I’ll admit it – I’m a fan of those “top 10” lists that you see on Reddit and I’ve even taken some of those “which character from show _____ are you?” quizzes to see if who I think I am matches up to the quiz. I find those kinds of sites to be mildly entertaining and occasionally educational.
So in the spirit of the “top 10 dogs that are so ugly they are cute” style lists, I thought I would compile my own top 10 list!
TOP 10 STUPID RULES FOR LICENSED MIDWIVES IN ARIZONA!
Now…some are new interpretations of the rules, some completely new rules…and some are very old rules that had been treated as so ridiculously obsolete that NOBODY has followed them, but the rule remained because nobody felt it necessary to remove them. (can you imagine if they started enforcing the other absurd laws in Arizona – you know, like the law that says that it’s illegal to manufacture imitation cocaine! No more powdered sugar, citizens! Or the law that says you may not have more than two dildos in a house. Yes. Yes, it’s a law. No, really….I’m serious.)
Alright….here we go!!!
10. A midwife must weigh every client at every prenatal visit!
Okay, that may not seem like a big deal for some, until you realize that if you don’t weigh yourself your midwife has to terminate care! For someone to be required to weigh themselves or else lose their midwife is bullying and coercion. Especially when there is no medical value to weighing someone – swelling can be determined by feeling their legs, asking them. It doesn’t help determine quality of diet or anything that would be medically relevant.
9. Must do periodic vaginal exams.
It’s in the rules – and it’s required! And the Arizona Department of Health has stated it clearly that vaginal exams are REQUIRED on EVERY laboring mother and can not be refused. If a vaginal exam was not performed, then the midwife may be sanctioned or worse!
8. Must see a pregnant mother every 4 weeks of the pregnancy until she is 28 weeks pregnant, every 2 weeks until she is 36 weeks pregnant, then every week until the baby is born.
Not that we should, but that we MUST. The Dept of Health has gone so far as to say that care can not be continued if visits do not happen at that frequency. If a client is ill, unavailable, can not come in and desires to reschedule her appointment for the next week – care for her should be terminated. If she is 39 weeks pregnant and having car trouble – she can not schedule another appointment for the following week – Arizona says that if she can not find a way to be seen, she will lose her midwife. Midwives MUST see mothers on that schedule – without exception.
7. A midwife must transfer care if the mother has a postpartum hemorrhage.
Okay, that law is actually okay. If the mother hemorrhages we should take her to the hospital – I agree with this one. There is a catch, however….the Dept of Health has determined that if a transfer of care occurs, the midwife may under no circumstance off any further assistance to that family – at all! So when she is discharged from the hospital in 24 hours, she is on her own. The midwife who has previously seen her throughout her pregnancy can no longer provide any care for her or her baby – nothing. No newborn screen, no breastfeeding assistance, no monitoring for preeclampsia (which can occur AFTER baby is born! In fact, 80% of the women who DIE from preeclapsia have postpartum preeclampsia!) If we do the right thing and transfer a woman in who has had a hemorrhage, we can no longer help her in any way. In fact, if a midwife has to call for assistance during the birth AT ALL, care must be terminated permanently. Lets say your baby needs some oxygen at birth and the midwife – being the very safe and cautious midwife that she is – calls 911! And lets say that baby responds VERY quickly (as they almost always do)….the paramedics show up and you are holding your very pink perfect baby in your arms, admiring her nose, her sweet mouth that’s now smacking for her first meal of breastmilk….you see no reason to have your baby go into the hospital as she’s perfect! It’s your right to thank the paramedics for showing up and keeping your baby in your armss – however, the midwife must now leave your home. Even though you haven’t birthed your placenta, even though there is nothing wrong right now – the midwife must leave your home. Absolutely absurd, dangerous, and scary! (and anything that makes a midwife have to hesitate in calling 911 is a HORRIBLE rule in my opinion!)
5. A midwife must receive a consultation (with a physician or CNM) if a woman has excessive vomiting or continued vomiting after the end of 20 weeks gestation.
Please, ladies….do not get the stomach flu!
Why get a consultation if she must terminate care? Not sure – but Syphilis is written both in “prohibited practice” AND in “required consultation”. Maybe the midwife can choose which one she prefers to do?
3. A midwife in Arizona can not provide any services to anyone who is 6 weeks postpartum or greater.
The means that the typical 6-week postpartum visit that is normally done to ensure adequate healing after birth can not be done. Once your baby is 6 weeks old, you no longer can legally have a midwife help you in any way.
2. A midwife in Arizona must submit a report on every single client they have assumed care for – and must submit this report within 30 days of the last visit.
This report is submitted, embarrassingly, via Survey Monkey! The link to it is available to the public (as are the midwives’ license numbers) – which means anybody can click on the link and submit a report. The Department of Health thinks that the things it’s asking for are so complicated and technical that it would be difficult for someone to submit a false report on another midwife’s license number – but you are welcome to see for yourself what they are asking. Remember, it’s not password protected – anyone can submit a report. ANYONE. Don’t believe me….Check this out
1. A midwife in Arizona MUST obtain a Syphilis screen. This is considered a non-refusable test.
Non-negotiable. “It’s the law” they say….and they are right. It has been in law forever, and it was such an obscure law that nobody has upheld it for decades. This law doesn’t cover just midwives – but anyone who cares for a woman during pregnancy. If you do not agree to a Syphilis screen, then the midwife must terminate care with you. They have recently began to ACTIVELY enforce this requirement and have been giving STEEP fines to midwives who don’t comply and respect a family’s right to refuse this test.
This list was even more fun to compile than I thought it would be! But as fun as it was to make a top-10 list, many midwives are frustrated at being caught between trying to provide competent, safe care….and following the rules. Rules should be in place to ensure safety and competence – not bureaucracy and compliance from citizens. Midwives are fighting to be able to provide care that is in line with the Midwifery Model of Care – fighting to continue to provide the thorough, respectful, holistic care that is the hallmark of midwifery care. The state of Arizona now requires all midwives to obtain the certification CPM – Certified Professional Midwife, in which we are held to a scope of practice and standard of care…..we are required to obtain and maintain this certification while the state demands that we don’t practice within that same scope of practice and model of care.
I fear that there will be midwives in the very near future losing their license because they refused to do something dangerous that the state requires – because they continued to place health care choices into the hands of their clients, respecting the clients autonomy, continued to help people who otherwise are without care. Even more than that fear, however….is the fear that Arizona birthing families are losing options. They will need to stand up and tell the state that THEY will not stand for a state department of health restricting their right to informed consent (coercion is not informed consent). That they can not be forced to make health care choices based off of fear of losing their health care provider. That they have the right to medical decisions for their families.
For as long as I am able to – I swear to each and every one of my clients that I will do whatever I can to respect them and help them to be kept as safe as possible.