate and grave harm to the client,
baby, or other immediate family members.

STANDARD TEN ~ The licensed midwife shall make an **deleted word**
effort to ensure that a second midwife or a qualified birth attendant
who is currently certified in neonatal resuscitation and
cardiopulmonary resuscitation assist at every birth.

STANDARD ELEVEN ~ The licensed midwife shall order, prescribe or
administer only those prescription drugs and procedures as authorized
in the Licensed Midwifery Practice Act, Section 2514 and shall do so
in accordance with the client's informed consent.

STANDARD TWELVE ~ The licensed midwife shall order, perform, collect
samples for, or interpret those screening and diagnostic tests for a
woman or newborn in **new** accordance with customary midwifery
practice and the client's informed consent. (note reference to LMPA
deleted)

STANDARD THIRTEEN ~ The licensed midwife shall participate in the
continuing education and evaluation of self, colleagues, and the
maternity care system.

STANDARD FOURTEEN~ The licensed midwife shall critically assess
evidence-based research findings for use in practice and shall support
research activities.
=======================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  5:19 am
Subject: Re: let's come together // questioning this idea

Liz Woscester wrote:
>
> Hello Dear Everyone,
>
> So, it seems there may still be two camps happening. CAM and it's
> ACNM/MANA idea and Faith and the CCM followers. Is there anyway we
> can all get together in our regions rather than have separate
> meetings of these camps? I care about us ALL and believe
> we can come together for a solution. With love, Lis Worcester SF

Unfortunately, what "come together" seems to mean in CAM terms is for
everyone else to simply acceed to the CAM's point of view. Consensus
is achieved by having people with a differing point of view drop out.

The opportunity in the current situation is to continue the dialogue
between the various 'camps' so that each point of view is able to be
fully expressed. As we go thru time, circumstances will present
themselves so that some eventual conclusion will arrise, and no doubt
it will either combine elements of both points of view or it will be a
totally different "third way" necessitated by circumstances and out of
our control (and usually beyond our ability to imagine ahead of time).

The question has always been what MBC & ACOG and Senator Figueroa's
staff find acceptable, not CAM vs CCM.

The CCM document gives up the easy ability to made changes in exchange
for a legal acknowlegement of "full service" midwifery based on the
healthy, mentally competent mother's right to have control over the
manner & circumetance ofher normal childbirth, even if she is a VBAC
or other medically unpopular status. Presently we have a definition
arrived at by various MBC investigators and lawyers for the AG's
office, who continue to beieve that "the midwifery standard of care is
dangerous" and 'guilt by association', that is, if a midwife was
associated with the mother or the birth, she is 'guilty' for haivng
caused a bad outcome or for failing to prevent a bad outcome.

If an articulated standard of care such as the CCM document gives us
shelter from the storm, its worth the inconvience of having to return
to the Board for regulatory "updates" and eventually, to remove it
from its status as "incorporated" 2 to 5 years down the road. This is
similar to having the luxuary of quiting your job -- in order to do
that, you first have to get hired.

If the identified "standard", whether that is the CCM pages 2-5, MANA,
NACPM or ACNM standards do not do protect and preserve mother-friendly
midwifery, then we are going to have to find us a good legislator so
we can pursue those goals thru a "legislative remedy". The legislative
remedy is about 25 times as harder (in time, money and worry) and
takes much longer.

I've noticed that the line of LMs who want to give up big, successful
midwifery practices so they can travel to Sacramento to attend MBC
meetings and legislative hearings is very short. And we still have the
issue of physician looming over us.

warm regards ^O^

=========================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  8:56 am
Subject: Re: let's come together // questioning this idea

Carrie >>>>> I really have to take issue with you saying that CAM is
not trying to find a point of compromise. CAM seems to be the only
one trying to find a point of compromise.

faith reply: If you read my reply carefully, you will notice that i
was suggesting it was not "bad" to be continuing the dialogue and that
it was perfectly fine for each 'camp' to do what they felt would help
to further the action. Last i heard, CAM was having regional meetings
to work out new language for the ACNM document. I am not complaining
that this is some kind of disloyality for CAM to follow thru on the
plan decided on at your last board meeting. Quite the contrary.

Carrie: >>>>> In terms of who has to accept it we can leave the
senators office out of it because they will support anything that can
make it through the MBC as long as it says midwives at the top. They
dont care if it is the one sentence we had last year or the current
book as long as midwives are being judged by the midwifery standard.
Carrie

faith's reply: Yes, i have been saying this since last September --
Senator Figueroa's purpose in crafting this provision of SB 1950 was
something that said "midwives" at the top. They liked the first
regulation which simply said "mfry standard == California Community of
Licensed MIdwives"

As for Ed's suggestion that simplier would be OK with him, the dumbing
down the standard of care is no trouble at all to Figueroa's office.
Ed Howard does not have a 'dog in the fight", he just wants this issue
to get resolved and the sooner the better. The bottom line question
remains **will the MBC tolerate (i.e. vote to pass) this 'simpler'
version? We had "simple" before and it didn't work.

I regard to the idea that my posted comments are designed to 'scare'
people, it scares me to think that this dangerous distraction by CAM
could very well cripple licensed midwifery in California for another
decade. Stand back and take a good, long look at this situation. We
actually have a historic first here -- both the MBC and ACOG in
agreement on a midwifery standard of care and suprise, surprise --- it
was CAM that threw a monkey wrench into the machinery with the idea
that somehow a national standard (that doesn't offer any protection
California midwives or mothers) would be better.

If the 'solution' to SB 1950 ONLY states the obvious, that midwives
are to be judged by a mfry rather than a medical model, we will in
fact have created absolutely NO change in our relationship with the
MBC as a result of the regulation. For the last 3 years, the Board has
indeed been using LMs as 'expert witnesses' -- i.e. they have,
functionally speaking, acknowledged that using OBs as the source for
midwifery standards isn't legally supportable in an administrative law
hearing (such as Alison's).

The political gain possible in a delineated standard is that it
acknowedges "mother-friendly" midwifery in return for more "details"
than other MLPs. From the standpoint of midwives and mothers, I think
that is a fair price to pay and in fact, we are getting the best of
the bargin. That will be important to every midwife who gets
"reported" for providing care to someone who does not fit the mold of
the lowest of low risk pregnancies. Because the CCM document "spells
it out" she will NOT get prosecuted.

If CAM bargins that chip away, each and every prosecution of LMs for
the type of cases identified in the "moderate risk" categoty will be
unnecessary prosecutions.

I remember only too well when i was being criminally prosecuted by the
MBC for the "illegal" practice of midwifery in 1991-1993,CAM's offical
line was that they "couldn't get involved in these cases". In other
words, you are on your own girlfriend. We sympethize with your plight
but as an organization, we can't help you defend yourself. We just
stand by and hope for the best.

So i did my own legal research and the legal information i uncovered
is why i eventually prevailed in court. When i left the court house i
walked right out that door into being a permanently politically active
midwife becasue it was clear that the only person that i could count
on to fight for my civil liberties was me and I've had me nose to that
grind stone for 11 years now and pretty succeffully at that. I have an
"informed opinion" becasue i did my home work. You can disagree with
it but trying to make me and it "wrong" is unacceptable.

I and others will continue to pursue the CCM document as a potential
vehicle for satisfying SB 1950 becasue it has a good track record so
far and is the most likely solution if judged by the MBC's own
reasoning and prior actions and by ACOG's goals.

The "point of compromise" here between the CCM position and CAM is
that CAM should do own its "thing" and CCM will do own its "thing".

Sometime in the next 1-2 months we will have a mfry task force
workgroup, which will be chaired by Dr Fantozzi and attended by Lori
Gregg (the OB on the DOL/Med Bod), the ACOG lawyer/lobbyist and the
District IX OB, Dr Haskins. The 3 main proposals-- CAM, CCM, Senator
Figueroa's office -- will be put on the table, discussed and in a very
short time, we will know what is going to be 'acceptable' to the
people who count -- our regulatory agency.

faith ^O^

===========================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat Mar 5, 2005  9:09 am
Subject: Re: a different idea Diane Holzer> wrote:
>>>>>> I have been trying to think about a way that we could all get
what we need out of this regulation and have come up with the
following idea. >>>> That we offer the suggestion to the MBC that we
will organize a grievance committee. When a complaint comes into the
MBC, it should go directly to the grievance committee. We would offer
to volunteer as midwives to be appointed to the committee. Midwives
could submit their CV's to the MBC and the MBC could choose who they
would like to sit on the committee. We would also offer to find OBs
and pediatricians willing to volunteer their time to sit on a
grievance committee.

Faith's reply: This idea doesn't actually address **this** regulation.
The concept would require new legislative authority, which would mean
getting Figueroa or another legislator to carry a bill repealing SB
1950's provision and creating a grievance committee in its place.

Such a bill would have to reorganize the way the MBC currently deals
with complaints and possibly other licentiates (doctors) would also
like to have this different system. Presently the first decision of
"merit" is based on a doctor hired by the Board for that purpose (for
mfry,it used to be Dr Pat Chase).

If we had a different type of board (such as the one the naturopaths
have, which is to say, our own board), this might work.

warm regards, ^O^

========================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Mar 16, 2005  4:38 am
Subject: my email to CAM lawyer Tim Chanber about editing CCM document

aLL Yahoo group midwives, esp. CAM members:

CAM lawyer Tim Chambers called me recently, concerned that CAM
midwives and board members felt left out of the CCM editing process.
Clearly that has not been the case but just in case anyone else is
confused, see my reply to him below. Also, the CCM membership and work
group info has been copied at the end.

So far, Carrie is the only person to comment on or make editing
suggests for the first installment. All her suggestions were
incorporated in the "Standards of Practice" subdivision of the CCM
document, along with adding a line from the Tennesse Assoc of Midwives
that states ".... the following standard of care document is not meant
to replace the clinical judgment of the licensed midwife.

Also it states that we have a 'section three' that addresses family
planning and well-woman gynecology. So where are the midwives doing
gyn who are going to write section #3????

faith ^O^

======================================================================
Dear Tim,

Below is info on CCM organizational goals relative to the MBC
regulatory process. Please read the 7 priority goals and especially
note numbers 2 and # 7.

And again i will restate that ALL California LMs, as well as
consumers, physicians, CNMs, etc already are (and continue) to be
contributors to the CCM document. The theoretical voting status of
CCM members means that WHAT CCM members would eventually be presented
to vote on as a finished product will be the general consensus of all
the above listed sources -- all LMs, (both CCM members and
non-members), CAM midwives, as well as non-midwives, including both
consumers, lawyers, MBC staff and physicians.

You may think of this process as similar to voting in the Nov. general
election -- who we get to vote for is what the grass-roots party
politics & the primary election has presented us with. In this case ,
non-members actually have a numerically larger in put into the final
product than members have. And conversely, if those suggestions turn
out to be counter-productive, then CCM members can keep such content
from becoming ensconced into an official form by voting it down.
Practically speaking, its a nice parity of power and you may be sure
that i will not be presenting a defective version of the document to
anyone -- members or otherwise. The goal here is to find a workable
solution (and live to fight another day!).

Cheers, faith ^O^
================================================================================\
========
--
Membership -- State Chapter of ACCM // California College of Midwives

The California College of Midwives would like to invite all LMs to
participate in the on-going development of the CCM Standard of Care,
relative to the following goals (hyperlink) and in conjunction with
the following defined activities (hyperlink) and within the identified
organizational structure (hyperlink):

Priority Goals:
1. To have the Midwifery Model of Care officially acknowledged by the
MBC, with or without a regulatory reference. Presently, letters and
other public records from the MBC and ACOG contain a clear
acknowledgment by both organizations that the practice of midwifery is
different and distinct from the practice of medicine. Clearly we have
already achieved aspects of this goal and these public documents would
serve us in the future should we have to define or defend the concept
in a legal context.

2. To have the entire CCM Standard of Care remain under the control of
its members, as is the convention for other comparable professional
disciplines.

3. To perfect the CCM Standard of Care by addressing two areas of
concern: (a) correcting any errors, omissions, inconsistencies or lack
of clarity and, (b) removing any statements that conflict with
evidence-based parameters, prevent appropriate practitioner
flexibility or block the appropriate updating of criteria based on
current scientific data

4. To continue making the CCM Standard of Care document (revised
edition) available as a public service via the Internet to all
interested parties: consumers, other professionals, our regulatory
agency and to California Legislators.

5. To add language or sections that deal with recognized methods and
criteria for the incorporation of new or advanced practice skills for
individual practitioners, and for new skill sets for all California
licensed midwives.

6. To add language that (a) recognizes the important field of study,
knowledge, and skills sets relative to providing care to women
recovering from post-traumatic stress disorder and/or childhood sexual
abuse, and (b) that recognizes that the LM makes the appropriate
referrals while providing appropriate support for clients with signs
of postpartum depression and/or PP anxiety /mood disorders.

7. To participate fully in good-faith negotiations with the MBC and
ACOG to reach a mutually agreeable solution that acknowledges the
midwifery model of care as the appropriate standard of care, while
still permitting the language defining the standard of care for
California licensed midwives to remain, as with other professional
disciplines, separate from the regulatory process (i.e., not
referenced in regulation).

During this process we, as members of CCM, would accept a compromise
solution incorporating in regulation those revised (per goal # 3)
sections 1 and 2 of the CCM Standard of Care, provided that such a
compromise

(a) upholds the autonomy of the healthy, mentally competent woman with
a normal term pregnancy as defined in the LMPA (no current medical
complications, spontaneously progressive labor and vaginal birth not
necessitating the use of artificial, forcible or mechanical means) and

(b) acknowledges a woman's right of informed refusal relative to
medical management of her normal pregnancy and (

c) allows licensed midwives with specified additional skills,
appropriate client selection criteria and appropriate practice
protocols, to continue to provide midwifery care for a planned home
birth to clients with VBAC, frank breech or twins who meet the
**agreed-upon criteria.

Secondary Goals ~ Family Planning / Routine Gyn Care // Hospital Based
Practice

Many LMs are interested and able to add an additional section for
family-planning & well-woman gynecology. This would require research
into the language in the LMPA regarding the legal impact of the word
"intraconceptionally". There is at least one instance in which an
obstetrician claimed that LMs were not permitted to do "pre" and
"post" conceptional gyn care -- i.e., the virgin and the crone -- and
refused to hire an LM to work in his office based on that
(mis)understanding. However, if a solid case can be made for routine
gyn care under the LMPA, it should be included before the Midwifery
Task Force meeting, or at the very least, recommended as a "work in
progress", to be completed as soon as possible.

Hospital-based midwifery practice and well-woman gynecology as
provided in clinics and physician's offices currently falls under the
direction of the LM's own physician supervisor and thus is beyond the
scope of the CCM document as it is presently written.

Defined Activities

The deadline for our first official activity will be that of the next
scheduled Midwifery Task Force meeting (approximately 6-8 weeks).
Using the Internet as a forum for communication among members, I will
post, in sequence, each subdivision in sections one and two of the
current CCM document. These will be sent out one at a time to be
commented on via the Yahoo CAmidwives group. At the close of that
discussion (approximately 72 hours), each individual member's
corrections, additions or substitutions should be sent to me to
reconcile and incorporate. I will then circulate that revised version
on the Yahoo group.

The current working title makes several artificial distinctions that
are not actually representative of its contents and which, resulted in
confusion. For the purpose of our own internal understanding of the
legal concepts, any subdivision that contains the words "the midwife
shall" or "the midwife must" or "is required" is functionally
considered to be a "standard of care". By common definition all but
one of the individual topics is a "standard" Therefore the title of
the revised edition will be changed to read "Standard of Care". Within
that framework, the participating members will identify each
subdivision (A thru M) as belonging in one of following categories:
· Definition of terms
· Statement of a professional standard
· A guideline
· A protocol
· A direction to the LM to create and maintain her own practice
guidelines and protocols
· A minimum standard for the competent practice of midwifery
· Any necessary information, instructional or teaching material

For the present, the structure of the two sections will remain
essentially the same, except that "educational" material deemed to be
of a background or non-essential nature will be moved to
"Clarification and Commentary" (section 4). I will edit the responses
into a cohesive format and post the final edition. This finalized
document will then be put to a vote of participating members before
the next Mfry Task Force workgroup.

Organizational Structure

In order to be involved in **editing the CCM publication an LM must
agree to be identified as a member of the ACCM/CCM.

(**Tim, all public sources get to be contributors -- providing
suggestions, want they might want to add in or request to be taken out
or re-worded, where as only CCM members get to block or "edit out"
material -- i.e., veto power but not "source" power),

Membership involves no dues or other financial responsibilities to the
ACCM/CCM all economic aspects of professional representation with MBC
and Legislature to remain with CALM // Renee Anker, Chair. While
membership doesn't require your money, a request for membership is a
statement of concurrence with the seven goals and defined activities
listed above and the organizational structure as described in this
section.
· Ability to withdraw membership status upon your request

· Simple majority vote for simple business

· Super majority (60%) for final decisions on Standard of Care language

· Finalization of "interim" edition before May MBC meeting // agenda item

· Concur that it is appropriate for me to negotiate for the members of
the CCM on behalf of the above goals at Midwifery Task Force and the
May Medical Board meetings, both of which will also be attended by
designated reps from CAM, MANA, CALM and many independent midwives
representing their personal point of view (including CCM members)

· Revisit and reassess the Standard of Care one year after the
finalized version is published and every two years thereafter (with
recognition of an emergency clause, based on CCM's advice or a super
majority vote (60%) of the membership, to be applied whenever necessary).

Formal Request for Membership

If you concur with the above statements and wish to be a voting member
of the ACCM/CCM, please reply by email. Provide your full name,
licensure status, address and phone number and any comments or
qualifiers that you want to have recorded. Please note whether or not
we have permission to list your name in the published roster of
members posted to the College of Midwives' website.

Please consider joining CALM if you are not already a member.

======================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Mar 16, 2005  6:53 am
Subject: Re: my email to CAM lawyer Tim Chanber // sec #3 WW gyn

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:
>
> Thank you Faith for doing this work, replying and for your time and
effort. Sue Turner, LM

You're quite welcome. I hope someone comes forward to start the family
planning // well-woman gyn section as i have little to offer in that
department.

warm regards, faith ^O^

===================================================================

April 2005

From: "faith_gibson" <goodnews@...>
Date: Thu Apr 14, 2005  8:12 am
Subject: Reply to Jodi's request for update on CCM

Dear Jody and others,

Apparently the midwives on the Yahoo group, as well as those who read
the California College of Midwives' web site, were not interested in
editing, adding to or otherwise making changes in the CCM document.
Except for Carrie, no one emailed me any suggestions. Either people
like it as it is, or they were uninterested in modifying it.

As for the addition of gyn language to the CCM Standard of Care, no
one has expressed an interest (except for our phone conversation) in
actually writing standards for family planning & well-woman gyn. No
one has come forward to offer language for it that was not basically
just a list of protocols taken from a medical practice.

As for the Medical Board, they are unable to make any changes (that
is, to let us make any additions) in the CCM document as published
prior to the last regulatory hearing, due to the legal restraints of
the regulatory process (what they vote on May 6th must match the
content of notice sent out 45 days ago).

The Midwifery Task Force work group will consider deleting topics or
sections from the CCM document and, as of last week, they are planning
to amend the language of the regulation by incorporating the changes
ACOG asked for.

The ACOG language states unequivocally that clients with multiple
gestation, breech presentation or post-cesarean pregnancy must to be
referred to a physician for care and that the midwife must immediately
terminate her care. It also stipulates that LMs may not provide any
midwifery services to clients referred to a physician for evaluation
or for obstetrical services until such a time as the client is
released from the physician's care.

As for the on-going politics from CAM, I can only express my continued
bewilderment. The most recent letter from CAM is again proposing the
MANA standards as regulatory language, as if the critical factor (and
eventual decision by the Board) was solely to be determined by the
preference of midwives, that is, simply a matter of us `voting' for
our favorite. The thing that seems to be missing from CAM's plan is an
acknowledgement of basic political realities and the qualities of
negotiation, compromise and offers to met our worthy opponents half way.

