Take a look at the awesome letter Human Rights in Childbirth sent in to Arizona!
Recently, some unhappy moms in Arizona brought to our attention the situation in their home state, where guidelines for licensed midwives are in the process of being updated. Arizona’s midwifery guidelines, as proposed (view them here) lay out a specific course of treatment for women in pregnancy, labor, and birth that licensed midwives are to provide to the women who hire them.
We are concerned for two reasons: one, there are significant discrepancies between the state-prescribed courses of treatment and current evidence-based practices, and, two, if a woman declines any of the individual state-prescribed treatments, her midwife must drop her care. In other words, if a woman attempts to exercise her legal rights to informed consent and refusal–even to avoid non-evidence-based care and access more current, personalized care–she is penalized by losing her choice of provider and is no longer eligible to be seen by her licensed midwife.
One of the guidelines requires that a woman submits to a vaginal exam. That the state would ever require a woman to have an exam of such an intimate nature is unconscionable to us.
Either a woman has the rights to informed consent and refusal, or she does not. She should be able to exercise those rights at home, at a birth center, or in a hospital, without penalty. Either a woman has the right to chose her care provider, or she does not. She should be able to exercise that right, without penalty.
We understand that the state’s position is based on a degree of responsibility to ensure the health and safety of its residents. In this case, we must respectfully say to the state, “This is over the line. Women can be trusted to choose their care providers. Women can be trusted to make decisions about their healthcare. Women can be trusted to make decisions on behalf of their babies. No one but a pregnant woman is more concerned than she about her baby’s well-being, and no one but she has the right to decide what treatments she undergoes in her maternity care.”
The good news is that the director of Arizona’s Health Services Department seems to be taking the issue very seriously. Unfortunately for him, he inherited the outdated regulations upon which the proposed guidelines are based, and he has his work cut out for him. The other side of that coin is that he also has the opportunity to make some ground-breaking changes to bring these guidelines current, respectful of women’s legal rights in maternity care and in line with evidence-based practices. Mr. Humble can set an example for every other state in the union that is considering updating guidelines, regulations, and laws pertaining to maternal health care. We are optimistic that Mr. Humble will rise to that challenge.
Today, we sent him the following letter:
Dear Mr. Humble,
ImprovingBirth.org is a national nonprofit that advocates for evidence-based care and humanity in childbirth. We became aware of your efforts to update Arizona’s midwifery guidelines after some of our supporters brought it to our attention.
First, we want to thank you for reconsidering the guidelines to expand the scope of midwifery care to include women who may benefit the most from individualized, supportive care: women who, otherwise, might be given no other options than Cesarean section. This is invaluable for these women who wish to avoid the increased risks that come with major abdominal surgery.
Second, we want to encourage you to push through. The guidelines you inherited do need some more work if they are to reflect a current understanding of the scientific evidence around best birth practices and of women’s legal rights in birth (for example, vaginal exams in and of themselves do not yield better health outcomes, but do increase the risk of infection, and we feel strongly that no woman under any circumstances should have to undergo an unwanted exam involving her sexual organs). But putting in that work means safer, healthier, happier, and more positive experiences for mothers and babies on the most important day of their lives. You have a unique opportunity to make a lasting impact on the forward movement of quality healthcare in Arizona. Your leadership on this effort is sorely needed and much appreciated.
We work with obstetricians, midwives, lawyers, and researchers, and would be happy to submit an opinion to you on how the guidelines might specifically be updated to reflect current practices and rights. We have made a preliminary review of the guidelines and believe that some fairly simple edits would go a long way towards bringing them current.
Thank you for undertaking such a meaningful task. As maternity care across the country changes, your efforts will set an example for other states as they look to improve their own practices to benefit families.
Please don’t hesitate to contact us by reply to this email or here if we may be of help in any way.
Dawn Thompson, President (San Diego, California)
Cristen Pascucci, Vice President (Baltimore, Maryland)
Rebecca Dekker, Secretary (Lexington, Kentucky)
Dallas Bossola, Member (Outer Banks, North Carolina)
Amanda Hardy Hillman, Member (Ames, Iowa)
Direct Contact: https://www.improvingbirth.org/contact-us/