Hi Terri-

there was one item I forgot to include yesterday.  That is, what obligates a doctor to discuss/consult with a LM?  There must be something put into law that helps this to happen.  At present, no (not one) doc in my area will consult with a midwife who attends homebirths, or with clients who are planning to birth at home.  Thanks, Alison

----- Original Message -----
From: Alison Osborn
To: tkizer@medbd.ca.gov
Sent: Thursday, December 05, 2002 9:22 AM
Hi Terri-
I am a licensed midwife, and rec'd The letter regarding developing regulations.  I am supportive of these regs as written with the following additions:
1- Provision for advanced training.  (background:  some of have been practicing for over 20-25 years, and have attended hundreds of births.  Along the way, I/we have availed ourselves of expensive advanced training in VBACs, twins and breeches, as well as postdates pregnancies.)  I have developed criteria for attending each of these unusual circumstances, as well as informed consent documents.  NO novice midwife should attend these unusual circumstance births, and should refer.  However, there MUST be provisions for midwives with these advanced skills, both for receiving training, and for attending them.  Texas has made informed consent documents, and parents who refuse transfer of care have the right to do so. 
2-  State to adopt criteria for advanced training
3-  State to adopt informed consent documents for unusual circumstances births where parents refuse transfer of care: twins, breeches, VBACS and postdates births.
4-  State to adopt standards for advanced-trained midwives.
My GOP_ (Guidelines of Care) document states "Midwives recognize the medical factors of risk involved with some situations including breech births and twin pregnancies.  It is my policy to counsel any client with these situations regarding these risk factors for both herself and her baby.  I encourage the parents to make a responsible decision in conjunction with their physician, while upholding the right of the consumer to informed consent and self-determination.  The intrinsic right of the parents to choose their place of birth is recognized, and within the bounds of my training and comfort level I shall not be prohibited from aiding the clients with their choice.  If any unusual circumstances exist and the parents refuse transfer of care to a physician, an informed consent document will be signed.  Midwives reserve the right to withdraw care if situations arise that are irreconcilable or are outside her training and comfort level."
If the above are added to the regulations set forth in the papers you sent to me/us, I don't believe you will have ANY negative feedback from midwives. 
Please respond, and please add my input to the dialogue. 
I do have informed consent documents for breeches and VBACs and criteria for all four unusual circumstances if you'd like me to pass them to you. 
Thanks, Alison Osborn, LM, CPM   Ca license #LM16