The Medical Board and ACOG have and will continue to have interest in
and control over the practice of licensed midwives for the foreseeable
future. Just as midwives "need' certain things in order to be able to
do our job, so the Board and ACOG have "needs", that is, conditions
that must be met so that they can fulfill their obligations and
preserve their honor and the respect of their peers. The Medical Board
especially needs to be seen (by themselves and others) as competently
performing their duties as regulators.

They see their role as a `high calling', which consists of protecting
the interests of consumers and the reputation of the Medical Board
(and that of the medical profession) in the eyes of the public. They
are horrified at the idea of being embarrassed in public or in front
of other doctors by a `bad' decision and thus are "risk adverse". They
want important decisions to have the support and approval of all the
heavy hitters in the field – in this case, ACOG, CMA, doctors on the
Board and Senator Figueroa's office. (Sorry girls, but we don't have
much political capital in this arena!)

I believe that it behooves us to figure out what the Board and ACOG
want and come to the table willing to meet them half way. We need the
good will and cooperation of organized medicine and our regulatory
agency. It is to our benefit to forge permanent, mutually-satisfying
relationships, as it assists us in achieving our `calling' as
midwives. Our calling includes the need to protect and preserve the
right of mentally-competent, healthy women to have control over the
manner and circumstance of normal childbirth (thus acknowledging the
mother's right to choose independent midwifery care and home-based
birth services), even when or if the mother makes a medical unpopular
decision (which acknowledges our right to provide home-based midwifery
care and the mother's right to have access to professional childbirth
services). Childbearing women are intellectually unprepared (and often
lack expereince, insight and foresight) to be the primary locus of
political activism in regard to these issues. They need our wise-woman
"midwifing" here just as much as when they are in labor.

However, what I see and hear in the CAM strategy is denial of the
Board or ACOG' legitimacy, that is, the idea that neither should have
any `say' in regard to the practice of midwifery, that how we practice
is "none of their business". This results in a rejection of any effort
to study the dynamics of the Board or ACOG, to learn what makes them
tick and to do one's best to give them what they want so the we can
get what we need from them in return.

While it would be nice to have total and complete control over the
public face of midwifery, it isn't what is actually happening (just
ask anyone who is being investigated or prosecuted by the Medical
Board or endures ACOG's lock out of midwives in regard to doctor
backup, obstetrical services or hospital privileges). All over our
country and world, there are individuals and groups who are strongly
opposed to other people and political entities. Resenting them or
wishing they would be different doesn't reduce their influence over
our lives.

For instance, the Republican party wishes that all Democratic
candidates running for public office would just go away, liberals wish
the religious right would just disappear, the far right wishes all gay
peoples would be magically converted to heterosexual Christianity
overnight and all of us wish OPEC would just evaporate so that gas
prices would come down out of the stratosphere. And yet none of us
would vote for a public official whose `plan' for dealing with these
natural conflicts of interest was simply to ignore their reality and
insist that we can get what we want by just insisting, and we don't
need to learn about our opponents, enter into on-going dialogue,
negotiate in good faith or be willing to meet them half way.

When I think about this I can't help but note that the practice of
midwifery is itself very isolated (and isolating) and so often happens
without any interface with the `real' world. What I mean is that many
times we get called after going to bed, get up and drive thru the dark
to someone's home in the middle of the night, catch their baby, weight
it, clean up, pack up and return home before daybreak and before our
family's ever realized that we had gone out (my family thinks I'm just
lazy and like to sleep all day!). As a midwife, our relationship with
midwifery is very private and personal and "none of your business".

Functionally speaking our experience of midwifery usually does not
have any public `face', doesn't interface with other professionals or
bureaucrats. This invisibility is magical and rewarding but it is also
disorienting. It seems to lead us to believe that we midwives `own'
midwifery', that it is our personal possession and therefore, anyone
who isn't a midwife (for example Frank Cuny or Senator Figueroa) and
anyone who isn't a **CAM** midwife, has no business butting in. "Its
ours, go away and leave us alone" seems to be a constant theme.

We all wish it was just our private business and personal possession.
However, when our clients need obstetrical evaluation, NSTs,
ultrasound, Rhogam or hospital transfer or have an emergency, we need
and want the respect and cooperation of the public, bureaucratic
daytime world.

The way to get that respect and cooperation is to give respect and
cooperation. That's my `plan' for the April 27th Task Force work
group. Hope lots of others who are committed to such a goal will also
attend, listen carefully and see if we can't simply accept that the
Medical Board is doing what its doing because it needs go down this
road right now.

Its impossible to predict the outcome of the Task Force meeting, as it
depends mostly on entities outside of the midwifery community and
outside of the control of any of us as individuals. The answer willbe
an amalgamation of the input f ACOG, Figueroa's office, MBC politics,
the legal restrictions of the regulatory process and perhaps other,
incidental or "happy accident" events. The one overriding concern is
that we not permit a standard of care regulation to re-define and
limit our scope of practice.

Lets all pray for a lot of good will and happy accidents.

======================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  12:20 am
Subject: The timber we trade does not belong to us

"Lesley@m..."wrote >
> -----Original Message-----
> From: faith_gibson [mailto:goodnews@b...]
> "Childbearing women are intellectually unprepared (and often
> lack expereince, insight and foresight) to be the primary locus of
> political activism in regard to these issues. They need our
wise-woman "midwifing" here just as much as when they are in labor."
>
Leslie: I disagree, most respectfully. Midwifery belongs to
childbearing women and no one else.

Dear Leslie,

Thanks for the wonderful phrase about the 'timber we trade not
belonging to us'. Your right if you mean that midwives are "not
childbearing women" but frankly (even thought my ovaries are honorably
retired!) i still feel myself to be a woman and one who was and is
interested in promoting improvement in childbearing services.

As for depeding on childbearing women to be the agents of change in
their own behalf, I share your sentiment, admire your trust,
appreciate your hope in humanity but disagree with the practicality of
it. If we midwives are waiting and expecting (young, inexperienced,
distracted, financially vulnerable, often single) childbearing women
to "lead" the way, we are foolish and will simply continue to wonder
in the wilderness, which we have now been doing (that I can personally
attest to) for forty years. Worse yet, we sentence our daughter and
granddaughter and great granddaughters to more of the same – which is
to say, the extinction of physiological childbirth and by extension,
of independent midwifery.

Forty years ago, as a student nurse, I expressed this same sentiment,
and trust and was wildly hopeful as I patiently waited for women to
see the travesty in "knock'em out, drag'em out" childbirth (forceps
and general anesthesia) and rise up the wings of a pure white dove and
march in droves on Washington – The Million Moms and Midwives March
for Sanity and Common Sense in Childbirth.

In 1962 when I was an 18 y/o student nurse in L&D, women were
routinely being given scopolamine (an hallucinogenic and amnesic drug)
during labor and general anesthesia, episiotomy and forceps (what I
call a `vaginal CS) for birth. Many of us L&D nurses were properly
horrified at this institutionalized violence (to say nothing of the
male chauvinist aspects of it) and dreamed of the day when CB women
would stop asking for and expecting to be 'put to sleep'. However, all
laboring women (including my mother) had delivered this way since the
early 1940s and so by 1960-something, there was no one left alive of
childbearing age to tell their daughters anything about normal labor
and natural birth.

Twenty years later the push for "awake and aware" childbirth was
successful but that success had a great deal more to do with a simple
change of fashion in the medical profession that was independent from
any influence of women or birth educators. It was time for a "change",
in this case, a move to replace the more dangerous general anesthesia
with the less dangerous regional (spinal and epidural) anesthesia. The
profession of anesthesiologist was just hitting its peak, and running
registered nurse anesthetist (CNAs) out of the business, just as GP
and midwives had already been dispended with by OBs in earlier decades.

This change in anesthetic style and staff was greatly benefited and
advanced by the makers of medical supplies, in particular, the
suppliers of angio-cath IV equipment (Baxter, Bayer, etc) who gave
free workshops at every hospital to teach L&D nurse how to do away
with the metal hypodermic needles that had been used for administering
IVs for the last 100 years. At that time we used the same kind of
needle that goes on a hypodermic syringe to give IVs by placing it in
the antecubital space (bend of the elbow). This required the mother's
whole arm be taped down to an `IV board', which was then tied to the
bed, as without this restraint device the needle would puncture the
woman's arm if she accidentally bent her elbow.

As a result, giving people IVs was creepy and none of the nurses liked
doing it. However, with the more acceptable angio-cath, giving
laboring women IVs (which was a necessary accompaniment to
spinal/epidural anesthesia) became acceptable and routine. And
incidentally, it also gave doctors a "better way" to administer
Pitocin and soon that too became routine. We quietly exchanged
drug-the-mom and drag-the-baby out delivery under general anesthesia
for "awake and aware" induction, epidural, episiotomy and low forceps
birth, with the dad in the delivery room. Then our hospital added some
colorful curtains to the labor room window, put a comfortable chair
next to the hospital bed and advertised itself as having "liberalized"
policies which promoted natural childbirth! However, childbirth was
and is (and I'm afraid will be) STILL faithfully conducted and billed
as a surgical procedure and that hasn't been changed one bit in more
than a hundred years. I know, I regularly provide labor support for
these "natural" births in our local hospitals.

In 1962 the CS rate at our hospital was 3 percent. In 2003 it was 27.6
percent. I believe that `Waiting and Hoping' as an effective political
strategy has been tested and found to be a failure. During that time I
have listened to other nurses and childbearing women and more
recently, midwives and young mothers who have had home births, repeat
that same mantra about this silently growing ground swell of savvy
childbearing women (or of childbirth educators) who are going to
change the world, one birth at a time. This notion reminds me of my
flower-child days and anti-Viet Nam movement – "What if they gave a
war and nobody came?" Well, I've noticed, young men still keeping
becoming soldiers in great numbers and childbearing women still
keeping going to obstetricians in great numbers and when in labor keep
coming to hospitals for 100% medically intervened with childbirth.

This "just be patient and wait for women to rise up" idea was repeated
as recently as yesterday as I encouraged a home birth client (gravida
4 who incidentally will be running the Boston Marathon this next
Monday at 15 weeks of pregnancy) to consider becoming a midwife when
her youngest child started to school. One of her many remarks was
about how she was going to teach her daughters about how `natural'
childbirth was and then by the time they were having babies, the whole
problem would have gone away, because women will just "see the light"
and then maybe she'd train to be come a midwife.

So here are the major flaws in depending on childbearing women as a
political strategy. First childbearing women are usually young,
inexperienced, untested by life, naturally afraid they won't have the
"right stuff" and overly sensitive to the opinions/trends and fashions
of their peer group. At present their peer group (and ever magazine,
TV show and movie) have a very simple message – "childbirth is AGONY,
it is DANGEROUS – the baby could DIE, it RUINS your body so you wind
up PEEING down your leg OR having to wear DEPENDS and you are STUPID
if you don't (a) get an EPIDURAL in the parking lot or (b) have a nice
neat, conveniently scheduled CESAREAN! Well, now that we have
discussed everything there is to know about having a baby, where shall
we eat and what movie did you want to see?"

And second, you have to have some history or experience of `another
way' to have the vision and intellectual tools to function as a
political change agent – a deep understanding and well founded
commitment – to work for the social, economic and political changes to
necessary to bring it about. However, the 20th century propaganda
machine of organized medicine exterminated the common history of
childbearing women who talked to one another and passed on the benefit
of their experience. Women who give birth under general anesthesia
don't have a lot of memories, so for the whole of the 20th century, we
have never had a large enough pool of cultural wisdom that there was
something to "pass on" in sufficient numbers to do the job.

Equally lethal, the propaganda machine marches on with more effective
tools and more influence, in particular, thru the ubiquitous media of
the 20th century world which is now beamed even to third world
countries that used to use midwives but are now beginning to see the
error of their backward way. All we have to do is tune in the "Baby
Story" on the cable channel (its being watch by young women in Bali!)
and get taught how to be a good obstetrical patient – one who demands
to be induced and demands to be given "our" epidural on admission to
the hospital so we won't "feel anything" while being functionally
paralyzed from the waist down. People with spinal cord injuries might
wonder that we are so quick to think being numb from the waist down
and unable to stand is something to aspire to. Worse yet, in Bali and
other non-industrialized countries where women traditionally squat to
give birth, young childbearing women are now beginning to show up at
the hospital, lay down on the bed and put their feet in stirrups in
expectation of "being delivered" by the doctor "just like they do in
America!"

So the issue is who or what is a responsible and dependable and
effective 'change agent' in this regard to this issue. Its not who
SHOULD do it (i.e, childbearing women), it's who CAN do it (i.e., has
the understanding and know-how) and unfortunately, the natural answer
to that is us – i.e., midwives.

Bummer………………

=======================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  12:27 am
Subject: Re: Questions for Faith --- In CAmidwives@yahoogroups.com, "licensedmidwife"
<licensedmidwife@y...> wrote:

> I may be confused again, but the reason that I asked for an update was
> because I thought the changes were going to be on this site and the
> CCM members( I thought I signed up) were going to be able to see all
> changes and comment on them. I have not read anything here and have
> been watching daily. I was looking for the posts on section 1 and 2
> revisions if any.

Faith reply: I didn't post additional sections because i got NO
response to what was posted. And then shortly after that happened, the
Medical Board called me and in our conversation let me know that the
document could not be changed at this juncture. So after the next
round of hearing we can try again.

> I still believe that the CCM document will serve us best and I hope
> that the MBC will appreciate our willingness to work together.

Faith: Me too, but there are ways to improve it and if possible i'd
like to do that. The Gyn-issue if one of those issues. As for the file
you sent, appearently i did not get it or it got accidentily trashed as
spam. Could you send it again?

> Thanks for all you are doing.

faith : Thank you -- always appreciated being appreciated.
> Jodi
========================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  1:28 am
Subject: Views on MANA document & recent MBC mailing

I think there is a lot of misunderstanding about the role of the MANA
document, particularly in regard to the SB 1950 regulation. The
Medical Board has, in public and in private, said repeatedly that they
did not think the MANA standards were appropriate for being
incorporated as regulatory language.

However, that does not mean that California midwives cannot "practice"
under them or that MEAC-approved schools should not teach their
philosophy and principles. Along with the core competencies, they are
the heart of the preparation of students and they define the
overarching foundation for the practice of independent midwifery. Not
adopting them only means that, **in addition**, California LMs have
regulations which we **also** would have to take into account.

As for the idea that it never hurts to ask, well of course, asking is
a fine idea. However, anyone who has actually been personally involved
is convinced that we have asked, again and again, and their answer was
no. It will be no again this time, if only due to the legal complexity
of the Keen Baggley Act. This law results in a requirement and a
specific process for "government in the sunshine', which in this case
means that Board can't vote on anything that wasn't sent out already
during the 45-day pre-hearing notice period. We midwives benefit from
this rule because it means the Board can't vote in something that none
of us had read or ever heard of.

I think the packet that came today in my mail from the MBC with the
agenda for the April 27th meeting perhaps encapsulizes the issues and
the reason for going forward better than anything i could have
written. On page 4, agenda item 5, it says:

"Dr Fantozzi reported that he directed Dr Pat Chase, Medical
Consultant for the Licensing program, to poll every state regarding
midwifery standards of care. Dr Chase found 18 states that have
regulations in place addressing midwifery standards of care. Dr
Fantozzi then directed Dr Chase to compile a document encompassing all
standards of care, identifying which states include each standard. He
stated that when this information was compared to the CCM Standards of
Care document, CCM's guidelines (the choice of the word 'guideline'
was made by the secretary typing the report and not used in a 'legal'
sense) were found to be complete and fulfilled the requirement. He
indicated that the Standards of Care Subcommittee reached consensus
that the CCM protocols (another instance of general descriptive phrase
chosen by the secretary and not a legal definition of "protocol")
provided an appropriate level of informed consent, were the most
comprehensive and clearly defined the midwives responsibilities and
practice limitation. He explained that CCM protocols (ditto above)
represented the midwifery, not the medical, model of care and these
guidelines (ditto above) could be brought forth as a document that
would satisfy the standard of are regulation requirement.

So the question for everyone in regard to the MANA document is do they:

(1) Track with the regulatory language used in other state midwifery
regulations?
(2) Are they 'comprehensive'?
(3) Do they provide for an appropriate level of informed consent?
(4) Do they clearly defined the responsibilities of midwives?
(5) Do they clearly define the midwife's practice limitation?

Since the current version of the MANA document does not (as yet) do
these things, it will not be seen by the Board as an acceptable
reference for the regulation. That isn't happening because I somehow
wrongly influenced the Board.

In fact, if we did not have the CCM document, they would be voting on
the Alaska regulation instead. The reason they aren't is because i too
download the regulations from the same 18 states, stole their ideas
and plagerized their language, carefully leaving out (of course)
things that were unfaithful to the midwifery tradition, failed to
acknowledge the clinical judgement of the professional midwife or
would be harmful to the rights of healthy, mentally-competent
childbearing women.

Here is what Lesley posted on the topic of Alaska's regs just yesterday

" Having come from a state in which midwives sold-out long ago for
their license (Alaska – no HBAC's Twins or Breeches, along with a long
list of reasons to transfer and transport that can't be deferred to
good judgment or informed decision-making), I can tell you, the
mothers and babies have both benefited and suffered.

And now the midwives will not fight for mother's rights – it is up to
the mothers themselves.

In my mind, HBAC's and breeches are deal-breakers. I'd give up my
license (if I had one!) for these.
With love, Lesley Nelson, CPM AAMI #1585

============================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  1:36 am
Subject: Re: Questionaire in the mail today from CAM

sue turner wrote:
>
> Correct me if I am wrong but, I was not under the impression that
the medical board had reviewed or is in anyway reviewing an other
protocols(ie MANA).
> I thought that the time period for this has passed for a protocol
to be submitted. It is also my understanding that the midwifery task
force which CAM in just a single digit among quite a few, is to
refine and not to submit new to. Is this not correct? Faith?
> Sue Turner, LM

Yes and no -- it's not impossible to start all over again, just darned
unlikely and in my own opinion, not very helpful.

Just consider this for a minute -- what if we all just gave up and
acceeded to the reality that the Board was going to pass the
regulation as written, with only a few modifications.

Then our role and goal would be to be certain that those few "new"
words were to our benefit and not to our detriment and we could get
together to agree on what is most helpful to add in and what is most
necessary to keep out.

And we could come to some general consensus on what would be a "deal
breaker" and what we do if we have to 'break' out.

Have any thoughts on that? warm regards, faith ^O^
======================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 15, 2005  3:19 am
Subject: Re: The timber we trade does not belong to us

"Tonya Jamois" <president@i...> wrote:
>
> Interesting discussion on the role of the childbearing women as
> agents of change.

Please be assurred that i am not inferring that the entire class of
childbearing women was somehow unable to act on their own behalf --
quite the contrary, the experience CB woman are a powerful force to be
reckoned with -- and i'm one of them.

What i'm pointing to is that it is irrational to expect women who have
not yet given birth, as a class, to take the lead in this campaign.
The obstetrical professionon needs to be held accountable for the
false claims and misleading promises of organized medicine but i
question the idea that this group of "maidens" would be the first and
best choice to do that, since they are in a different part of their
journey. Its unfair to them and to us.

And when i speak of 'midwives', i'm using that general category as a
verb instead of a noun. You "midwife" the ICAN organization 40 hours a
week. Many in your organization funtion as the 'spirit' of midwifery
in serving the "walking wounded" amoung new mothers, faciliting public
education and protecting our options (as individuals and for society)
for a normal (physiological) birth.

And yes, i believe that ICAN is a crucial player, espeically because
ICAN is not easily derailed and sullied by the 'blow-back' from the
sharply differing opinions among midwives. Your independence is a good
thing.

