Update: Delaware Dept. of Health response puzzling at best, women's freedoms still in question5/22/2013 Kelly Bachman from Governor Markell's office of Delaware e-mailed me today, along with a letter from the Delaware Department of Health which was said to have been e-mailed to me prior to this letter regarding a previous note I sent to them, but I have never received that first letter until now. A response at all is a great step; the door is opening. I'm also glad to see they are still reviewing everything. And she's absolutely right, there IS one non-nurse midwife practicing in Delaware, who was grandfathered in prior to the regulations in question being put in place to attend to the Amish and Mennonite women in our community only, and even those are somewhat limited. There have been NO NEW Non-Nurse Midwives to license in the state of Delaware since those regulations took place in 2002 and not for a lack of trying on the part of our midwives. Ms. Rattay from the Division of Public Health seems to misunderstand the problem. It is not just "difficult" for our midwives to obtain licensure by having those collaborative agreements, it is impossible. They absolutely cannot become licensed in the state of Delaware with that regulation in place. as the malpractice insurance of the doctors with whom they would collaborate do not allow for these agreements between non-nurse midwife and doctor. She goes on to say, "DPH recognizes both that giving birth at home is an important part of the birth experience for some families..." which makes me wonder if she has seen any statistics on the safety of home births vs. births in a hospital setting. It is not just about an experience. Parents usually make informed decisions surrounding the care of themselves and their children after a lot of thought and research, with the safety of everyone in mind and of utmost importance. She also mentions: "DPH is reviewing our current regulations and recent incidents in Delaware of births that involved serious complications." It is my hope that they are also reviewing "recent incidents in Delaware of births that involved serious complications," that may have involved doctors or nurses. Over 99% of our country's population births in a hospital or birthing center setting, yet we don't often hear about the incidents in those establishments, even when pregnancy-related death occurs. I am cautiously optimistic to see that the state is "committed to balancing these interests" and certainly hope they understand they are not only restricting our freedoms, but discriminating against women in the process. We are fully capable of making informed decisions regarding our own healthcare and that of our children, which includes the decision of whom we decide to invite to our birth, no matter where that may occur. In the meantime, our families are still being visited by state investigators and our midwives investigated for trying to allow women in Delaware to exercise their due right to making our own informed healthcare decisions with competent care provided. Ms. Antonik, Thank you for contacting the Governor's Office with questions regarding the safe delivery of newborns in Delaware. We are aware of your concerns and have responded previously through the Department of Health and Social Services, Division of Public Health. Their previous response to questions similar to those posed in your recent inquiry is provided again for you, below. While we understand the issue and maintain that ensuring the safety of both mothers and their newborns is paramount, we have no new information to share at this time. Best, Kelly M. Bachman, Social Media Manager Office of Governor Jack A. Markell 302.577.8495| 820 N. French Street| Wilmington, DE 19801 | cell: 302.299.9791 Dear Jennifer Antonik,
Thank you for your correspondence to the Governor's Office regarding: Change regulations to allow Certified Professional Midwives (CPMs) to obtain permits to practice in Delaware so that families have the right to choose how they give birth. Licensure of CPMs will support an integrated maternity care system. The Division of Public Health (DPH) regulates non-nurse midwifery (Title 16, 4106 Practice of Non-Nurse Midwifery) under Title 16 Del.C. Ch1 §122(3)h. Since 2002, DPH regulations have required permitted non-nurse midwives to establish a collaborative agreement with a Delaware licensed physician with obstetrical privileges. This agreement must include the following: a minimum number of medical provider prenatal visits; guidelines and protocols for access and use of oxygen and medications; and emergency protocols for labor, delivery, and postpartum. These requirements are to protect both the mother and the baby in the event the pregnancy or birth faces complications. We understand the collaborative agreement with a trained physician with obstetrical hospital privileges is difficult for non-nurse midwives to secure given the difficulty in finding liability coverage. And, DPH is aware of situations in which non-nurse midwives have practiced and will be seeking an increase of the penalties for those practicing outside the scope of the law. There is only one non-nurse midwife legally practicing in Delaware and that individual is serving low-risk women in medically underserved communities in central and southern Delaware. Pursuant to Executive Order #36, DPH held open public hearings this fall to hear suggestions on how regulations could be streamlined to improve efficiency and reduce red-tape. Non-nurse midwives and their client families attended and expressed their interest in eliminating the collaborative agreement requirement. DPH is reviewing our current regulations and recent incidents in Delaware of births that involved serious complications. We are reviewing laws from other states to determine how other jurisdictions handle this issue. DPH recognizes both that giving birth at home is an important part of the birth experience for some families and that home births need to occur in a manner that is safe for both the mother and the baby, is integrated with the health care system, and provides access to a hospital setting when needed. We remain committed to balancing these interests. Thank You, Karyl T. Rattay, MD, MS Director Division of Public Heath Keep up with the Story: Speak Out: Delaware moms losing freedom to birth safely (printable) Freedom to safe birth options denied, Investigators visit Delaware families
3 Comments
5/22/2013 01:51:03 pm
Jennifer, The inability of CPMs to get the DE permit doesn't just hinge on the question of OB's malpractice insurance covering them if they work with CPMs who attend out of hospital births, it more directly relates to the practitioners themselves refusing to sign an unrealistic agreement that adds more liability to their own practices. OB's should not HAVE to sign a written collaborative agreement in order for CPM's to obtain a license to practice. In 24 other states that license CPM's there is NO requirement for written collaborative agreement in order to get a license. Of course most midwives would be more than happy to form informal collaborative relationships with hospital based OBs, in order to be able to refer clients when a situation arises that is out of their scope of practice. It's the formal "contractual" agreement which creates added liability for the physician and makes the agreements impossible to obtain in a country and climate where OB's are sued often enough to put many out of business .
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5/22/2013 02:04:27 pm
Thank you Karen, you made it much more understandable to the consumer side of this. I have heard about this cpm, although with the things you mention here. I have also heard that she is quite pricey and attends births out of her own home, rather than the clients home? I'm not sure if these things are true, which is why I haven't blogged about them.
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