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September 15, 2005

Report on MBC Task Force Meeting

Bottom Line -- The text (but not the title) of the Labor Day Consensus Document was adopted. The 2-year 'sunset' clause was not, as the midwifery advisory committee is to convene in a few months and would deal with any modification or updating the standard of care document on an on-going basis. While this document originally was a consensus between CCM, CAM and CALM, the regulatory version will drop that reference. In the regulation it will simply be referred to as the "California Licensed Midwives' Standard of Care". 

However, getting to this eventual outcome was an emotional roller-coaster ride of the most extreme variety. It certainly took 10 years off my life!

BACKGROUND: The purpose of the Task force meeting today was to arrive at a consensus conclusion on licensed midwives' standard of care. The players were the four MBC members, which includes 2 new members (both women, one of whom is an extremely helpful obstetrician), ACOG representatives, licensed midwives, consumer groups and Senator Figueroa's representative. 

WHO: It was attended by Vince Marchand from Senator Figueroa's office, Shannon Smith-Crowley and Dr Ruth Haskins from ACOG; Frank Cuny and Donna Russell from California Citizens for Health Freedom,  CAM representatives Carrie Sparavohn, Tim Chambers & Claudia (sorry, don't remember last name); CALM reps Lucinda Chazar-Johnston and Dana Fox,  CCM reps Faith Gibson and Alison Osborn and many other people, both midwives and MBC staff whose names i can't recall at the moment.

WHAT HAPPENED: We started from a very unfavorable circumstances, namely, that ONLY the October 2004 CCM document would be considered, that breech and twin gestation would be summarily barred by the standard of care, that no mechanism for "informed refusal" would be permitted and that no discussion of any of the above would be permitted.  This decision completely dismissed the Consensus document as irrelevant and seemed to ignored the legal and ethical right of healthy, mentally competent  women to make an informed refusal relative to a wide spectrum of unwanted medicalization. The Task Force  was clearly promoting a unilateral proposal that failed to conform to what we midwives believed to be the spirit and letter of SB 1950.

Dr Fantozzi then announced that attending VBACs would be "permitted", provided we could arrive at an acceptable informed consent document. Discussion of the VBAC topic and the informed consent protocols was the first  'officially' sanctioned activity at the beginning of the meeting.

However, each midwifery organization began by speaking about our distress at what we experienced as strong arm tactics. Each of us went to the microphone and made a statement for the record,  objecting to the MBC's proposal.  During a short break, Carrie and I briefly discussed a strategic response and it seem that all we could do was file a legal objection with the Office of Administrative Law.    Eventually, Carrie decided that staying on  would be to condone what was happening and she and Tim left.

Dr Fantozzi asked us to confer with each other and come up with language for the VBAC informed consent and called a brief recess in the recording of the formal Task Force Meeting. During one of the 'breaks', Ruth and Shannon approached him with a strong suggestion that he reconsider the possibility of a different standard of care document and expressed ACOG's preference for the Labor Day Consensus document. They were very persuasive and eventually, Dr Fantozzi began to warm to the idea.

After additional discussion and the most minor of corrections (spelling out abbreviations such as FHTs & NSTs), we arrived at the version as posted on the College of Midwives web site.

What Next?  The MBC will mail out notices to all "interested parties" asking for comments that must be returned within 15 days. As you can imagine, organized medicine will be replying with objections. We MUST have midwives and consumer groups send supportive letters, especially in regard to preserving the right of "informed refusal".  At the moment, we will have a week or two lead time, as the 15-day clock doesn't start ticking until the notices are mailed out.

More Questions? Call or send an email to any of us who were present at the conclusion of the meeting -- Lucinda, Alison Osborn, Dana Fox, Claudia, me, etc.