Somehow, somewhere all our groups have to coalease into a lean, mean
fighting machine and literally bring an end to flat earth obstetrics
in our life time, for the good of women, for midwives, for taxpayers
and yes, even the good of doctors. Don't you think obstetricians would
be happier doing real obstetrics (breeches, twins, VBACs,
macrosomia,high-risk moms, etc) instead of **pretend** obstetrics --
delivering the 7 1/2# babies of perfectly healthy mothers who are numb
from nipples to knees?

Looking forward to seeing you Friday, April 29th at the Conference. Be
there or be square!

warm regards, faith ^O^
=========================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  2:39 am
Subject: Re: MBC Regulations for Phys Supervision -- coming up fast

No, not AOL -- it was the Attorney General's office. The MBC was
awaiting the AG's opinion, which technically was addressed to Senator
Figueroa's office. The specific content is sealed (ie not published,
not helpful). T

This means the waiting phase is now over and the Medical Board will be
drafting language and scheduling a regualtory hearing the near future.
Any idea about proposed language? faith ^O^

--- In CAmidwives@yahoogroups.com, Lis <stara4@y...> wrote:
> Thanks for the heads up Faith. Hasn't the OAL been reviewing
something too, as I recall?
> Best, Lis
>
> faith_gibson <goodnews@b...> wrote:
>
> Dear Midwives,
>
> I know that everyone's attention is on the standard of care issue at
> this point. But irrespective of the outcome of the Aprial 27th work
> group, the MBC is also planning to move forward on the 2nd half of
> SB1950 -- regulations defining physician supervision.
>
> In this regard, its best that we try NOT to track too closely with
> CNMs, as their paperwork requirements would be impossible for us to
> meet. By insisting that the LMPA law is functionally "the same" of it
> is for CNMs, it opens up the way for the Board to look to the BRN and
> use CNM regulations/standard procedures as a model for an "equivilent"
> regulation on supervision.
>
> It would be a good thing for LMs to begin to think about proposed
> language for the other half of this reTgulatiry process. What would one
> say in a regulation about physician supervision that would in any way
> track with what is possible (as usual, determined by the MBC, ACOG and
> Figueroa's office). And we should keep this topic in mind when it
> comes to negotiating with the Board and ACOG during the upcomming
> April 27th meeting.
>
> If it seems that midwives are naively unaware of political realities,
> stubornly unrealistic in our expectations and lack a grasp for what is
> achievable, we risk being discounted as a force to be reckened with.
> If that happens the Board will fall back to its super-authoritarian
> mode of yester year and craft's its own version, which would include
> some form of documented mutual agreement with a supervising physician.
>
> Unfortunately, the regulatory process for physician-supervision will
> likely make the standard of care issue look like a walk in the park.
>
> warm regards, faith ^O^
>

=====================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  5:44 am
Subject: Onerous micro-management protocolsanother state

I was doing a legal review and came accross these protocols that are
used in another state. They is a good example of hardcore
micro-management via protocols in other jurisdictions:

I know that we argue endlessly about the amount of "detail" in the CCM
document, but for regulatory language, its pretty good.

==============================================================
General Protocols:

Persons able to perform neonatal resuscitation procedures will be
present at each birth.

Records shall be complete and accurate to assure transferable
comprehension.

Prenatal Criteria **mandating physician consultation or transfer**:

The following conditions should **at all times warrant consultation
with a physician when observed by the midwife or reported by the
patient**: (partial list only)

a)Elevation of BP: rise of more than 30 mm Hg systolic and /or 15 Hg
diastolic or 140 systolic or 90 diastolic.
b)Persistent glycosuria and /or abnormal blood sugars
c)Unusual finding on abdominal examination including (excerpt)
polyhydraminios and excessive fetal size
d)Persistent vomiting, persistent weight loss aft eh first trimester,
pain unrelated to minor discomforts of pregnancy, dizziness,fainting,
loss of consciousness
e)Pregnancy more than **two weeks beyond EDC
f)Skin rashes
g)**Herpers genitalis
h)Any problem which would indicated the **need for an ultrasound
i)A **combination of two or more** of the following:
a.Albiminuria
b.Excessive wt gain (4# a week)
c.Edema of hands, face or legs
d. visual disturbances
e.headache – severe or recurrent

Protocols for Intrapartum Management:

1. First Stage of Labor (partial list)
a)Evaluates labor status
b)Remains at client's home if home birth is planned or leaves
client home if false labor or early labor diagnosed
c)Reviews antepartum record and takes medical and obstetrical
history as indicated
d)Reassesses physical stats as indicated

Re-evaluates presentation and position

1)At beginning of labor
2)With abnormal progress
3)Any time mal-presentation or mal-position suspected
4)Consults with a physician if any abnormal evaluation is made

Assesses need for and implements the following"
g)Ambulation
h)Type of nutrition & hydration

Observes for signs & symptoms requiring medical consultation
j)Consults with physician if any complication develops
k)Assesses labor progress as well as physician and emotional status

Monitor maternal and fetal condition according to the following schedule:

1.Measure and record vital signs **as follows

a.take temp, pulse, respiration and BP on initial exam
b.measure BP every hour until cervix is 8 cms, then every 30 minutes
c.take pulse every two hours while membranes intact and temp normal,
and every hour after membranes rupture
d.take temperature every 4 hours to rule out dehydration or
infection and every hour if elevated to 100 F or above

2.Assess the general condition of the patient as follows:
a.Measures **urinary output at least **every two hours in the active
phase, more frequently if there is a bladder distension
b.Test urine for **keytone every 2 hours
c.Observe for hydration, edema, comfort, and normal progress and
determine patient needs

3.Assess & records the status of labor **as follows:

d.Measures frequency, duration and intensity of the contraction
every **half hour and more frequently if indicated by changes in labor
pattern, bother's behavior, excessive pain, or progress slower than
expected for normal labor
e.Observe vaginal discharge including amniotic and bloody show,
noting changes and deviations from normal color and character

4.Assess and records fetal heart tones **according to the following
schedule:
a.Every hour during the latent phase
b.Every 30 minutes during active phase of first stage
c.Every 15 minutes during transition
d.Every 5 minutes during second stage, preferably at the end of a
contraction
e.Immediately after appearance of amniotic fluid in vaginal discharge

5.Performs sterile vag exam under the following circumstances:
a.Assessment of cervical dilation initially and as necessary to
determine status of labor, presentation, position and station of fetus
and status of membranes
b.If the membranes have ruptured, the patient shall be examined to
determine cervical dilation and presenting part

Immediate postpartum (partial list)
a. inspect cervix, vagina and perineum for bleeding and lacerations
b. Repair **1st degree laceration – **refer to physician for repair
of cervical, second, third or fourth degree lacerations

Newborn Management (partial list)


1.If indicated, clears airway of mucus to establish respiration
(bulb syringe or DeLee
2.Deviation or suspected deviations from norm reported to pediatrician

Intrapartum Problem List (partial list)

1)**Meconium stained Fluid
a. assess amount, thickness, color and time noted
b. carefully monitor FHT
c. If birth is not imminent, **transfer client to hospital via
ambulance for delivery by physician
d. If birth is imminent, **notify EMS and have paramedics in
attendance ready to intubate if necessary
e. Transfer of newborn if respiratory distress is noted

Client will be referred for physician care if the following conditions
occur during the intrapartum period or early postpartum period
(partial list):

1.Fetal heartones of 90 or per minute for 3 minutes
2.Non-vertex presentation
3.**Estimated fetal weight of less than 5 pound or more than 8# and
13 ozs
4.**Lack of steady progress in dilation and descent after 24 hours
in primipara and 18 hrs in multipara
5.Cervical edema
6.Any condition requiring more than 4 hours of postpartum observation

Postpartum Problem List: (partial list)

Fever – definition: any two temperature elevations 6 hours apart of
100.4 or greater

Newborn Problem List (partial list)

1. Resuscitation

b)Apgar 7-10 – no resuscitation required, routine care only
c)Apgar 4-6 -- dry off, suction mouth and pharynx, stimulate by
rubbing spine or flicking feet
d)If respiratory pattern irregular – all ow infant to breathe
"blow-by" O2
e)If respirations absent, give mouth to mouth ventilation at rate of
30 breaths per minute and transfer via EMS
f)If infant **does not become pink on 100% O2 after 1-2 minutes,
call 911 and prepare for **transfer
g)Apgars 0-3 -- dry off, suction mouth and pharynx, begin mouth to
mouth ventilation at 30 breaths per minute with oxygen enrichment via
tube in corner of rescuer's mouth or via nasal cannula (editor's note
– what happened to bag and mask??)

General policy regarding Newborns

1. Any acute deviation from normal, as assessed by the newborn
examination will be referred immediately to pediatric care this
includes but is not limited to the following conditions:

a)Apgar score of 6 or less at five minutes
b)Signs of pre or post maturity
c)Weight less than 25oo grams (5#)
d)Jaundice
e)Persistent hypothermia (less than 97 F rectal temp after 2 hrs
after birth)
f)Respiratory problems
g)Exaggerated tremors
h)Any condition requiring more than 4 hours of observation post-delivery

=====================================================================
Personally I would find it impossible to practice in accord with these
protocols and am grateful not to have to.

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  6:32 am
Subject: Phys Supervision regulations Abigail Reagan <rebirthsf@y...> wrote;
>
> I hear what you are saying about the supervision issue being a much
> bigger and more challenging issue for everyone to work out to their
> satisfaction and that saying "we want to be like the CNMs" will not
> work in our favor on this one. Your thoughts on our approach?

Already crafted language for last go-round, which is what was turned
down, so at present, i don't have any new / different ideas, other
than taklking to Senator Figueroa's staff, maybe they have a new
apporach.

faith ^O^
========================================================================================
From: "faith_gibson" <goodnews@...>
Date: Tue Apr 19, 2005  6:34 am
Subject: Re: Onerous micro-management protocols another state

BCappsmidwife@c... wrote:

> > 3.**Estimated fetal weight of less than 5 pound or more than 8# and
> > 13 ozs

Me too -- average baby born at home is way over 8 pounds. Many of the
other protocols were likewise very unworkable and unnecessary. faith ^O^

>
> I think this is ridiculous most of my babies weigh between 8-10 lbs.
>
> Brenda Capps

==========================================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Apr 20, 2005  1:15 am
Subject: Texas Law emergency transport/exact language used in CCM

This is the language (and place from whence it came!) used in the CCM
document.

faith ^O^

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:
>
>
> Texas Administrative Code
>
> Next Rule>>
>
> TITLE 22 EXAMINING BOARDS
> PART 38 TEXAS MIDWIFERY BOARD
> CHAPTER 831 MIDWIFERY
> SUBCHAPTER D PRACTICE OF MIDWIFERY
> RULE §831.58 Transfer of Care in An Emergency Situation
>
> In an emergency situation, the midwife shall initiate emergency care as
> indicated by the situation and initiate immediate transfer of care
in accordance with the protocols of his or her practice by making a reasonable
effort to contact the health care professional or institution to whom the
client will be transferred and to follow the health care professional's
instructions; and continue emergency care as needed while:
>
> (1) transporting the client by private vehicle; or
>
> (2) calling 911 and reporting the need for immediate transfer.

========================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed Apr 20, 2005  1:16 am
Subject: Re: Texas Law, defiinition of inter-professional Care/Standards of practice

ditto -- also used this language in CCM document, with minor treaking.

faith ^O^

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:

> Texas Administrative Code
>
> Next Rule>>
>
> TITLE 22 EXAMINING BOARDS
> PART 38 TEXAS MIDWIFERY BOARD
> CHAPTER 831 MIDWIFERY
> SUBCHAPTER D PRACTICE OF MIDWIFERY
> RULE §831.52 Inter-professional Care
>
> The following definitions regarding inter-professional care of women
within a midwifery model of care apply to this chapter.
>
> (1) Consultation is the process by which a midwife, who maintains
primary management responsibility for the woman's care, seeks the advice of
another health care professional or member of the health care team.
>
> (2) Collaboration is the process in which a midwife and a health care
> practitioner of a different profession jointly manage the care of a
woman or newborn who needs joint care, such as one who has become medically
complicated. The scope of collaboration may encompass the physical care of the client,
> including delivery, by the midwife, according to a mutually
agreed-upon plan of care.
> If a physician must assume a dominant role in the care of the client
due to increased risk status, the midwife may continue to participate in
physical care, counseling, guidance, teaching, and support. Effective communication
between the midwife and the health care professional is essential to ongoing
> collaborative management.
>
> (3) Referral is the process by which a midwife directs the client
to a health care professional who has current obstetric or pediatric
knowledge and is either a physician licensed in the United States; or working in
association with a licensed physician. The client and the physician (or
associate) shall determine whether subsequent care shall be provided by the physician
or associate, the midwife, or through collaboration between the physician or
associate and midwife. The client may elect not to accept a referral or a
physician or associate's advice, and if such is documented in writing, the
midwife may continue to care for the client according to his/her own policies and protocols.
>
> (4) Transfer is the process by which a midwife relinquishes care
of the client for pregnancy, labor, delivery, or postpartum care or care of
the newborn to another health care professional who has current obstetric or
pediatric knowledge and is either a physician licensed in the United States;
or working in association with a licensed physician. If a client elects not to
accept a transfer, the midwife shall terminate the midwife-client
relationship according to
> §831.57 of this title (relating to Termination of the Midwife-Client
> Relationship). If the transfer recommendation occurs during labor,
delivery, or the immediate postpartum period, and the client refuses transfer; the
midwife shall call 911 and provide further care as indicated by the situation. If the
> midwife is unable to transfer to a health care professional, the
client will be transferred to the nearest appropriate health care facility. The
midwife shall attempt to contact the facility and continue to provide care as
indicated by the situation.
>
> Midwifery Standards of practice

http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&
> p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=38&ch=831&rl=51

=============================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu Apr 21, 2005  7:23 am
Subject: Reply to the idea of a conspiracy between Faith & MBC

Carrie wrote:

>>> When CAM asked to be part of the discussion we were told that
**only** Faith would be heard.

Faith's reply: Carrie, we have talked exhaustibly about this issue and
still you continue to misrepresent the simple and straightforward
facts and use that misrepresentation to scapegoat me as an individual,
while working up a firestorm of opposition to the CCM document that is
unjustified and harmful to the interests of midwifery.

In the many years that I was liaison for CAM and other California LMs,
I NEVER, EVER met privately with physician Board members (including Dr
Fantozzi!) nor did any of them EVER confer with me or even so much as
talk to me on the phone or in any way include me in the development of
Board policy towards midwifery. My access to Dr Fantozzi and other MBC
decision makers is exactly the same as EVERY midwife in California (or
any other interested party or consumer) and that is the **US mails**,
in letters address to MBC, 1426 Howe Ave, Sacramento, CA 95824.

I write one to five letters to the Medical Board and other involved
persons each quarter. I attempt to be informative about the scientific
evidence or political realities in regard to the topic du jour (phys
supervision, home birth, birth certificates, regulations, etc). I make
an effort to educate the Board about the midwifery profession in a
manner that acknowledges and is respectful of the Board's role and
honors their "labor" as a regulatory agency. The best way to gain
respect is to give respect.

I have an entire shelf of three-ring binders containing my
correspondence to the Medical Board (copies posted on the CCM web site
for all to read). The notebook for each calendar year since 1993 is 2
inches thick, with an average of 15 letters annually addressed to the
Board or agency staff. Since the last Board meeting in February, I
have written letters to Dr Fantozzi, ACOG, Senator Figueroa's staff,
Governor Schwarzenegger's office (supporting Dr Fantozzi
reappointment), MBC deputy director Joyce Hasnot and emails to Tonya
Jamois (ICAN president) asking that her organization send a
representative to the April 27th meeting and that she ask ICAN members
write letters to Senator Figueroa. I call this important function
"minding the store".

In order to know what needs to be covered in those letters each
quarter, I had to be present and paying attention for the entire Board
meeting cycle (i.e., attend all the meetings during the two days, not
just the one-hour mfry task force). This cycles repeats four times a
year. The way to play the `influence' game is by faithfully "minding
the store", which means to show up and suit up. And it costs plenty in
time, travel, missed births and sometimes, dissatisfied customers (and
my family **hates** that I put Medical Board business before all
else). If they made a movie on my life the title would be: "Married to
the Mob".

And after all that, the only influence I have with the Board is that
they know me and trust my judgment based on my reputation with the
agency staff over the last decade and their personal experience with
me. However, this only means they are willing to listen to me but NOT
that they follow my suggestions or requests. The historic meeting
between LMs and Anitia Scuri at the end of the November Mfry task
force was the first (and only) time a representative of the Board EVER
embarked on a "joint venture" with LMs in regard to crafting language
or making crucial policy decisions on midwifery issues.

As for the October 8th meeting, it has become the embodiment of a
Shakespearian tragedy in which: "Hell hath no furry like a woman
scorned (and if she be a midwife – well, you really better duck and
cover!" You talk about this as if it was a MBC/CCM conspiracy to lock
you or CAM out of the policy-making process but the plain and simple
facts don't support that notion. All that happened was that the Board
changed its mind about the nature of one meeting. As you will recall,
Dr Fantozzi announced at the end of the July 31st, 2004 Mfry task
force meeting that he would convene some form of a "group" which would
include **all interested parties** (his words)to work on the proposed
regs before the next quarterly Board meeting. At that time he
acknowledged that everybody was invited to attend BUT we would "be
more likely to get the job done" if each group sent only one or two
people as representatives for their membership, so it would be more
likely that we could accomplish the necessary work.

Dr Fantozzi was obviously enamored with Alaska regs so when I left
that July 2004 meeting I read them in their entirety and was frankly
horrified. They reminded me of putting a giraffe's legs and elephant's
trunk on a monkey and calling it "cute". My distress over this
possibility (actually a probability!) lead me to embark on the already
much described down-loading and collating of all 18 states regs (along
with other sources) and the eventual crafting of an "example" of what
a good standard would look like -- functionally comprehensive, true to
the history and tradition of midwifery, reflective of the LMPA and
California LM educational requirements, and protected and preserved
the self-determination of childbearing women.

During the time between July and October, Dr Fantozzi was just
chugging forward to `fast track' **his favorite solution**, which is
to say adapting the Alaska regs for California LMs. At the same time,
several of the agency staff had a different opinion.

Pam (the MBC/DOL secretary) called me in late September, to ask if I
could come to a meeting on October 8th. I assumed this was the "whole
enchilada" get-together spoken about at the July Task Force. Being a
good girl, who wanted to be helpful and be a `team player', I called
you and told you about the meeting. Then you called the Board, talked
to one of the staff members. Then the Board secretary called me back
and said the Board had decided against a big "all interested parties"
type of public meeting, becasue they feared it would turn into a food
fight between ACOG, the trial lawyer lobby and the midwives. Since
this would not be helpful to the Board's goals, they nixed the idea (I
think the staff talked him out of it).

Dr Fantozzi decided to have a small work group instead, but
unfortunnately the Keen-Baggely Act prevented the Board from inviting
*just* midwives and not giving the same "notice" to the entire public,
including to organized medicine. The only way around this legal
dilemma was to have one person come as a "consultant" to an agency
staff conference and (according to Pam), Dr Fantozzi asked that I be
that person. He said that was because he knew me better, had worked
with me on this topic already for 3 years and there wasn't time to get
to know you or work with you in advance of that meeting. Pam was very
apologetic and offered to call you if I didn't want to come (due to my
recent retirement). For the same reasons that Dr Fantozzi identified
(worked with him on this topic for 3 years, etc) I thought the right
thing was for me to go, based on my decade of up-close and personal
relationship with the Board and my specific knowledge the topic,
especially the regs for the other 18 states. .

