As a CPM, it is very easy for me to provide Disclosure of Risks to Clients - this is an established part of my practice.  I am very comfortable with providing not only the Midwifery Model of Care and the latest quality research to my clients, but I also include information from the medical model when informing my client of risks and benefits.  Although this is not a new task for me, it is an on-going challenge due to the lack of clear, evidence-based medical model materials.

This NOIRA states:

"If the factors or criteria have been identified that may indicate health risks associated with birth of a child outside a hospital, a requirement for the midwife to provide evidence based information on such risks. Such information would be specified by the Board for certain conditions and would include statements and evidence from both the medical and midwifery models of care."

I urge the Board of Medicine to use data from well-designed, well-executed studies in formulating the information and disclosures that will be required of CPMs.  Furthermore, any statements used in generating the information/disclosures for CPM clients must themselves also be backed by such.  One source that I turn to is the Agency for Healthcare Research and Quality (AHRQ) which continually looks at the data available by topic and the quality of the data available in making its recommendations for evidence-based practice.  The AHRQ helps clinicians in "obtaining objective, detailed information on clinical practice guidelines," looking for "consistent results from well-designed, well-conducted studies."  This is the quality of information that I use in my practice, while continually reviewing the latest data available.   I want to make sure that my clients continue to receive the latest, well-founded research to assist them in making their decisions and that the information/disclosures that I am subject by the Board of Medicine to providing to my clients are continually updated.

Respectfully,

Tammi L. McKinley, CPM
Northern Virginia Midwifery, PLLC
Arlington, VA
http://www.novamidwife.org