Virginia Regulatory Town Hall
Department of Health Professions
Board of Medicine
Regulations Governing the Practice of Licensed Midwives [18 VAC 85 ‑ 130]
Action Disclosure requirements for high-risk pregnancies
Comment Period Ended on 11/25/2009
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11/14/09  10:49 am
Commenter: Pamela H. Pilch, JD, LCCE

CPMs and Evidence-Based Informed Consent
I am the mother of three young children, two of whom were born at home with Certified Professional Midwives.  I understand the state's interest in consumer protection, and I support in principle the provision of evidence-based maternity care across the board.  My own experience is that CPMs already obtain the fully informed consent of their clients without the need for additional oversight in this area by the state.  Before choosing a home birth, I fully researched my options and I interviewed and questioned the midwives in much more detail and at greater length than I would ever have questioned a physician about his training, competence to handle complications, and philosophy of care.  I was completely satisfied with the training and competence of the CPMs and I had safe and successful births at home.  I know many other women who have had successful home births and all have been fully informed without the need for state-mandated documents, including some women who have given birth at home following previous Cesarean sections. 
I would only urge the Board of Medicine, in drafting these documents, to be educated by the Certified Professional Midwives involved in the process about their practices and protocols, and the evidence that underpins it.  Please rely on good quality evidence, including that coming from the Cochrane database and the Agency for Healthcare Research and Quality (AHRQ).  And please consider, once the document is drafted, extending the requirement to provide evidence of both the risks AND benefits of both home- and hospital birth to all maternity care providers.
Thank you.
CommentID: 10098