Naturally I was up all night at a birth on October 8th and didn't get
home until 7:30 in the morning. I was so sleepy I had to have a family
member take off work to drive me to Sacramento. The meeting was a
miserable affair, with me sitting between Dr Pat Chase and the new
executive director Dave Thorton (former enforcement director for 24
years who was personally involved in getting me arrested in 1991!).
The style of the meeting was for Dr Fantozzi to grill me about **why
shouldn't the Board pass a regulation about** (name your poison!) –
for instance, that midwives not be permitted to provide care to
pregnant women who were over 40, who smoked more than 10 cigarettes a
day, whose pregnancies were 42 weeks, whose unborn babies were
estimated to weigh more than 8# 12 ozs, if there was ANY meconium,
DGM, VBAC, breech, twims, etc, etc, etc, ad nausem.

For one hour and 45 minutes this went on relentlessly and was doubly
hard for me because I hadn't slept all night and had "fuzzy brain"
syndrome. During the entire meeting I never argued FOR anything nor
even suggested (not one time, not one word) that the CCM standard of
care document be considered as a regulation (didn't even know such a
thing was possible!).

Fifteen minutes before the scheduled end of the meeting) it seemed
clear to me that this was more of the "same ole same old". It didn't
matter what I or other midwives did or said, how much documentation we
had, etc., the Board had already made up it's mind and was going to do
what it was going to do, come heaven, hell or high water. I started
shutting down inside so I wouldn't be too upset by this spectacular
political failure as i watched the functional end of my life as a
licensed midwife pass before my eyes, to say nothing of 10 years
wasted in my attempt to get the Medical to recognize us competent
professionals (instead of teenages who needed the "father's know best"
fix.)

Suddenly there was a lull in Dr Fantozzi's `cross-examination' of me
(for which I was grateful) and that famous interchange between
Fantozzi and Anita occurred (recounted in earlier emails) and poof –
in 5 minutes, they had changed directions 180 degrees. They simply
"decided", on the spot and **without** any discussion, to "incorporate
by reference" the CCM document. I gasped and wondered if I was having
a sleep-deprivation hallucination! But no, they were proposing to
adopt a regulation that was actually compiled by a midwife from
midwifery sources. Better yet this regulation specifically
acknowledged (gasp AGAIN!) the right of LMs to provide care to
moderate risk women (HBAC, breech, twins) and had many other very
mother and midwife friendly policies, including the overarching aspect
that the Board's actions which, for the first time, recognized and
treated LMs as independent professionals.

What I couldn't know then, but what was revealed in the Board's most
recent mail-out, is that the **agency staff** preferred the CCM
document (in part, because it was already a competed work and was
specific to California LMs) and was trying to talk Fantozzi into using
it instead of "recreating the wheel". The workgroup for that day was
scheduled from 10a to 2p but I was only invited to be there from 11 to
1. It's clear that in the hour before I was permitted to come into the
room they had already come to agreement on the CCM document. My
presence and my comments were irrelevant to that decision.

And if instead they had scheduled the `whole enchilada' type of
meeting, indeed, a big fat food fight with ACOG and Tonya Brooks'
organization would have ensued, no consensus or agreement of any kind
would have be arrived at and the Board would have returned to its
smoke filled back rooms to glue the arms of an orangutan on the hind
quarters of buffalo (Alaska regs blended with Arkansas!), outfit the
poor guy with roller skates and send him out to cruse the Santa Monica
freeway during commute traffic, while reporting "Mission accomplished"
to Figueroa's office.

IMHO, the outcome of the October 8th meeting was not a tragedy. I came
away from that meeting (can you believe it!) **actually thinking
(stupid me!) that I had done good for LMs and for childbearing women
and that ** you and other midwives would be **pleased and happy for
our good fortune. And if you will recall, you and Diane were pleased
for the next two months.

Then toward the end of December Elizabeth Davis suddenly "discovered"
that the CCM document and the proposed regulation. After reading it
she took umbrage at the idea that LMs would have to do all those fetal
heart tones (the story going around was that midwives in Holland don't
"do" heart tones until second stage). Elizabeth convinced herself that
if the CCM document to be adopted, she would have to change the
teaching curriculum for her midwifery training program. In one of her
emails, she said midwives WOULD NOT be **WILLING** to follow the CCM
standard of care. First was talk of editing the CCM document, then
Diane and others started talking about how the MANA national standard
would be better because it didn't contain any of those awful `details'.

And presto, change-o, vilifying me became the sport du jour.

However, adoption of MANA standards does NOT provide Cal LMs with any
particular benefit – doing so would mainly be a feather in MANA's cap
and help MANA push for their adoption in other states. What MANA
standards don't say (no 'details') may be an advantage in certain
situations, but the same lack of content also means that **the Medical
Board remains in **control of all the undefined, unsettled issues**
such as HBAC, moderate risk pregnancy issues, PROM, mec, etc and a
host of issues such as a clear definition of terms such as consult,
refer, transfer and transport.

Keep in mind that the Board is already drafting language that will
require each LM to report to the Board each and every time there is a
`transport', as well as reporting all morbidity and mortality. Doesn't
it make sense to be writing the definitions of these terms ourselves
rather than investigators or lawyers for the Medical Board?

**Carrie wrote**: Now is the time for all of us to meet with the MBC
and present the document that should have been presented in the
beginning, the national standard, that of MANA.

Faith's reply: The US mails having being going from your house (as
well as Elizabeth's and Diane's) 365 days a years for all three years
that SB 1950 was on the table. What in God's name were you waiting for
during the last 1000 days?

Never mind, I will make a GodMother deal with you -- one you can't'
refuse. You have my blessings to present the MANA standards at the
very start of the April 27th meeting AND if they are declined, you and
other CAM midwives will get over it and join me and other CCM
supporters in our efforts to preserve self-determination for
childbearing women, while protecting midwives the best we can. This
means that we are all nice to Dr Fantozzi and that we save
"deal-breaker" language for real deal-breakers, not just issues that
are a disappointment. Deal breakers are things that make it impossible
for midwives to do their job (written supervisory agreements) or that
deny healthy women the same right of "informed refusal" as ACOG's
policies and/or criminalize midwifery care for moderate risk women.

warm regards, faith ^O^

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu Apr 21, 2005  5:10 pm
Subject: Re: CAM Responsibility

Lis wrote:
> Please watch the accusatory and presumptive language. We are all
friends here. Thanks, Lis

Rest assured that i (and i assume others) are not sitting up nights
writing these emails for the purpose of insulting one another, but
rather because these are vitally important topics that need full
scrutiny and vigorous debate. Certainly CAM communication has been very
"no holds barred" and that is acceptable (that is, doesn't break off
negotiation, at least for me) as long as the rest of us can speak our
mind truthfully. I'm a passionate person and sometimes i yell at my
loved ones, who don't like it but then, they yell back and eventually,
it all works out.

In general it seem that too much attention on being nice-y/nice gets
in the way of progress. The great value of this electronic forum is
for the work we can accomplish, not as a social club.

So in case i have offended anyone, i appologize and request that you
email me (either on the group or privately)to clear up any
misunderstanding.

warm regards, faith ^O^

=========================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 22, 2005  2:18 am
Subject: Re: M Responsibility

Carrie> wrote: By Faith's own admission no one but me responded to her
request for edits or to join on with her in her campaign to get the
CCM document adopted into regulation.

Faith reply: You misunderstand here -- what my original sentence
conveyed was that either midwives are OK with it as is OR do not want
to make changes enough to do work a list of suggested edits. So far
Carrie and Andrea Ferroni are the only two to have submitted suggested
changes.

That is quite different from the idea that no one is "joining her in
her campaign to get the CCM documented adopted into regulation" --
there is no "campaign", as the CCM document is **already
incorporated** into the current version of the regulation.

If the Board adopts the CCM document into regs, the next activity for
California LMs would be to begin to improve the document and eventual
request a regulatory hearing to amend the previous version.

If the Board does NOT adopt the document into regs, the next activity
will be for CCM members to begin to improve the document. One is
easier than the other but both are do-able.

faith ^O^

==============================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 22, 2005  5:29 am
Subject: One Liners, past, present and future -- the CRUX of the matter

Carrie wrote>>>> The MBC already scheduled another midwifery task
force meeting over this regulation because of the "large number of
letters in opposition to it" from a medical board staffer.

Faith's reply: Read this as "the ACOG's letter of opposition was very
`large' and asked for big changes". The Board received 69 letters in
favor of the regulation and only 24 against it,12 of which were from
out of state (mfry schools).

Carrie wrote>>>: the Senator's office says that the CCM document is
not what they envisioned and they would be just as happy with the one
liner that was presented previously.

Faith's reply: This is **THE CRUX of the matter**, the whole heart and
soul of the controversy. We *already* had a **one liner** – I was at
the meeting in Figueroa's office when Ed Howard came up with that "one
liner" -- and arm-twisted the Medical Board (Ron Joseph and Dr
Fantozzi) into accepting it. It actually was the "right" answer to SB
1950.

Then we had a year's worth of writing testimony and holding hearings,
capped off by ACOG's threat to sue the Medical Board in Nov 2003 if
they preceded with the regulation as written. The Board instantly
folded and sent the physician supervision part of Figueroa's "One
Liner" to the Attorney General's office.

Then the Board let the clock run out on the other half of the One
Liner -- the `standard of care'. And *then* the Board just **started
all over again**, this time using Alaska's regs as the Gold Standard
and generating lists of No-No's that I personally could not practice
under in good conscience (draconian limitations & eliminated informed
refusal by childbearing families). In July'04 the Board was racing at
80 miles an hour towards a brick wall of really bad regulatory
language and then, by the grace of God, the CCM document slowed them
down in to a crawl and aimed them in a better direction by Nov'04, to
the benefit of all of us, most especially childbearing women.

What CAM wants now is a Second Coming, or a "Second" one-liner", since
the MANA standards have a lot more text than the original One Liner,
but **still no content**, which is why the Board and ACOG rejected the
one-liner in the first place.

This resistance to no-content regulatory language is NOT going to go
away. Remember, all the "Big Boys" in this scenario are professionals
who are engaged in this work 40 hours a week (and get paid big bucks).
This is not a spat of temporary political activism for these people --
its their full-time job to manipulate things to go their way and so
far, they have had 100% success. More to the point, *we* are going to
**need cooperation from these same entities/personalities** in the
very near future on the supervision issue.

The 51 members of CAM and their leadership do not control the Board
and ACOG any more now than they did in Aug 2003, Nov 2003, July 2004
or Nov 2004. When efforts to derail the current positive momentum goes
badly and the dog do-do hits the fan, there is no personal
accountability in CAM's scenario. The major architects of this risky
adventure (Elizabeth, Diane and Carrie) all have unique reasons why
they personally will not have to bear the brunt of the fall-out,
either because they don't practice, they don't provide home birth
services or they have other credentials and access to medical
interface/quasi-supervision that few of us enjoy. The CAM leadership
will not be offering to materially defend even their own members,
never mind the rest of us. The easy answer for them will be to
suddenly discover compelling reasons to `retire' from their leadership
roles (health, moving, busy practice, etc) and leave the LMs of
California holding the bag, trying to figure out what the hell to do now.

Carrie wrote >>>> Candidly I was told (by Figueroa's office) that if
this was a document for lawyers they wouldn't have it.

Faith's reply: If we were lawyers, we wouldn't have any of this
bullsh*t. If we were lawyers, we'd be writing our own laws. Instead,
the lawyers that represented ACOG wrote our crummy licensing law, with
its physician supervision, etc. Then their lawyers wrote letters to
the Medical Board threatening to sue them if they didn't buckle under.

Carrie wrote>>>>I thought that to be quite telling, good enough for
midwives but if attorneys had to have something similar (lengthy) they
would not like it.

Faith's reply: We do not "like" it either, that is, this situation in
which we have regulation without representation, one in which other
groups trigger legislative changes that we did not ask for, one which
puts us constantly in jeopardy (every hospital transport is a
potential $50,000 prosecution), one in which 99% of the American
public is either totally ignorant about normal birth and midwives OR
downright prejudiced, and ESPECIALLY one in which it was the lawyers
trial lobby who insisted that Sen Killea strike the original "hold
blameless for care not rendered" clause from the LMPA, which would
have protected doctors from being sued for `vicarious' liability.

But we aren't lawyers and wishing we were won't make it so.

Faith reply: There is a bottom line to this thread and that is what
legislators and lawyers refer to as "unintended consequences". SB
1950 was *intended* by Senator Figueroa to simply correct two specific
problems – (1) the Medical Board was improperly using medical
standards and obstetrical expert testimony to hang midwives and (2)
the unworkable, fatally-flawed physician supervision issue had defied
all other efforts to de-fuse, so Figueroa was going to try a
regulatory "end-run".

However, SB 1950 was also a very big bill (**33 pages long**) with
LOTS of things in it. The "one-liner" language about midwifery
standards and supervision were written by her staff and *do not
exactly track with her intent*. In fact, the actual language of the
law is awful. It actually does give the Board powers way beyond what
Senator Figueroa had in mind.

Unfortunately, it is also a legal truism that whatever language the
Legislature voted on and passed is the language that prevails, not
what the author "meant". Once a piece of legislation become law, *not
ever the legislator who authored it* is permitted to define or control
its interpretation or application.

Bottom line, the unintended consequences of SB 1950 is that even
Figueroa's office cannot stop the MBC from pursing an articulated
standard of care. One would have to go back to the legislature to
write new language to fix this problem. And bad as this is in regard
to standards of care, it is potentially lethal in relation to
physician supervision.

So in spite of the fact that Figueroa's lawyer thinks that lawyers
wouldn't personally "like it", we don't enjoy the professional status,
income or political power that lawyers enjoy. I don't want to put too
fine a point on it (pointing out the obvious that is) but it was
lawyers that wrote SB 1950, so I guess you could say it is a little
late for certain lawyers to come that conclusion. The train pulled out
of that station 3 years ago and is half way to China by now. Lawyer or
not, this opinion is of no value to us in determining a course of action.

Faith ^O^
===============================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri Apr 22, 2005  4:39 pm
Subject: MBC Proposals for Standards of Care - October 2004 & October 2002

State of California
Department of Consumer Affairs Medical Board of California

M e m o r a n d u m

October 8, 2004

Medical Board of California
Midwifery program
Dr. Pat Chase, Medical Consultant

SB 1950 ~ Original proposed regulation for Midwifery Standard

SELECTION OF CLIENTS

The licensed professional midwife shall not accept for care and shall
not during pregnancy, labor and delivery and postpartum knowingly
continue to provide care to a women who has or develops any of the
[30] following conditions:

· Heart disease
· Pulmonary disease, tuberculosis or
severe asthma uncontrolled by medication
· Renal disease
· Hepatic disorders
· Endocrine disorders
· Significant hematological disorders /coagulopathies
· Essential hypertension )
· Active cancer
· Insulin-dependent diabetes mellitus
· Previous cesarean section or invasive uterine surgery
· Current serious psychiatric illness
· Alcohol abuse
· Drug abuse or addiction
· Serious congenital abnormalities affecting childbirth
· Significant pelvic/uterine abnormalities
(tumors, malformations, etc.)
· Neurological disorder-epilepsy
· Multiple gestation
· Younger than 16 or older than 40
· Non-vertex presentation at onset of labor
· Gestation <37 weeks or >42 weeks
· Hepatitis B, HIV positive or AIDS
· Rh sensitization
· Contracted pelvis
· Smokes more than 10 cigarettes a day
· Greater parity than 5 with poor obstetrical history
· History of difficult hemorrhage with previous delivery
· Placenta previa
· Genital herpes
· Sickle cell disease
· Thrombophleibitis

================================================================================\
=======
State of California
Department of Consumer Affairs Medical Board of California

M e m o r a n d u m

To: Members, Midwifery Task Force
Date: October 7, 2002
From: Dr. Pat Chase, Medical Consultant
Subject: Definition of Midwifery Standard of Care

ISSUE:

Existing statute requires that a midwife practice under the
supervision of a physician and refer a complications to a physician
immediately (B&P section 2507, attached). There are no clarifying
regulations for these mandates. The newly chaptered SB 1950 requires
the Board to adopt regulations, by July 1, 2003, that define the
appropriate standard of care and level of supervision required for the
practice of midwifery.

BACKGROUND:

There is increasing interest worldwide in developing and applying
appropriate guidelines to assure the safety of out-of-hospital births.
A fundamental agreement is that only normal, low risk pregnancies
should be dealt with in non-hospital settings. Given that all
deliveries by Licensed Midwives are in the home and that >normal= can
only be applied after the fact, the focus in defining standards of
care must be on the risk factors for this setting, and for all phases
of the pregnancy: antepartum, intrapartum, and postpartum.

A review of the literature as well as personal communications have
provided a number of standards currently in use for both home
deliveries and for birthing centers. These included criteria from the
California College of Midwives, extensive regulations in Texas,
guidelines in Tennessee, criteria for both free standing and
in-hospital birthing centers in California as well as longstanding
exclusion criteria in the Netherlands.

Given that the State of Washington has a school of midwifery and a
supportive approach to the practice of midwifery, the following
criteria from that State=s APilot Project for Planned Home Birth@ are
discussed below as a potential basis to begin discussions regarding
developing regulations in California as required in SB 1950.

Washington=s project is a five year one which was implemented in
January 2001 with the goal of serving pregnant clients who want to
give birth in a home setting and who are at low risk for adverse birth
outcomes. Providers must participate in an ongoing evaluation of the
process and outcomes of the program and comply with project requirements.

The risk screening guidelines and the indications for consultation and
referral were developed by a group including physicians, licensed
midwives, certified nurse midwives, emergency medical technicians, a
public member who had experienced a home birth, and members of the
Washington State Department of Health.

It is important to note that the provider in this project may be a
primary care physician, a certified nurse midwife, or a licensed
midwife and that all must comply with the same requirements for
consultation and referral.

Risk Screening Guidelines for Planned Home Births

The following are conditions that exclude individuals from having a
planned home birth:

Previous caesarian section
Current alcohol and/or drug addiction
Significant hematological disorders/coagulopathies
History of deep venous thrombosis or pulmonary embolism
Cardiovascular disease causing functional impairment
Chronic hypertension
Significant endocrine disorders including
pre-existing diabetes (type I or type II)
Hepatic disorders including uncontrolled intrahepatic
cholestasis of pregnancy and/or Abnormal liver function tests
Isoimmunization, including evidence of Rh sensitization/
platelet sensitization
Neurologic disorders or active seizure disorders
Pulmonary disease, active tuberculosis or
severe asthma uncontrolled by medication
Renal disease
Collagen vascular disease
Current severe psychiatric illness
Cancer affecting site of delivery
Known multiple gestation
Other significant deviations from normal as assessed
by the home birth provider

Indications for Consultation and Referral

1.Antepartum-Consultation required

Breech at 37 weeks
Polyhydramnios/oligohydramnios
Significant vaginal bleeding
Persistent nausea and vomiting causing a weight loss of >15 lbs.
Post-dates pregnancy (>42 weeks)
Fetal demise after 12 completed weeks of pregnancy
Significant size/dates discrepancy
Abnormal fetal non stress test
Abnormal ultrasound findings
Acute pyelonephritis
Infections whose treatment is beyond the scope of the provider
Evidence of large uterine fibroid that may obstruct delivery or other
structural uterine abnormality
No prenatal care prior to third trimester

2.Antepartum-Referral required

Evidence of pregnancy induced hypertension
(BP >140/90 for more than six hours with client at rest)
Hydatidiform mole
Gestational diabetes not controlled by diet
Severe anemia unresponsive to treatment (Hgb <10, Hct, 28)
Known fetal anomalies
Noncompliance with plan of care (e.g. frequent missed appointments)
Documented placental abnormalities, significant abruption past the
first trimester,or any evidence of previa in the 3rd trimester
Rupture of membranes before 37 weeks
Positive HIV antibody test
Documented intrauterine growth retardation
Primary genital herpes in the 1st trimester
Development of any of the high risk conditions listed under exclusions

3.Intrapartum-Consultation required

Prolonged rupture of membranes (>24 hours and not in active labor)
Other significant deviations from normal as assessed by the provider

4.Intrapartum-Referral required

Labor before the completion of 37 weeks gestation, with known dates
Nonvertex presentation or lie at the time of delivery, including breech
Maternal desire for pain medication or referral
Active genital herpes at the onset of labor
Sustained maternal fever
*Persistent non-reassuring fetal heart rate
Thick meconium stained fluid with delivery not imminent
*Prolapse of the umbilical cord
*Maternal seizure
Abnormal bleeding (hemorrhage requires emergency transfer)
Hypertension with or without additional signs or symptoms of pre-eclampsia
Prolonged failure to progress in active labor
*Sustained maternal vital sign instability and/or shock
*Requires emergency transport

5. Postpartum- Consultation required

Significant maternal confusion or disorientation
Development of any of the applicable conditions listed previously
Other significant deviations from normal as assessed by the provider

6. Postpartum-Referral required

*Anaphylaxis or shock
Undelivered adhered or retained placenta with or without bleeding
*Significant hemorrhage not responsive to treatment
Lacerations, if repair is beyond provider=s level of expertise (3rd or
4th degree)
*Sustained maternal vital sign instability
Development of maternal fever, signs/symptoms of infection or sepsis
*Acute respiratory distress
*Uterine prolapse or inversion

7.Newborn-Consultation required

Apgar score 6 or < 6 at 5 minutes
Birth weight < 2500 grams
Abnormal jaundice
Other significant deviations from normal as assessed by the provider

8.Newborn-Referral required

Birth weight <2000 grams
*Persistent respiratory distress
*Persistent cardiac abnormalities or irregularities
*Persistent central cyanosis or pallor
Prolonged temperature instability
*Prolonged glycemic instability
*Neonatal seizure
Clinical evidence of prematurity (gestational age <35 weeks)
Loss of >10% of birth weight/ failure to thrive
Birth injury requiring medical attention
Major apparent congenital anomalies
Jaundice prior to 24 hours

ADVANCE \d12Definitions of Consultation and Referral i.e. levels of
supervision:

Consultation - The process whereby the provider who maintains primary
management responsibility for the woman=s care, seeks the advice or
opinion of a physician on clinical issues that are patient specific.
These discussions may occur in person, by electronic communication, or
by telephone.

*Requires emergency transport

Referral - The process by which the home birth provider directs the
client to a physician for management (examination and/or treatment) of
a particular problem or aspect of the clients care.

======================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue Apr 26, 2005  6:57 am
Subject: Re: MBC Proposals for Standards of Care - October 2004 & October 2002 --- In CAmidwives@yahoogroups.com, Carrie <carrielm@s...> wrote:
> Lis
> Faith's was selected because her document covers MORE than this. Her
> document covers the most number of things from all the states combined.
> That is why her document was chosen, as I have said before. Faith has
> the longest list.
> Again, I do not have a problem with a list that midwives have control
> over. What I am trying to prevent is the MBC having a list they have
> control over. Of course the Washington statute provides a basic
> framework that we can all probably live with, this is how most midwives
> practice, the essential thing though is that right now we have the
> ability to decide the nuances of our own lists and putting it in the
> hands of the MBC will take that right away from us and our clients. As
> long as we have to refer any client to a hostile or potentially hostile
> doctor who then has to agree that the woman can deliver at home before
> we take her back into care we are loosing something very important to
> the midwifery model, the right to educate our clients and their right to
> make informed choices.
> Carrie
>
> Lis wrote:
>
> > Faith, thank you so much for sharing this. It is the first I have seen
> > of it and didn't know it existed. I respect what Washington has done
> > and could live with this. Why hasn't this been a topic of conversation
> > do you think? Was yours selected over this? Thanks again, most
> > respectfully, Lis
> >
> > faith_gibson <goodnews@b...> wrote:
> >
> >
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> > October 8, 2004

=======================================================================

May 2005

From: "faith_gibson" <goodnews@...>
Date: Tue May 3, 2005  9:25 am
Subject: CCM Report on MBC Task Force 4/27
The good, bad and the ugly and the Bottom Line ~

But first, a synopsis:

The Board tabled the currently proposed regulation. Tabling means
that the current regulation is still the one we are working with.

Specifically when the Board tables a regulation that is `in `play' it means that:
(1) they did not take an up/down vote on the regulation
(2) they did not kill it or decide to `start over'

However, in the future they may still:
(a) kill it,
(b) pass it on for the consideration of the DOL by voting on it
(c) decide to change it or even to start over.

The Board did not decide to reconsider the MANA documents. However, ACOG district IX
rep Dr Haskins agreed to take and read a copy of the 3 MANA documents and provide an
official ACOG opinion on the use of them in place of sections one and two of the CCM
document. Stay tuned.

The most important issue at the Task Force meeting, from the Board's prospective as a
regulatory agency, was the cesarean prevention issue -- breech, twin and VBAC. Politically
speaking, the Board is hoping that LMs and ACOG can arrive at a mutually acceptable
consensus so that they will not have to make a "Solomon" like decision. ACOG's District IX
official and formal position is steadfastly to oppose midwife-attended breech, twin and
VBAC labors. ACOG claims that the LMPA prohibits midwives from providing care to
women with moderate risk pregnancies, even if the mother exercises her right of informed
refusal. In other words, they support unattended births and the re-creation of lay
midwifery. However, the ACOG reps would like to help us find an truly acceptable middle
ground.

The Board is (and will continue to be) `risk-adverse', which means they must have a nearly
fool-proof process for letting themselves off the hook should the final decision include
breech, twin and HBAC in the mfry standard of care. Eventually someone somewhere in the
state will have a `bad outcome' with an LM-attended labor or birth in a moderate risk
pregnancy and will show up at a Medical Board meeting to accuse the Board of
malfeasance for "having permitted a licensed midwife" to attend their breech, twin or
post-cesarean pregnancy. This is why the "informed refusal" is important, as it
acknowledges the California and US constitutional right of mentally competent healthy
women to exercise self-determination in childbearing, a civil right that supersedes the
regulatory authority of the Medical Board (thus protecting the Medical Board as much as it
does the mother and midwife).

In regard to the progression of midwifery politics, i am particularly impressed with the
legislative gains in other states that has occurred since the LMPA was passed here 12
years ago. In spite of increasingly `conservative' red-state dominated national politics,
none of the states that have passed licensing laws since the LMPA in 1993 (Colorado,
Tennessee, Utah, Virginia, etc.) have required supervision and none of those states with
pending mfry bills mandate supervision (Wyoming, Wisconsin, Massachusetts, Nebraska,
South Dakota, Missouri).

Except for New York, no other state requires supervision and yet, ACOG is a national
organization and is in all these other states (in other words, it's acceptable to ACOG that
22 out of 24 states with licensing do not require physician supervision!). As for VBACs,
both New Hampshire and Colorado specifically acknowledge the legal provision of care by
midwives to VBAC mothers, a situation also accepted by ACOG. Texas and other states
actually have mfry boards composed primarily of midwives. Its clear to me that it is to
ACOG's benefit to climb down off their high horse and begin to develop a 21st century
attitude toward midwives.

Now for the Good news: For the last 11 years, ACOG has exercised a great deal of
abstract influence over midwifery-related matter but has mainly shown up as missing in
regard to being an interactive presence. Since i approached Shannon Smith Crowley (ACOG
lobbyist) at the February Hearing, we have been able to forge an increasing dialogue
between midwives and ACOG representatives. That process was expanded at the
conclusion of the Wednesday meeting to include an e-mail discussion group between
CAM, CCM, CALM and ACOG in regard to the issue of defining an `appropriate' standard of
care and of even greater importance, cesarean prevention -- twins, breech, and HBAC.
This is vital, because we can never develop a stable base for the practice of midwifery
without the cooperation of the medical community -- both MBC and ACOG. The notion
that we can go around them, over them or thru them is just not realistic -- we have to go
with them together towards a mutually workable solution.

I believe that ACOG's presence in the capacity of a facilitator has been a major missing
piece over the last eleven years. During the year-long process of implementing the LMPA,
which consisted of seven day-long meetings at the Medical Board, ACOG refused to send a
representative. (These meeting were held in the very room we occupied Wednesday and
attended regularly by Maggie Bennett, Maria Iorilla, Tosi Marcelene and myself, as well as
other midwives no longer active in mfry politics.) In the minds of the midwives who
attended the implementation meetings, ACOG's absence reinforced its position as one of
total disdain for midwifery -- a kind of "we don't do windows, we don't do midwives, and
we're hoping you all will just drop dead or move out of state or get arrested or something
so we never have to deal with you again" impression.

This message was bad for midwives, bad for mothers and bad for the medical community.
Most especially, it meant that 100% of the Medical Board members and agency staff in
charge of the midwifery licensing program had no personal or professional experience
with midwives or normal birth. At the same time, they all shared the cultural prejudice that
community-based midwifery care was irresponsible on the part of the midwife, was a
hedonistic indulgence (or ignorance!) on the part of the parents and that the LMPA has
been a `mistake' on the part of the California legislature. Many MBC members and staff
thought that if they just waited long enough, organized medicine would `eliminate' their
problem by eliminating licensed midwives, so they had little incentive to foster
cooperation.

ACOG's functional absence in this process resulted in many crude and counterproductive
attempts by the Medical Board to regulate midwifery with a brick bat in areas where
mutual cooperation or, at the very least, the light touch of a feather would have been far
more effective. This produced a big backlash against the Medical Board by LMs (as
expressed by a 99% vote against the MBC Wednesday!). It also permitted many in the
midwifery community to discount the legitimacy of ACOG's point of view and get in the
habit of thinking that ACOG had no business `meddling' in matters of midwifery licensing
or practice.

While i attended all the Medical Board meetings during this same 11 year period of time,
the agency staff did not have any legislative or administrative mechanism that permitted
them to consult with or include me or other representative of LMs in even the most
mundane aspect of the decision-making process. As you all already know, midwives are
legally prohibited from being appointed to the MBC and we have no standing "Midwifery
Committee" (a `task force' is by definition disbanded each time it's `task' is accomplished).
So the policy-making and implementation process for LMs has often been in the hands of
newly-hired, low level bureaucrats with little or no understanding of, or sympathy for,
midwifery. And every 6 to 15 months, the MBC replaces this employee with a new and
inexperienced person so there is no continuity or `institutional memory'. This has made
life uniformly miserable for midwives while failing to exercise effective oversight on behalf
of consumers. Because the LMPA substituted physician supervision (which isn't available
and doesn't work) for Medical Board oversight (which would) the Board's current method
is to wait for a bad outcome to result in a formal complaint. Each `bad outcome' (whether
preventable or not!) reinforces the Medical Board's prejudice that normal birth is
dangerous in the hands of mothers and midwives.

So i am pleased to have attended the funeral of the "bad old days" of ACOG as a negative
force and to celebrate a new way for a new century. I hope that with the continued
participation of the Shannon Smith-Crowley and Dr Haskins, as well as Sacramento
obstetrician Lori Gregg's appointment to the DOL (and one would hope, to a standing Mfry
Committee!), that we could improve the functional relationship between LMs and California
obstetricians.

The Bad: We did not "win" as in reaching the finish line. The easiest political strategy to
accomplish is to propel the Medical Board to "table" something. The real deal here will be
what happens next.

The Ugly: The unhappy truth here lies in three areas.

First, the level of political sophistication of midwives is generally low and needs to be
greatly improved in the near future. Midwives (even those who don't personally attend
medboard meeting) need to understand the philosophy // politics that motivate the
actives of the Board (a preference for control and overriding need to avoid embarrassment
// public humiliation!) and the specifics of the legal processes for passing and
implementing regulations. For example, once the text of regulatory language is sent out
as a "notice", it cannot be modified until the actual hearing is held. This kind of
understanding will be help to midwives and to the Board and keep many of us from
becoming so frustrated.

Secondly, neither i nor other CCM members are going away and that is not "bad". I would
suggest to midwives that this is not a tragedy -- in fact, the differences of opinion that we
represent are helpful, they engage midwives in useful dialogue, they help to `further the
action' in many places (Board, legislature, etc.). I would also suggest that the often-
repeated idea of unity as promoted by many CAM midwives is a thinly veiled assertion that
i and all other CCM members and sympathizer should simply acquiesce to CAM's
preferences for the dubious benefit of `consensus'. That's not the strong unity of
compromise but rather of a phone consensus that results by stifling debate.

I've been an up-close and personal "Medical Board Watcher" for 12 years and can report
that all parties to the Medical Board authority come in different flavors and so far, it has
not prevented the Medical Board from (sooner or later) making appropriate decisions and
taking action. And i might point out that the place that "consensus" really did matter --
agreeing to voluntarily give up the right to provide care to VBAC mothers -- 100% of LMs
voted it down instantly, on the spot, without a word of discussion amoung ourselves.

Three -- the CAM-CCM controversy. I think the message is clear -- CAM has not been
meeting the needs of the majority of California LMs. An easy measure of that is the
number of midwives that never or no longer belong to CAM -- a membership of only 50
out of approximately 150 LMs is very telling. Only 22 CAM members attended the CAM
board meeting last Friday evening at their annual conference.

My personal experience with CAM has been that anyone who `disagreed' with CAM
leadership was sent to the dog house or wood shed. For me that disagreement revolved
around the idea that unless one was designated as a `team player" by CAM's ruling elite,
then one was not "allowed" to participant in the political process or osterizized if one
insisted on pursuing political action.

It seemed strange to me that an organization of `pushy women' would be so punitive to
one of their own who was `brazen' enough to be push back within the organization. After
a several years of being the `bad girl', i decided to take my business elsewhere. More
recently, the controversy for me has centered on the medical board and the tension
between national versus state control of California licensing issues.

However, there are other midwives who do not feel served by CAM's brand of mfry politics,
for whom the issue is the intense "goddess" focus that imbibes CAM events. This is a real
turn off to many observant Jews and Christians or to LMs who are basically secular and
don't want to begin every public meeting by holding hands and singing "Sisters on a
Journey". It may be that CAM members so disposed towards woman's spirituality feel so
strongly about the benefits of having this one place in the world (CAM meetings) that
acknowledges this aspect of their `spiritual' beliefs, that they would vote to "bifurcate" the
organizational aspect of midwifery politics from the social aspects.

The membership of the California College of Midwives is fast approaching that of CAM's
and consists primarily of LMs who also do not find CAM to be meeting their needs as
California LMs. Eventually, the CCM membership will exceed that of CAM unless CAM can
make the necessary changes and begin to address the dissatisfaction, instead of
attempting to deny or stifle alternative voices.

While i am presently both founder and director of the CCM, i suggest that over the next
five years, CCM membership may well rise to a majority of LMs and were that to occur,
strong consideration should be given to melding CCM and and the political aspects of
CAM into a single organization with an elected leadership and advisory board, while
preserving the social structure of CAM seperately for its own value.

Bottom Line: We are in a `holding pattern' in regard to the MBC, while facing an exciting
opportunity with ACOG to move us past the `grid-lock' of the last decade. As for the
poltics of this, each midwife must choose for herself to either to be personally present and
polticially active or, by their absence or their expresses wishes, delegate decision-making
to those of use who are present. This is not the first time midwives have had this hard
choice -- only about 20 midwives ever came to the 40-plus hours of committee meetings
during the implimentation phase. Less than 10 of these midwives actually stayed the
course. And yet, midwives did not think of these activists as dictorial or despotic but
generally appreciated them for their efforts.

warm regards, faith ^O^

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat May 7, 2005  11:55 pm
Subject: Supporting the Mdfy /MedBd liaison // Stop the press // Great news

sue turner midwife@a... wrote:
> I also appreciate the representation and that is a really good idea. Who
> would be willing to pay for someone to represent us at the Medical Board
> meetings? What about you Faith, you have been representing us for along time?
> Maybe we can send you some money? Has anyone sent you finances to support your
> representing us?
> Sue

Are you kidding? I stay up nights attending births so i can afford my MedBd habit. Which,
by the way, was Thusday and Friday in SF and very interesting.

Dr. Fantozzi was elected president of the Division of Licensing and agreed to appoint a
permanent / standing Mfry committee, which will be comprised of MedBd members. And
even MORE exciting, he also authorized formation of a Mfry Advisory committee to be
comprised of LMs, a CNM, an OB and (i believe) a consumer. So call the newspapers -- this
is a big step forward for the MedBd. However, we have no idea of the time line or other
specifics. I do know that Dr Fantozzi spent about five hours meeting with various
members/organs of organized medicine in an effort to hammer out a suitable compromise
so he really had been pro-active in our behalf.

He believes that we will not have sufficient votes to get any moderate risk birth attendance
thru the DOL as part of our standard of care. Best as i can tell, we only have 2 out of 7 (we
need four) votes. This means we must develop a informational/educational materials to be
sent to each of the members of the DOL (including letters from ICAN members/
consumers) when and if we are able to find suitable consensus with ACOG on this topic.
The one OB on the DOL is willing to acceed to the "informed refusal" of the mentally
competent women in regard to the 3 biggies (Breech, twin & VBAC) but officially, ACOG is
still in opposition.

Other news is that the Mfry program also got a new staff member assigned to it -- a man
who we can all hope will be wonderful but he is a former police officer so i'm a bit
nervous.

As for reimbursement or other money, if anyone want to send money it goes to the Collge
of Middwives fund. For example, I spend $125 a month on Internet service for College of
Midwives (so far over 40,000 visitors) because it is visited so often it sucks up bandwidth.

At the moment my DSL service for web is down so pass on info about Friday MedBd
meeting as i'm unable to post into on College of Midwives.org web site.

warm regards, faith ^O^


> In a message dated 5/3/05 9:28:17 A.M. Mountain Daylight Time,
> licensedmidwife@y... writes:
>
> Besides letter writing,what are your
> thoughts? I know that it has been brought up before but why are we
> LMs not paying for representation? I am interested in your thoughts
> on this.
> Jodi

=========================================================================================

From: "faith_gibson" <goodnews@...>
Date: Sat May 7, 2005  11:58 pm
Subject: Re: UCSF does VBACs

So happy to hear it was a 'mistake', as it came from client who was told she
would be sectioned if she tranwsfered in.

thanks, was going to call but too much else going on with MedBd meetings.

warm regards, faith ^O^o


--- In CAmidwives@yahoogroups.com, Maria Iorillo <sfmidwife@y...> wrote:
> To all, just to let you know that UCSF is definately still doing VBACs. Faith,
> I am not sure where you got your information from but I spoke to Judith Bishop
> yesterday and she said they are definately still available for VBACs. She then
> called me today to say that she had a successful VBAC today with a mom who
> 1)was diagnosed with severe preeclampsia, 2) was induced, and 3) had a
> successful VBAC even though she never labored with her first baby (CSEC for
> breech). I will write a letter to the Medical Board correcting this mistake
> because it is a very influential piece of information. Please let moms know
> this info if they can not find a VBAC provider in their location.
> Maria Iorillo

==================================================================================From: "faith_gibson" <goodnews@...>
Date: Tue May 10, 2005  8:21 am
Subject: Radical Hope and a tad more fun than usual.....

Ending flat earth obstetrics in our life time while having fun!

Dear Midwives,

Just for today I'd like to change the channel from our usual focus to a fresh perspective --
one that is creative, very hip, technologic ally-cutting edge, wickedly funny and and far
more soul satisfying that than the usual way we spend our time.

I'm talking of a whole new relationship to `the issue'. First, let me define the "issue" as
vastly more than any one aspect of mfry licensing, standard of care, MedBd politics, CAM
vs CCM, etc. For me at least (and all those lovely women at the ICAN conference) its about
a maternity care system that systematically doesn't work for mothers and midwives. I
would even go farther and say this `system' doesn't even work for obstetricians, who in
fact, have become the medical equivalent of `eunuchs'. While ACOG may not have actually
castrated anyone, ACOG policies, combined with those of the malpractice carriers and
hospital administrators, have left obstetricians in the unenviable position of playing
`mother-may-I'. No wonder they hate midwives -- it must look to them like we are the
grown-ups having all the fun.
So my fun project is a 21st century, media-savy way to tell the magical story of norma
birth, in which it is the courage of childbearing women that is the legitimate drama and it
is the mother (instead of the obstetrical surgeon) who is the hero of the story. Equally
compelling is the true story of how the routine use of obstetrical intervention in normal
birth warps the physiological process so badly that very soon somebody needs to be
rescued -- mother from the pain of her induced labor and tetonic contractions and or the
OB from his/her fantasies of a bad baby and a 30-million dollar law suit.

So here are a variety of ideas. Their purpose is to `further the action' towards science-
based maternity care as the norm and physiological management as the foremost
standard of care for healthy women with normal pregnancies, regardless of the category of
caregiver (physician, obstetrician or midwife) and the birth setting (home, hospital or birth
centers). Just to get you in the grove, think The Daily Show and SNL and subversive theater
such as SF Mime group and Act Up AIDS groups. So here goes.

(1) A contest for the best 15 second, 30 second and one minute script advertising an
obstetrical intervention, modeled after the many TV ads for drugs. You know the type --
romantic shots of happy attractive people running thru open fields of green grass, flowers,
blue sky, white clouds, butterflies, etc., while the voice over touts slowly list the
miraculous benefits of their new drug therapy for 20-30 seconds and then, a different,
usually male voice who rapidly ticks off, gattling gun fashion, the counter indications
(don't take if you have liver disease, cancer or are pregnant, may become pregnant or are
breastfeeding) and then (also very rapidly) lists the complications that can be caused by
the drug (cancer, heart disease, kidney failure, blindness and erections lasting over four
hours!).

Here is my submission: Picture the familiar ad for Camel cigarettes, but with a very
pregnant camel and the middle and several small inset pictures of obstetrical interventions
arranged around the boarders of the poster -- (1) EFM, (2) IV with Pitocin, (3) epidural, (4)
a woman lying on her back in stirrups, (5) episiotomy, (6) vacuum extraction, forceps, etc.
The text box at the bottom right corner that states "Warning: The Surgeon General has
determined that the routine use of obstetrical interventions on a healthy woman with a
normal pregnancy can be dangerous to your health". Then the small photo of each
intervention would, one by one, be momentarily enlarged and for 2-3 seconds, followed
by an enlarged text box. After all the interventions are spotlighted, the final frame of the
30 second ad would be a small camel with a large text box blinking "danger" -- use only
for bona fide medical indications.

The idea is to be wickedly funny but not mean, personally insulting or its the unwise use
of drugs and surgical procedures that are the issue and a hundred years of defective
medical education that must be rehabilitated.

A couple of other fun ideas are:

(1) During the LMPA implementation process, Dr. Joas (chair of the committee) took and
failed the NARM exam. I've always want to develop questions for obstetricians who want to
become `certified' to attend home birth -- questions like "how do you get blood and
meconium out of installed fabric surfaces -- mattress, carpeting, upholstery, etc.? How
do you wash linens with blood and/or meconium? What to do if you get lost in the middle
of the night in the mountains or a remote rural area and its raining so hard that the road is
washed out and the phones don't work? Then there is the whole topic of "psychological"
distocia and getting moms to deal with emotional issues so that they can actually have
their labor progress. Last but not least, what `procedure' and which billing codes do you
use when you have to `catch' the baby while the mom is standing in the shower (water
on!) in a travel trailer bathroom about the size of the toilette in an airliner. (surely there is
a code to get reimbursed for dry cleaning expenses!).

Stork Races -- stories from midwives about `racing the stork `, grace under pressure, the
purple heart, etc.

Extreme Midwifery -- conduct above and beyond the call of duty, the "you won't believe
this" category, etc.

Starting our own Pod-cast -- running our won radio station thur Bloggs and i-Pod radio
broadcasting which are posted and down-loaded from the a special blogg site on the
internet and played on i-Pod. Lets face it, sooner or later, childbearing families will have
iPods and can listen to maternityh radio programs, starting with my favorite -- "The
Mother's Home Companion".

So have fun, let your imaginations go wild and lets see if we can't use humor and
ingenuity to turn the tide.

warm regards, faith ^O^
========================================================================================

From: "faith_gibson" <goodnews@...>
Date: Sun May 15, 2005  9:26 am
Subject: Re: Update needed // update provided --- Jodi > wrote:
> Does anyone know what the time frame is now with the MBC re: documents?
> Are they going to review them again before the next MBC meeting? What
> is needed from us at this time? I am still wondering how we can move
> forward to hire someone to represent LM's in an official way. Faith
> and others who have been going to these meeting for years are you
> interested in being paid and what kind of yearly salary would interest
> a person to do this work. It seems to me that a change is needed. Is
> there anyone from CALM that is interested? Should we have a survey of
> LM's? Jodi

At the moment we are in limbo as to what and when the MedBd will move on proposed
language for the SB 1950 regulation. THey have to propose language by 45 days before
the July 27th Board meeting if we are to have a scheduled hearing.

In preparation I have already started contacting LMs and ICAN members and laying the
ground work for an organized educational campaign for members of the Division of
Licensing. These are the 7 people who will vote yes or no on what ever the language for
the final proposed regulation. Presently we only have one vote and maybe 2 others.
However, we need 4 to either stop the regulation or move it on to OAL.

I went to the Thursday MedBd/committee meetings so i could talk to Dr Fantozzi, Anita
Scuri and Dr Lori Gregg, the woman OB on the DOL, which i did. My instincts tell me that
ACOG and Dr Fantozzi will push for a "no VBAC, no twins/breech" clause but they did not
tell me that directly. Lori Gregg said she could accept an "informed refusal" from the
childbearing woman in regard to these particular moderate risk circumstances. Dr Fantozzi
thinks we should agree to no VBACs for the time being and come back later to change it. I
strongly disagree.

Dr Ruth Haskins and Shannon Smith-Crowley now have the e-dresses of all the midwives
who attended the 4/27 task force meeting. I have gotten two emails from Shannon
regarding the email group (adding people) but **NO emails with any content about the
topics**. I'm beginning to get a little antsy about this big build up and no follow-through.

In regard to a part-time salery for representing LMs, that would depend on the situation
but probably about $400 a week, plus travel expenses.

At present i am starting a video editing project on "elective Cesareans" and the near total
lack of candor and true informed content provided to the public and to childbearing
families on the real risks of medically unnecesary cesarean surgery -- immediate,
iatrogenic, intra-operative, post-op, delayed and downstream -- that accompany the
substitution of elective surgery instead of physiologically managed normal birth. The first
purpose is to use it when approaching legislators about scheduling legislative hearings on
the topic of elective CS and the lack of access to VBAC services.

The first thing on my agenda is to make a 15 min. DVD to promote the idea of legislation
mandating a state-sponsored information booklet such as already requried for breast
cancer, hysterectomy, silicon implants and prostrate cancer. Eventually we will want this
same type of information for all routine obstetrical interventions.

My first contact for this project is John Robbins (does anyone have his address???, i lost
track after his book "Healing the Planet" that included a chapter about me and other
prosecuted midwives). After my DVD is finished i will be spending Fridays at the Capital,
walking the halls with my DVD-playing laptop to show the DVD to the legislative
assistants. I have a short list of legislators that have already shown themselves to be
interested in healthcare topics and espeically womens issues.

As you all will recall, i 'retired' from the role of sole MedBd liaison because it appeared to
me that we could not win with the Board without first changing the paradeim for the
practice of obstetrics in the US. That is why i have been producing informative DVDs on
the topic of "Ending Flat Earth Obstetrics".

While i am 100% comitted to follow through the current topic (standard of care
regulations), i am hoping that others will also become knowledgable about MedBd politics
so that i can spend more time doing research, writing scrips and developing a docu-
drauma.

And i must say that so far my plan has been a smashing success. Carrie, Diane, Megan
Roy, TIm Chambers and Karen Erhlich all came to the DOL and general MedBd meeting last
Friday. Except for Tim Chambers everybody else stayed the whole day. I can't tell you who
many times i was the ONLY person in the room representing LMs for Board meeting after
Board meeting. So this change is a very gratifying indeed.

warm regards, faith ^O^
===================================================================================
 

From: "faith_gibson" <goodnews@...>
Date: Mon May 16, 2005  2:39 am
Subject: Re: RE; Hiring a LM representative

What a sweet letter.

Thanks Donna, i'm honored to be spoken of in such glowing terms.

warm regards, faith ^O^

"Donna Russell" <donna@c...> wrote:
> Dear Licensed Midwives:
> I pray that the LMs finally recognize the treasure you have in Faith and give
her the means to lead your fight effectively while training your future warriors.
>
> Faith, Frank and I consult frequently on LM issues and we know of her wisdom
and effectiveness first hand, and hold her in our highest regard.
>
> Donna Russell

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Mon May 16, 2005  2:42 am
Subject: Re: MBC Representation

--- In CAmidwives@yahoogroups.com, "licensedmidwife" <licensedmidwife@y...>
wrote:> Ok so 400 a week is 1600 a month or 19,200 per year.

> How many hours a week is part time?
> Jodi

about 3 hrs a day or 15 hrs a week -- which is about how much time i spend on
the phone and doing emails each day.

faith ^O^

==================================================================================

From: "faith_gibson" <goodnews@...>
Date: Mon May 16, 2005  6:16 am
Subject: Re: MBC Representation

Sure.

faith ^O^

> Thanks Faith for clarifying. Now does that mean you are willing (if we
> can get OUR act together to pay you for the next say 1 year?
> Jodi

================================================================================

From: "faith_gibson" <goodnews@...>
Date: Mon May 16, 2005  6:50 am
Subject: Re: MBC Representation

Yes. i would be delighted to have my "labor' acknowledged and compensated. However, we
would all still have to ponder the basic issue here -- can i (or anyony one) have a postive
impact on the MBC and if not, are my time and talents better spent in plowing new ground
instead of just tying to sweep back the ocean in an unwinable war with the MedBd?

I don't have a ready answer and regardless of who ultimately functions as the eyes, ears
and mouth peice between midwives, mothers and Medical Board, we also need "students"
of MedBd/Mfry politics to become educated in the law, in the history of licensing and the
behavior of regulatory agencies. Afer learning the skills relative to being an effective
ambassador for mothers and midwives, these LMs will need to be ready to take over the
job in the next 2-5 years. I'm 62 years old and frankly don't want to do this forever. And
who knows, i could get sick or hit by a bus. Midwives should not have all their eggs in one
basket. Not only that but i have a fifty 3-ring notebook archive that needs a permanent
home.

But even more to the point, we really do need a paradiem shift **in our life time**. What it
would look like if we ended flat earth obstetrics is a unified system for the
provision of science-based maternity care for healthy women with normal pregnancies.
Physiological managment would (once again) become the foremost standard of care,
regardless of the status of the practitioner (midwife or physician) or the setting (home,
hospital or birth center). Once having achieved that noble goal, the professionalization of
midwifery will take care of itself, based on its own merits.

You see, its not enough for midwives to just keep "asking for what we want", we have to
also **get** what we **need** and that includes protecting and preserving the right of
self-determination for healthy childbearing women. Midwifery should be more about
mothers than it is midwives. I reject the idea that we (mothers and midwives) alone, out of
all classifications of people in the United States, should be permanantly powerless and
locked in 19th century system of prejudice and predatory practices against women and
normal childbirth.

Yes, so far our gains are few and our losses are momouth, but in my book, that just means
we haven't found the right trigger point. When we do, we are going to be shot out of a
cannon, we're going right over the moon and then we're gonna come back to earth and get
busy rehabilitaing maternity care so that is too is (gasp!) actually evidence-based!

warm regards, faith ^O^

--- In CAmidwives@yahoogroups.com, stmidwife@a... wrote:
>
> You have a really good idea and it was terrific to see the price break down.
> You don't have to justify anything. Faith are you interested in this? I
> cannot see anyone else who would better suite this. I am happy to help draft
> letters and gather financial commitments.
>
> Sue Turner, LM
=============================================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue May 17, 2005  3:51 am
Subject: Re: MBC Representation // 2 midwives equal 3 opinions

Sue Turner wrote:
>
> Sounds terrific Faith, ebase is what I also agree with. Jodi, lets talk
> about making this happen and anyone else who want to help get this endeavor
> going. Sue Turner, LM

Heard a great ethnic joke today -- a rabbi on the NPR told the apoccrophil story that
where there are two jews, you will have 3 opinions. He could have made the same
statement about midwives.

With that in mind, i have to say that identifying me for a saleried position representing
midwifery with the MBC and the Legislatiure is a bit premature, seeing as how the CAM
echo chamber is at present diametrically opposed to me and all i stand for.

I continue to have many, sometime conflicting, ideas about what is the best course of
action, considering the current controversy between CAM and CCM. High on that list is
the thought that we all would benefit from having CAM leadership put in their time with
the MBC. I say this for two reasons.

First, there are new circumstances which may mean changes that we can't anticipate. Dr
Fantozzi had a new position as president DOL and his new committment to and envolment
with licensed midwifery is remarkable different than a year or so ago. Then there is
ACOG's willingness to dialogue with midwives, which is a first. Last but not least are new
representatives from the midwifery community (Carrie and DianeH, etc).

And of course, having several CAm members actually show up for every Board meeting
and stay the whole long day will help to equalize the functional understanding of
midwifery/MedBd politics. I hope this new perspectice will lay to rest the idea that, as a
strategy, just "asking for what we want" is all we have to do (and that somehow i failed in
that regard!).

Nothing will help to heal the scheism between CAM and CCM like the actual experience of
dealing with MBC politics up close and personal. Because CAM leadership has not beeen at
the table for the last decade, its all too easy to think that i just haven't been doing it right.
Tme and experence will naturally 'cure' the disease of disbelief.

So instead of the idea of hiring me as MBC liaison, i would suggest that for the next 6
months or a year, midwives who are interested, able and willing to contribute $100-$200
a year to the advancement of midwifery politics consider contributing that amount to
CALM so that CALM can reimbursement me/CCM and others for the expenses of
advancing the agenda noted in my last email.

While i would like someday to be a bona fide "lobbyist" for licensed midwifery, i think
realistically that we need a bit more time for free-form 'subversive' activities to apply the
kind of pressure needed to bring about a 'sea change', which i always define as advancing
the idea of physiological managment for all healthy women a single standard of care for all
maternity care providers (Yes Virginia, that includes docs!).

And while i would love to be relieve of the stress of trying to support myself staying up all
night with laboring moms (getting older makes that so much harder!), it would be
wonderful just to be able to be reimbursed for travel and expenses for the next year or so.
And anyone who would be willing to contribute to the monthy expenses for our 2 internet
site would be a saint in my book and my friend for life.

Here are other ideas for forwarding the action (i.e,. ending flat earth obstetrics will
continuing to professionalize licensed midwifery).

(1) Democrazing the history, law and education of midiwfery politics -- i have a ton of
documents (original and archival copies) amassed over the last 25 years on every possible
cateogy of midwifery history and practice, the obstetrical plan to eliminate the profession
of midwifery, MBC schenanicans (sorry spelling!) as well as records of every MBC meeting
and regulatory hearing and ALL our legisltaive efforts, as well as copies of every letter
written to physicians by LMs in an attempt to secure a supervisory relationship. These
documents are all in addition to the letters to MBC members, testimony and amicus briefs
and other articles i have written and posted on the California College of Midwives web site.

While physical archiving is a wonderful idea (sending to a library), an even better one is
scanning in these documents digitally to be stored on a web site so they can be read and
*searched by EVERYONE* who is interested. This is a project that individual midwives
could, at their own pace, over the course of 6 months, scan in one of those fifty 3-ring
notebooks and then post the files on web site. Its so important that this material be
indexed and be searchable, because i am going to die (sooner or later) and the knowledge
in my head should not be lost to the midwifery community and to childberaing women.

(2) www.Normal Birth.org -- In preparation for going to the Legislature for hearing and
state-mandated consumer informed consent for elective Cesarean, we need to actually
create documents that address the questions of truly informed consent for obstetrical
interventions in normal birth, starting with the issue of elective CS.

My Suggestions is posting that information to a web site devoted to consumer-specific
needs. And it so happens that i own the URL "www.NormalBirth.com", which i will freely
donate to the project. It would be wonderful if individual midwives were willing to start
the ball rolling by chosing a major (or minor) intervention (medical management/routine
hospitalization, immobolization in bed, IVs, EFM, induction, epidural, VE or forceps, etc)
and write a balanced and evidence-based account for each of these 'proceudres'. The idea
is to answer the question "My careprovider want to induce me. What do i need to know to
make an informed decision?". After developing these documents, they are to be posted on
the Normal BIrth.org web site. I also plan on reading them into an audio file to be posted
on the Pod-cast web site to be downloaded as Mp3s for those with i-Pods or other MP3
players.

In closing, all i can do is repeat the admonition of the Taco Bell TV ad, which is to "Think
outside the bun" (or in this case, think outside the Board").

I'm for floating like a butterfly and stinging like a bee until we get the respect that we and
the women we serve deserve.

warm regards, faith ^O^

=========================================================================================

From: "faith_gibson" <goodnews@...>
Date: Wed May 18, 2005  2:03 am
Subject: goody for today (5/17)

But first i want to thank Karen Ehrlich and Donna Russell for the good presentation of
facts and the kind words about my efforts. And if you guys are going to start sending
money to CALM, you beter forewarn Renee so she's faint from shock.

Now for the goody:

"Care more than others think wise,
Risk more than others think is safe,
Dream more than others think practical
Expert more than others think prossible".

From "Liberating the Human Spirit in the Work Place" by W. Bickham 1996 Irwin
Professional Publishing, Chicago

And for the REEALLY good news, after 2 years of trying to figure out how to record a
narration for each slide in my Keynote Presentation program (Apple version of
PowerPoint), i bought an upgrade of the software, went to an online discussion group,
at their arvise downloaded a sound program (AmadeusII) and actually figured it out.
Not only that, i was up til 3 am last night editing my DVD "Exploring Cesarean Issues"
and it is hot. By the time i add the Keynote presentation on the risks it will be
wonderful.

Anyone out there willing to preview it for me (would have to mail you a DVD which
may or maynot play on your equipment)?

warm regards, faith
PS -- feeling a little under the weather tonight -- may not be back on line til
tomorrow but you can always call me 650 / 328-8491

====================================================================================

From: "faith_gibson" <goodnews@...>
Date: Thu May 19, 2005  3:12 am
Subject: Re: goody for today (5/17)

--- In CAmidwives@yahoogroups.com, Ronnie Falcao <ronnie@g...> wrote:
>
>
Thanks, i will drop a DVD off at your house or at Peer Review if its Monday the 23rd. I
spoke too soon about the narration -- did one, worked fine, stopped for dinner and a little
nap and when i went back could not make the program work so at present won't be done
as soon as i'd hoped.

warm regards, faith ^O^

Hi, Faith,
>
> I'd be happy to preview DVDs for you.
>
> In general, I'd also be happy to proofread text captions
> or whatever.
>
> Keep up the good work.
>
> Hugs,
> Ronnie
>
>
> At 07:03 PM 5/17/2005, you wrote:
>
> >But first i want to thank Karen Ehrlich and Donna Russell for the good presentation of
> >facts and the kind words about my efforts. And if you guys are going to start sending
> >money to CALM, you beter forewarn Renee so she's faint from shock.
> >
> >Now for the goody:
> >
> >"Care more than others think wise,
> >Risk more than others think is safe,
> >Dream more than others think practical
> >Expert more than others think prossible".
> >
> >>From "Liberating the Human Spirit in the Work Place" by W. Bickham 1996 Irwin
> >Professional Publishing, Chicago

============================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri May 20, 2005  6:30 am
Subject: Re: MBC Representation // A golden opportunity

JoanWGreen@a... wrote:
> Just a little reminder in this CAM bashing, that Faith was representing CAM
> at the medical board meetings up until June of last year when she resigned that
> position at the CAM conference in Marin. Or was this my misconception????
> Joan

I don't mean to sound dense, but what is your point?

Indeed, my point is that **i was CAM's liaison, which is to say, that CAM respected my
abilities and opinion in regard to the MBC for the last 7 ot 8 years**.

I remind you that i quit the job for my own (not CAM's) reasons -- mainly the recognition
that trying to get the MBC to play fair was an unwinable war and that we needed to change
the paradeim at a higher level. Since i could not do both -- represent all of Licensed
Midwifery with the MBC **AND** promote science-based maternity care, physiological
management as the single standard of care for healthy women while ending flat earth
obstetrics -- i resigned as CAM liaison. That resignation assumed that CAM leaders would
be required to step in and take up the reins.

A great deal of my frustration in regard to the current contorversy grew out of the
"contempt prior to investigation' that was applied to my efforts on behalf of Cal LMs by
CAM leadership. My abilities were "good enough" for all you guys for many, many years, in
large part because no one else was interested in doing the work enough to show up
regularly and find out for themselves what was going one. That very lack of experience
over the last 10 years (since the conclusion of the seven 1994 Mfry implementation
meetings), put CAM in a poor position to turn their back on the advice of persons who had
been doing the job and whose opinions were based on direct knowledge.

But instead of capitalizing on my experience with the Board, my "informed opinion" as
CAM liaison was suddenly considered irrelevant, as CAM leaders and members insited that
LMs only had to "ask for what we want" and how we "shouldn't settle" for anything less, as
if i had not be beating my head against a brink wall for a decade, asking for "what we
wanted" // i.e., recognition that the appropriate standard of care for the practice of
midwifery was a **midwifery** standard.

The tension between myself, CCM and CAM is one that i suggest is most useful to CAM. If
CAM wants to be thought of and in actuallity to be the only Voice for midwifery in
California, then CAM must become sensitive to and develop ways to meet the needs of the
"rest of us". Numerically we are a majority (abet one which includes a large number of
midwives who are "apolitical").

I suggest to you and other CAM leaders that every minute spent on fighting and
complaining about me is a waste your time and mine. In fact, I am the best thing that has
happened to CAM in the last decade, as the 'push' of what i stand for is a golden
opportunity to invorgorate your organization so that you can actually deliver what you
claim. Believe me, nothing could make me happier.

warm regards, faith ^O^
============================================================================

From: "faith_gibson" <goodnews@...>
Date: Sun May 22, 2005  9:23 pm
Subject: I second the motion & suggest new website ~ MoveOn.cam

Very wise word.

How about getting the URL: MoveON.cam?

warm regards, faith ^O^


Jodi wrote:
> I am not "CAM Bashing". What I am doing is moving FORWARD with ideas,
> hopefully solutions, and progress. I cannot wait for the rest of my
> career as an LM for a what I consider a disorganized group(CAM)to
> block/hinder progress with the MBC. Again, I would hope that CAM
> would reconsider its efforts to truly represent LMs in a different
> way.
> Instead of hiding behind insults, hurt feelings etc. why not improve
> your organization? Faith is moving forward. CALM is moving forward.
> That is why I want to support them. For me it is a very simple
> concept. My goal is to see LM care for mommies and babies become
> commonplace in all settings.
> Jodi
>
> - In CAmidwives@yahoogroups.com, "faith_gibson" <goodnews@b...> wrote:
> >
> > JoanWGreen@a... wrote:
> > > Just a little reminder in this CAM bashing, that Faith was
> representing CAM at the medical board meetings up until June of last year when she
> resigned that position at the CAM conference in Marin. Or was this my
> misconception????
> > > Joan

===============================================================================

From: "faith_gibson" <goodnews@...>
Date: Sun May 22, 2005  10:10 pm
Subject: Re: MBC Representation //www.MovingOn.CALM The reason for my resignation, as i wrote just a few days ago, wasbecause nothing i did
seemed to be working -- the MBC operated like it was a law unto itself and was just
blunering on with it multiple attemts to define the mfry standard of care as a list of No-
N0s, many of which actually were restrictions on the mfry scope of practice, which i
continue to believe is not lawful under SB 1950.

My conclusion was that we (LMs) were going to have to look for another place to exert
poltiical power -- ie, changing the paradeim -- so that we would have at least a honest
chance at being treated by the MBC as equal professionals. That is reason why i designed
the CEO web stie and how the content posted on it came about
(www.scienceBasedBirth.com).

The theory is that you and i will not be able to make licensed midwifery (a kind of second
story activity) work while the foundation for maternity care in the United States (ie
obstetrical interventions) continues to be so profoundly dysfunctional. Even if we were
able to preveil, our infludence would be limited to 1/2 or one percent, leaving 99% of
healthy childbearing women to be victims of preditor obstetrics.

I just read someone's master thesis on the Santa Cruz Birth Center / Kate Bowland arrest,
prosecution and the case law precident it set and was shocked to realize how we have
actually lost ground since the early 1970s. When measured by the general political 'flavor'
(red vs blue states), what mothers want (or are willing to settle for), the march of OB
interventions, their success at hood-winking the public to accect " the materal choice
Cesarean" as (1) ethical for OBs to perform and (2) safer and better for the mother and
baby, i had to conclude that we are 50 years behind where we were in the 1970. What has
prevailed at a foundamental level, is the prenecious nature of organized medicine.

In the presence of this great need, a part of my frustration was caused by the fact that i
was the ONLY LM present at MBC functions on a regular basis (Karen attended sometimes
but had many out of town trips that prevent a real committment). No amount of begging
for 'participation' seemed to help one tiny sentilla and i couldn't do both -- represent all
California LMs AND produce media and connect with film producers and (we expect!) a
good law firm.

My own definition of my daily life was that it had been reduced to "joyless drudgery" in an
effort to maintain a midwifery practice to support myself, deal with the needs of my family,
represent LMs with the MBC and Senator Figueroa's office (which perports to suppoirt Mfry
but does some strangely unhelpful things!) AND trying to "end flat earth obstetrics in our
life time" so that mothers and midwives would have an a tiny chance. They only part of
that that could possible be done by other (and SHOULD included other!) was
representation at the MBC.

As for the idea that i resigned becasue "the MBC liked her so much she was not as effective
as she wanted to be" is factually wrong and irrelevant to the issue.

After (and ONLY after) i resigned, all the major players on the Board and staff expressed
great regard for me -- except for Anita, they never before had said how much they liked
working with me and what a good job they though i did in representing midwives. After
that, i made a casual remark to Carrie that maybe the Board like me too much, that is, that
i was not upsetting their apple cart enough. Since this observation came about only after i
had resigned and 'appointed' Carrie to be the CAM replacement, i obviously was not
'causal'.

And actually, i think it works for us for the Board to feel confidence in me. The silent
ethical 'deal' i made with the MBC (thru my actions of more than a decade) is that i would
never personally attack any of them as individuals on an indiviudal or public level, nor
would i attack in any public forum the basic work / authority of the Board.

That does not mean that i did not/do not take issue with a specific actions that are "not
helpful" and work for them to be changed, but i am very careful to be certain that the
areas that i push for change are actually ones that they honestly have control or authority
over. For example, the MBC did not write our LMPA nor did they write SB 1950. They do
not have the authority to 're-define' physician supervision. However, they did have control
over "omnibus" or clean-up legislation and therefore they could (and did) make changes
so that mfry students could obtain clincical experience w/o the LM being change with a
crime.

So lets just keep contributing to 'www.MovingOn.CALM' -- i like that URL best, as we need
lots of CALMness about this topic so that we aren't pissing our energies into the wind, to
the delight of our enemies. And i must mention that i have communicated with ACOG but
so far no reply.

warm regards, faith




Carrie <carrielm@s...> wrote:
> My understanding from the MBC liked her so much she was not as
> effective as she wanted to be the MBC. She asked me to take her place, which I
> did and she introduced me as such to the MBC in July of last year.
> Faith please correct me if I am wrong but that is how I remember it.
> Carrie
>
> stmidwife@a... wrote:
>
> >
> > Why was it that Faith resigned from CAM?

=====================================================================================

From: "faith_gibson" <goodnews@...>
Date: Tue May 24, 2005  12:49 pm
Subject: Re: What's not working about CAM

Ronnie Falcao <ronnie@g...> wrote:
>
> Diane asks what is not working for individuals about CAM:

Obviously, my experiences are very different than most laid-back "apolitical" midwives,
but i believe my observations are still relevant and merit discussion.

But before i address this topic, i want everyone to know that my main computer (the one
that gets emails addressed to "goodnews"), has been down for nearly a month. That means
that anyone who emailed me privately in the last few weeks probably didn't get a response
becasue i haven't been able to get on line. So if anyone has private email for me, please
forward it to "faithgibson@....

Also, this computer that i am using now doesn't have a word processing program and
doesn't have any spell check capacity.

So thank you Karen for sending me the correct spelling of several words i misspelled but
frankly, its hopeless. For emails that are not for public consumption, you guys are just
gonna have to suck it up. I can't spell (or type!) which is why it seems to be such a cruelty
joke for me to have become a spokesperson/writer of letters and producter of web content
for midwifery. Obviously God has a real sense of humor.

********************************************************

Now to the "What's not working about CAM" conversation. (see reposting below for remainder of email)

From: "faith_gibson" <goodnews@...>
Date: Tue May 24, 2005  8:28 pm
Subject: What is not working in CAM // 2nd post // trying to correct format

>**Re-posting after attempt to fix the problem with the format**

> Diane asks what is not working for individuals about CAM:

Obviously, my experiences are very different than most laid-back "apolitical"
midwives, but i believe my observations are still relevant and merit discussion.

First, i became an independent (non-CAM) activist in 1993 **because** of a negative
experience with CAM during the LMPA implementation phase. But before that story will
make sense, i have to provide a bit of background.

As you all will recall, after two years of being criminally prosecuted, the
charges against me were mysteriously dropped in April of 1993.

This occurred after 20 months of pre-trial hearings (and $30,000 of legal
expenses), after the DA admitted that the non-medical practice of midwifery was not a
crime. At the urging of my lawyer, i told the DA that i'd done extensive legal research
which was able to document that midwifery was statutorily neutral. Without batting an eye
or missing a beat, the DA said "Yea, i know". He went on to tell me and my lawyer (Ann
Flower Cummings) that he was aware of the lack of statutory basis for criminalizing the
traditional practice of midwifery and said: "I called up those guys at the Medical Board
and I told them that if they wanted me to keep prosecuting midwives, they were
going to have to get some new legislation passed."

Within 2 weeks of that conversation, the criminal prosecution against me was
mysteriously dropped (in its 21st month, with no further 'motions' filed by my
lawyer!). The legality of my practice under the religious exemptions clause was formally
acknowledged by the same DA in the same court documents that dismissed the
charges against me. In the newspaper interview on the courthouse steps, the DA was
quoted as saying that since it was **lawful** for any lay person to assist a woman during
normal childbirth, it didn't make much sense to prosecute midwives for assisting at
normal births.

Five days later I attended my first Medical Board meeting in Sacramento (May 3,
1993), which was how I discovered that public participation in the public meetings of
the agency was virtually non-existent.

And 5 weeks after the DA's famous conversation with the MedBd and the editorial
in the San Jose paper quoting the him as saying publicly that traditional midwifery was not
a crime (and the newspaper's editorial recommendation that the MBC should stop
persecuting midwives like myself and instead lend its weight to the licensing of midwives),
the California Medical Association lobbyist went to Senator Killea and made that infamous
"deal with the devil" -- i.e., they agreed to let mfry licensing legislature pass if Sen Killea
would permit the CMA to replace the CAM-sponsored language with the medical lobby's
preferred version (i.e., an exact copy of the CNM law, complete with the poison pill of
physician supervision).

By September 1993 the bill was passed and signed into law by the governor on Oct
11th. Sometime after the beginning of 1994, a Medical Board staff person was assigned
to the Mfry licensing program (Tony Argil). He suggested a meeting with representatives
of the midwifery community to get a feel for how to implement the LMPA.

As a recently arrested midwife (that is, my case had just been dismissed and i
was still reeling from the twin punches of legal expenses and lost income) i was, of
course, very interested in attending such a meeting. I certainly did not want the LMPA to
simply become a newer better way to arrest and prosecute midwives.

However, i was told by CAM representatives that this meeting (to be held at the
home of a SF midwife) was just for the CAM reps. By this time i had been attending
Medical Board meetings for nearly a year. I'd heard what the Board had to say to each
other about midwifery when they didn't know there was anyone watching or listening to
them. There was no way i was going to be blocked from representing myself and others
who, like me, were concerned that the LMPA was just a bigger better noose for 'catching'
midwives.

Since I was aware that the Keene Baggley Act required all meetings held by
regulatory agencies to be open to the public, i insisted on coming to that and all
subsequent meetings relative to implementation of the LMPA. This is actually the story of
how the ACDM got "founded". Obviously, i have continued to be a "player" by my interest,
my study of the legal and historical issues and my energetic on-going participation. This
has been in spite of the frank opposition or disdainful disinterest of CAM in those same
activities.

This brings us back to the topic of "what's not working" and in particular,
addresses the remark by Claudia about how we malcontents should just:

"Get involved. Come to meetings, call your regional rep regularly, make sure
your opinion is heard, volunteer to do some of the work and CAM will certainly work for
you."

I "got involved" and "made my opinions heard" but CAM certainly did not "work
for me" Instead, i was generally treated by CAM leadership as a troublemaker. I was
described repeatedly as "not a team player" and a "loose cannon". It is interesting to
note that when i was awarded the Brazen Woman Award, by Maggie Bennett, she
introduced me that evening as "someone who was not a team player, who often said
things she and other midwives did not believe or agree with, but which, (audible sigh!)
turned out to be right".

In 1997 i agreed to be an expert witness at Abby Odem's criminal trial,
testifying not on behalf of Abby's conduct but rather on the general standards of
traditional of non- medical, non-nurse midwifery. For my considerable trouble, i was
blackballed and black listed by CAM midwives up and down the state. I'd been specifically
asked to be a presenter at the MANA conference that year but several months after i sent
in my presentation packet i was notified that they "didn't have any openings for my
topic". I noticed that generally i was not invited to be a presenter at CAM conferences or
i if i was, it was to do a prayer group or something else irrelevant to midwifery politics.

This pattern has persisted over the years. For example, I was contacted by a
MANA conference coordinator last January about doing the "Ending Flat Earth
Obstetrics in Our Life Time" session again. I was told that my Oct 2004 presentation was
one of the best attended and most highly rated sessions of the Oct 2004 conference and
they wanted me to do it as as a general session for Sept 2005. However, i recently received
another letter informing me that they had "so many applications this year that they just
could not fit mine in". Keep in mind MANA called ME and wanted me to repeat the FEO &
DVD.

We always come back to the "team" and "team players" conversation. Believe me, i
wanted to be on the team and tried my very best to be a 'team player' but somehow, it
never took. I always wondered if it was because I'm was thought to be "religious". The
letter from Suzanne Suarez (Florida lawyer for MANA) to the MedBd in opposition to the
CCM standard of care stated as one of her objections that it had been written by a
"Mennonite midwife", as if that, in itself, would disqualify the concepts it contained.

For those who are part of the inner circle, CAM is a lovely mutually-supportive
social club. For the rest of us, CAM wants our membership money and our 'numbers' so
they can describe themselves as representing all of California midwifery, but when it
comes to actually being democratic and responsive, CAM becomes an echo chamber for
like-minded individuals.

As to what the specific issues are let me quickly list (with little explanation)
the specific topics or circumstances that i find "not working".

(1) CAM attempts to be all things to all people, which is not a bad thing but
creates divided loyalties when it come to "representing" licensed midwifery. Since CAM
is, in theory, just as supportive of lay or "independent" midwifery, it makes it very
hard for CAM's time and resources to be allocated to issues of licensing and legal and
Legislative efforts, lest the 'independent' midwives be offended or feel slighted.

In fact, CAM has regularly put all its time and money into CAM conferences and
then claimed poverty (or inability to get the Board to vote yes on the project) when
it comes to just about everything else (including the CAM web site).
I believe that one of the reasons is that the conference is the least divisive and
most "social" outlet for its efforts. However, that means that little or NO money has
been left for supporting the activity of liaison between the MBC and CAM midwives
and other issues of licensing (including the ability to use the CAM web site as a
"real time" communication source).

(2) CAM reps are disportionally mfry students, doulas or other non-practicing or
unlicensed midwives. They often have too little life experience for the job, do
not understand background issues (mfry history, law & legislation, MBC politics,
etc) or know about many of the issues relative to the practice of licensed midwifery. I
know how hard it is for practicing midwives to faithfully attend quarterly meetings,
especially when they have a client who is due, but we can't run a profession without
professional representation, and we can't have professional representation without
professionals doing the "heavy lifting" i.e, representation.

(3) CAM board meetings (of which i have attended many) are almost always a
different set of people for each meeting (depending on whether it is in northern or
southern CAL, etc). It is hard to carry through any agenda, as each time the wheel must be
"re-invented". Important business, such as decisions about policies for MedBd or
legislative issues (which are topical and time sensitive) may well be tabled for three
quarterly meetings in a row before a "consensus" is reached. That is 9 to 12 months. Many
of those issues either die an unnatural death (i.e., becoming a missed opportunity)
or were resolved without CAM every becoming a real "player" due to this
dysfunctional system for making important decisions.

(4) The idea that all CAM business must be conducted under the "rule" of consensus. It
doesn't actually work in regard to either leadership (executive function) or in
relationship to policy decisions for political issues that almost inevitably require
immediate conclusions.

I believe this specific issue is the basis of a fundamental split in which a
significant number of people simply give up and leave both CAM and MANA, since only
the inner sanctum every gets to advance an agenda -- the rest of us try, fail, try again,
lay low for a while hoping for better circumstances, try again and then finally give up. This
means that both CAM and MANA leadership winds up talking to themselves and
misinterpreting that as "consensus". Even worse, they take that empty "consensus" to
mean they have a "mandate" to do more of the same, since they never hear any
oppositional ideas, because the rest of us all gave up and went away.

(5) Lack of vital, enthusiastic, visionary leadership -- for the last 8 years
CAM presidents have in essence been "volunteers" who ran unopposed because not even
one other person in all of the CAM membership was interested enough to run for the
office. Does this not tell you that CAM is clearly not doing well when it come to vitality,
that it is not meeting the needs of enough people for its own membership to want to
advance the cause of the organization?

(6) The historic lack of participation in MedBd politics. CAM leadership ended
its participation in 1994 when the last of the seven Mfry Implementation Committee
meetings was concluded. However, the needs have only increased over the years.

It is unprofessional to have a "profession" and then turn your back on the many,
on-going professional needs. Participation means not only attending each and every Med
Board meeting but also spending the intervening 3 months doing whatever is necessary
to further the action on whatever is the current agenda for the next meeting. I
write 3-10 letters to Board members, legislators, lawyers, etc, for every MedBd meeting
cycle. I often make up informational booklets which are copied and sent to each member
of the DOL (and cc'd to Senator Figueroa and Frank Cuny).

Participation is much more than a 'waiting' game to see what will happen next.
It means having a plan and molding the action as much as possible. CAM still does not
seem to have a plan other than having hired a lawyer and thinking/telling the rest of us
that now the MBC is going to do what they want because they have a lawyer.

But i don't see any "lawyering' going on or dialoging with the major parties
involved. For example, Frank Cuny met with Dave Thorton (MedBd director and former
enforcement officer) twice in the last few weeks to negotiate on behalf of two physicians
being prosecuted by the Med Board. Is CAM likewise involved in the current on-going
mfry prosecutions, negotiating on their behalf?

(7) last and certainly least in my considerable litany of complaints are the
continued efforts by CAM leaders to get me to "go away", as they continue to perpetuate
the idea the because the MBC "likes" me, i couldn't or wouldn't be effective and i should go
off and leave it all to them and their lawyer. Frankly, i have no confidence that i as a
practicing LM I would be safe were i to take that advise. However, i'd like to be proved
wrong.

In conclusion:

I don't know how many of you are aware that PhD-epidemologist Ken Johnston and
his long-time partner Bette Davvis, RM, have recently been cut out of the MANA stats
project, and their entire earlier efforts (and the stats they generated) called into
question. They will no longer be invited to or attending MANA conferences.

As most of you already know, it was Ken and Betty who originally developed the
idea in 1993 for collecting data on midwife-attended births using recognized scientific
methods. They subsequently designed the MANA stats project, did all the original
research for and subsequently designed the statistical form for midwives, collected them,
paid people our of their own pocket to do the data entry and are in the process of
publishing the results in a major peer-review journal. However, they (like me) have clashed
with MANA's "team player" model and have been given the bums rush.

My point is that CAM and MANA have an in-bred and incestuous relationship and in
many instances they are the same people in both organizations. The "what's not
working" issue is the same for both organizations and for the same reasons -- their 'team
player' requirement eliminates all who disagree, which is also to say, they eliminate
vitality, creativity and vision from the pool of their membership. Only clones need apply.

Then both organizations advance the erroneous idea they have the "consensus" of
ALL midwives (at least all those midwives who really count, i.e., their members!).
This is then described as a profession-wide mandate for whatever ideas they are
promoting. When anyone speaks out or disagrees, instead of encouraging further
dialogue, they counter the specific complaints by conversations about "unity" or loyalty
and how important it is for us to "work together" and how horribly counterproductive it
would be to have "another" organization, etc.

So all this leaves us on the corner of 'go and don't go'.

What i want and have been working towards is a professional organization that is
modeled on the ones that we must come up against and whose unfair powers currently
oppress us and the mothers we serve.

Let me tell you what that looks like from my "up close and personal" observations of the
last decade as watcher of the MedBd and its alliance with organized medicine:

First, it is a sectarian (i.e. non-religious, not 'spiritual") organization devoted to one
central issue -- the professional practice of its discipline (in our case, LICENSED
midwifery). These groups neither start nor stop by getting in a circle and holding hands
while chanting, singing, lighting incense or other spiritual practices. Mind you, i am a
spiritually-orientated person, but that is not what i want from my professional
organization. I go to my own church, on my own time. I expect others to do the
same as do all the other professional organizations that represent physicians,
obstetricians and nurse midwives.

Second, it has business hours -- our competition is comprised of people
representing CMA, ACOG, etc, who do it as a full time job. They work a 40 hour week, 50
weeks a year, which is to say, they are really paying attention and putting out a **lot of
energy to defeat us**. We must take this work as seriously, with as much single
mindedness and one- pointed focus.

Third, it raises the money it needs to do a professional job. Doctors pay $600
to $900 to CMA or ACOG for annual membership. CNMs pay about $300. If LMs are not
willing to pay an equal amount for professional representation, we will each, one by one,
being hiring a lawyer (read "$10,000 retainer"!) to defend us against charges of
unprofessional conduct by the Med Bd.

Believe me, professional membership dues are far cheaper.

Fourth, professional organizations use simple majority vote for most items of
business with super-majority (60%) reserved for rare or very special circumstances like
changing the organizational charter, etc.

Fifth, professional organizations are not primarily about personalities. They
simply fill their positions, such as president, directors, etc with the most talented people
they can find, based on ability to do the job, whoever that is, whatever their
background. These organizations, as a matter of policy, cooperate with other individuals
and organizations without being dominated by emotional issues or a need to retaliate.
They do not operate out of the idea that differences of opinion equate to disloyalty. They
are clearly in it for the long haul and thus have a variety of "plans" based on short, long
and medium term goals and those goals are common knowledge within their membership.

=======================================================

I want to end by saying that both CAM and MANA have done many extraordinary and
commendable things -- legislation, the NARM exam, MEAC, which makes mfry
training programs possible, etc -- and i am truly grateful for those advances
and i have obviously benefitted by them, as have midwives all over the country.
Truly, it is with an attitude of gratitude that i ponder the gifts of both MANA and CAM.

The issue for me here and now is that California LMs are facing a very different
"animal" in regard to our regulatory board than has been the usual area of expertise for
CAM and MANA. The 'social' circumstance of the MBC is very differnt. We need to 'adapt"
and have that adaption not be seen as lack of unity or disloyalty, but just
a necessary and in fact, a good development.

I hope my words will spur additional dialogue and further the action towards a
more functional method for advancing our agenda towards professional autonomy and
the protection of self-determination for healthy childbearing women.

warm regards, faith ^O^

PS: I'm not mad at anybody, its just that i can't walk away until these serious problems are
appropriately and successfully addressed.

===============================================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri May 27, 2005  7:51 am
Subject: to Donna -- Carrie is an LM and ONLY an LM

"Donna Russell" <donna@c...> wrote:

> While you may be a Licensed Midwife, you are first and foremost a Certified Nurse
Midwife and have not practiced as a LM for many years, but as a physician's office based
CNM..

Donna,

You are mistaken about Carrie's status. She is an LM. Before being an LM, she was (like
most of the rest of us) a lay midwife, not a nurse midwife. I do not doubt her motives at
all. Yes, she and i and other disagree as to how exactly to achieve the immediate goal but
we do all want licensed midwifery to work in our state and we are all working to bring that
about.

I left a message with Frank's wife for you to call me and also one on your cell phone but
perhaps you didn't get it.

I understand why you repeatedly emphasis the poltiical importance of "one" professional
voice but i'm not sure that what your referring to is pertinent to the issue of LMs. We
actually are a cohesive group, despite the smoke and thunder. Our split is between
different areas of activity instead of different models of practice.

For example i was very careful to define the CCM as an organization restricted to the area
of legal and legislative issues, while CAM has the historical voice, is the source of social
interaction, conferences, CEUs, and maintains an organization that represents all ten
regions in the state, etc. Personally, i never think of CCM and CAM as in competition any
more than MANA, NARM, MEAC, and Citizens for Midwifery are in opposition or working at
crossed purposes.

If i were to design a "solution" to the current controversy of professional representation,
i'd encourage each organization (CAM, CCM, Christian Midwives, Tonya Brooks group,
CALM, etc) to do more of what they are already doing well -- represeting different
temperments, interestes, and goals.

Then i would develop a professional dues schedule similar to the one used by our
malpractice carrier when setting premiums for malpractice insurance coverage. What i am
referring to is a fair monitary assessment of the individual members of each of these
different groups which would be sent to CALM, to pay for professional representation with
the MBC and/lobbyist for the legislature (or money to a law firm to sue the ba*tards!).

This would translate into a very modest contribution from midwives who attend 12 or less
births a year ($75), another for those who deliever 13 to 24 annually ($175), then 25 to 40
($300) and 40 to 60 ($400). This would permit us to retain our individual nature (i.e.,
different professional groups) and still operate as a unified profession, incluidng money to
pay our way.

In earlier years, Frank and i had many conversations about the difficulty that naturopaths
were having in getting their discipline recognized as a lawful healing art. For many years
(decades) one of the biggest stumbling blocks was that they had two diametrically
opposed professional organizations.

One promoted a university degree program and considered its graduates to be "doctors of
naturopathy" and wanted exclusive licensing that would make the unlicensed practice of
naturopathy a crime. The other group was composed of naturopathic practitioners who
were informally educated // self-taught and beleived that naturopathy belonged to "the
people" and therefore totally rejected the idea of licensing. Are we surprized that they
were working at crossed purposes? And i should mention that the naturopaths did
eventually succeed at getting licensed by coming to a suitable agreement between the two
groups.

But that kind of split does not apply within the profession of licensed, direct-entry
midwifery (in fact, that kinf of split is the hospital-based training for CNMs and the
requirement for a masters degree versus the LM with "empirical' training in preparation for
a home birth practice).

I think you can lighten up on the idea that we all have to learn to play the same musical
instrument in order to play in the orchestra. I believe that in the next 6-12 months the
current siutaiton will iron itself out and pretty soon, we'll be making beautiful music in our
midwife orchestra. I'll be the 3rd person to the left of center, playing the harp.

cheers,
faith ^O^

===================================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri May 27, 2005  10:32 pm
Subject: Re: to Donna -- Carrie is an LM and ONLY an LM Me too... and thanks for the kind and clarifying thoughts.

warm regards, faith ^O^

"Diane van der Westhuizen" <diane@d...> wrote:
> Thank you, Faith, for putting into words so eloquently what I have been
> feeling in response to the call for a new midwifery organization.
>
> I belong to both CCM and CAM and find no conflict in maintaining both
> memberships. I find the debate on both sides fascinating and find myself
> both disagreeing and supporting finer points on both sides. One thing I am
> completely convinced of is the good intentions of both organizations, and
> the ability of both to support and advance Licensed Midwifery. I feel that
> forming a new organization will just diffuse energy instead of focusing
> it.
>
> I would also like to address some of the contentions aired in earlier
> posts that CAM - and I paraphrase - is the voice of just 3 or 4
> individuals. This has not been my experience on the board at all.
>
> I am a relatively new midwife, and joined CAM as the representative for
> Region 8 two years ago while I was still a student. My experience has
> always been one of warmth and welcome. And I have never once felt that any
> one person on the board had anything but the best intentions in supporting
> the interests of the members.
>
> Joining CAM was the first time I'd had any experience with Consensus as a
> formal policy and I was intrigued by how well it seemed to work. It was
> certainly clear to me that I had an immediate and powerful voice on the
> board. This seemed to be a valuable way to ensure that all voices and
> opinions in my region were heard. A majority vote can sweep away
> objections.
>
> Like Faith, I am hopeful that all this public airing of our opinions will
> ultimately lead to a resolution that works for all of us.
>
> Two good things have happened so far:
> 1 - The Medical Board was compelled to actually read midwifery based
> protocols and
> 2 - More midwives than ever before - in my brief career - are speaking out
> and making themselves heard.
>
> I think this will all lead to good things.
>
> Diane West

============================================================================

From: "faith_gibson" <goodnews@...>
Date: Fri May 27, 2005  10:43 pm
Subject: Faith's Main computer fixed / web site still not on line, but soon

My computer had 1064 "worms" and viruses and is 'sort of' fixed. Still have to load all my
programs such as email, web designer, etc.

I haven't been able to post to www.collegeofmidwives.org web site for TWO MONTHS!. It
should be back on line in the next few days.

Also the formating on this computer (the Apple) for the Yahoo group is AWFUL!.

So i will reserve further comments for Yahoo group until the answer is readable. If you
think reading it was crazy, my email from you all had NO carriage return -- that means
each senentece goes on and on side ways, so i have to scroll sideways about 4 feet to read
it. It was like tying to read text on the side of a moving bus.

So stay tuned, things will be back to normal soon (complete with a spell checker --
specially for Karen Ehrlich!).

cheers, faith ^O^

=====================================================================================

May 29th 2005

You all will be pleased to know that my spell checker is working again, and I’m back on my “real” computer, which formats text properly.   

In regard to the ongoing dialogue of this e-group, I hope we will be able to redirect our energies in the near future. There is so much potential for using our time and energies to brainstorm dynamite ideas and come up with innovative strategies, which we will need in order to counteract the dark forces of organized medicine.

As for me, I am working on a synopsis of my ‘vision’ over the next 3-5 years for California mfry politics, the ACCM/CCM, CAM, MANA other aspects of these issues. As soon as I finish (a few days) I will post it and, at least for me, I will be signing off from the on-going rehash of the CAM/CCM controversy.  

For tonight, however, I’ll jsut reply to Diane’s remarks. Let me state up front (since it is hard to hear a feeling tone in email format) that my remarks are without rancor. 

==========================================================================

Diane’s original text: I am not sure what happened with your presentation, but i do know that several speakers were turned down and ones that had been accepted were also turned down.

Faith’s reply: I didn’t “apply” to do a MANA session – someone from MANA called me personally and asked if I would do ‘Ending Flat Earth Obstetrics’ as a general session this year. Then after sending all the paperwork, they sent a “form letter’ saying “Sorry Charlie”. Perhaps is it just happenstance.  But it is one that also replicated my post-Abby Odem experience. But I’d be happy to think it was just a coincidence.  

===========================================================================

Diane: I still am not sure why you didn't feel part of the team when you were the rep for CAM?

Faith’s reply: It wasn’t a “feeling”, it was a direct criticism made to me several times. These comments appeared to originate with Maggie Bennett but were picked up and repeated endlessly as gossip, as if my identity in CAM/MANA was reduced to “not a team player” and as such, I was dismissed. This was very hurtful to me and I believe, it hurt California mfry politics.
=============================================================================
 
Diane: There are not a significant amount of midwives who leave MANA due to the consensus decision making process. In fact the feedback that we get as the MANA board is that the midwives are much more satisfied with this process
because it makes all the voices heard not just the select few. yes it takes longer to reach a decision, but when you do reach one, it is one that everyone is happy with.  

Faith’s reply: I guess the useful questions would be how many midwives either don’t join in the first place or who simply “drift away” and never make an issue of why they were disinclined to maintain their membership.

============================================================================

Diane: it involves compromise and forces us to figure out innovative ideas and ways to work together rather than trying to scramble and get the most players on our side so that one has a greater number of votes than the other side. It is a challenge to the status quo of "professionalism" as we know it. Consensus builds community as opposed to one group deciding for the rest of us.

Faith’s reply: I know the experience "on the ground" of consensus is a nice one -- refreshingly different than most public meetings (especially the MedBd!). And yes, it really does fuel ‘innovative ideas’ (as the dialogue on this E-groups demonstrates!). Consensus is a fine model for a 'woman's organization' who values this type of unified effort and has chosen by consensus to use that model. It works very well in regard to internal politics.

It is in the area of highly-charged & time-sensitive external politics, such as the MedBd, that inherent problems arise. It is nearly impossibility to get every decision maker involved in achieving ‘consensus’ to have (relatively-speaking) the same broad-based knowledge and experience, especially since neither the membership nor board members attend MedBd meetings on a regular basis. It really is a ‘specialty’ field.    

It is my professional opinion that we don't have the luxury of "gender-specific” politics in regard to the MBC, the Attorney Generals Office of Health Enforcement (the lawyers who prosecute LMs) or the State Legislature. None of our adversaries (organized medicine, other lobbyists and the MBC) depend on consensus, which makes them much more functional when it comes to making decisions and carrying out those decisions in a timely manner.

I believe that a good deal of the controversy over the MedBd’s proposed regulation was fueled by the idea that CAM could only support a political decision that represented the 'consensus' of its members. However, you and other CAM and MANA leaders did indeed have your own ideas as to **what that decision should be** (that is, as a leader, it was your opinion was that the MANA standard was the better choice).

Since there was/is no role or respect for “leadership” and the dominate idea is that midwives MUST operate **only** out of a consensus model, CAM leaders had to spend an enormous amount of emotional and intellectual time trying to produce "consensus" all across the state for what was, if honestly described,  the choice of its leaders. You were part of the CAM Region 3 Yahoo email group, and as you will recall, Carrie sent out an email in December in response to a meeting in her CAM region to discuss the CCM document that said of the CCM standard:

12/23/2004

Carrie: What we ultimately decided was:

were there things we wanted re-written?               yes

were there things we would have left out?             yes

were there things we would have added?                only a few

were there things we absolutely **could not live with?      **No

This naturally occurring 'consensus' happened just before Elizabeth (Davis) and you got involved (late December/early January). Your leadership began to shift the energy away from California politics and the regulatory language proposed by the MBC and to “think global”. If you are curious about my description of these events, go back and re-read the email traffic on the CAM region 3 Yahoo group – it’s all there in black and white, as the tide slowly turns.

You and other CAM/MANA leaders saw a chance to use the 'predicament' of SB 1950 (and Yes, Virginia – SB 1950 is a big predicament!) as an opportunity to get the MANA document cited as the California standard of care. That was not bad. In fact, that is what leaders do -- see an opportunity and run  with the ball. As a decision of the leadership, it was a "good call". 

In fact, if the political realities had been different, it would have indeed been ideal. The practical problem is that the choice before us was not the relative merits of one particular standard versus another particular standard, but what could we get the MBC to support. Ed Howard’s language for SB 1950 does indeed give the MedBd powers that Senator Figueroa did not intend. And to quote Shakespeare “there in lies the rub”.

Carrie recently remarked that she hoped to prove me wrong, as if I was the power behind the throne who inappropriately forced the MBC to choose the CCM document instead of the more popular MANA standard. 

That idea misses the point – I was (and am) more like a stock broker with specialized or “insider information” who tells you what stocks are most likely to do well and which ones have a high probably of tanking. What I was telling people was that the CCM document had the elements of success, **given the bizarre political realities of the MBC, Figueroa’s staff, ACOG**.

And I was also communicating that the MANA standards, as was true of the language of earlier regulation (2003) “California community of midwives”, was much more likely to be rejected. That didn’t make either the MANA document or the former regulatory language defective – it is just that the chances of them being accepted are slim and the possibility is pretty high that by rejecting the MBC proposal, we midwives will lose a unique opportunity to influence the course of events – to control the professionalism of licensed midwifery. 

IMHO, what made the CAM leadership position on consensus funky and problematic was that you guys could never just called a spade a spade (i.e., CAM/MANA leadership arriving at and promoting a professional decision) because it would seem 'unwomanly' to exert direct leadership.

Instead, you all had to wrap your decision up in the illusion that it really **represented a popular mandate by the ‘membership'** and thus, that you were "just" carrying out the wishes of the group. This called for great effort by the CAM board to bring about this 'consensus' by working on it until you got the 'right' outcome. This included lots of phone calls, emails, meetings, etc and in my opinion, surveys that were misleading or gave LMs a false choice.  As you will recall, the MBC received 69 letter in support and only 22 in opposition at the February MedBd hearing.

The issue of consensus, as I see it, is that such a philosophy unfortunately pictures consensus as a holy concept, one worthy of going to war over. It makes a conversation about consensus on a standard of care into a conversation **focused on consensus** instead of **standard of care** & the **realities of MBC politics**.

And it makes any non-consensus process (for example, a simple majority vote) look dictatorial, un-American and disloyal to women's values. Then people get to be disdainful of me, since my unforgivable "sin" was that I (unlike CAM and MANA!) did not operate out of this same model.

So i am for the truth, the whole truth and nothing but the truth, even if it is not "PC".

In many -- but not all -- circumstances, consensus is very useful. But there are some situations – political ones – where the best use of consensus is to authorize leaders to lead, to seize the ball and run with it and let the Devil take the hind most, **even if that decision is one that i personally do not agree with**.

Leaders need to be able to lead and if their leadership strays too far, they will be "recalled" and someone else will step in and start again. That is as it should be.

============================================================================
 
Diane: (about Ken and Betty) This is a most interesting thing for you to say Faith. It would be worth your efforts to check your facts before stating them so publicly.

Faith’s reply:  Ken visited me a few months ago when he attended a meeting at Stanford University. We spent the day touring the Stanford campus and went to dinner with Karen Ehrlich that evening. We each talked a lot about our individual experiences with MANA. Since then, Ken and Betty and I have talked on the phone several times. They are both distraught and heartbroken over this issue. Their conversation about how they have been treated and how they feel about MANA politics curiously tracks my own. Believe me, we would all like to be wrong.

If this is just a misunderstanding, perhaps there is something you could do to remedy the problem. I treasure what Ken and Betty have contributed to Mfry in North America over the last 12+ years and grieve for them.

And we (Ken, Betty, me and others) will continue to be a burr under MANA’s saddle until these and similar issues are appropriately addressed. Something is wrong and it needs to be righted. Its not a moral issue, it’s just a practical matter, in which listening, communication, negotiation, compromise and fair play should all play a part, along with a little dash of good humor, since life is too short to spend it being eternally pissy.  

=============================================================================

In conclusion:

As a facet of professionalism I expect that we will continue to go forward and, as time passes and events unfold, we will eventually work this out.

Warm regards, faith  

PS – Dynamite book to read (order from Amazon) is the “Oxytocin Factor – Tapping the Hormone of Calm, Love and Healing” by Swedish research scientist Kerstin Uvnas Moberg (a mother who breastfed all 4 of her kids!). Can’t say enough good things about this book, which I got from Karen Strange’s NRP course.